Endovascular control of haemorrhagic urological emergencies: an observational study

Somani, Bhaskar K.; Nabi, Ghulam; Thorpe, Peter; McClinton, Samuel

doi:10.1186/1471-2490-6-27

Cited by 26 publications

(19 citation statements)

References 18 publications

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“…There are numerous published series reporting the results of TAE to control pelvic haemorrhage, with success rates of 70–95% in the initial control of haemorrhage immediately after TAE, comparable with our 81% initial success rate [12–25].…”

Section: Discussionsupporting

confidence: 84%

Intractable haematuria: long‐term results after selective embolization of the internal iliac arteries

et al. 2010

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simultaneous carcinoma of prostate and bladder, one simultaneous carcinoma of prostate and kidney and one had haemorrhagic cystitis after radiotherapy. RESULTSTAE of the internal iliac arteries produced initial complete control of bleeding in 36 of the 44 patients (82%). At a mean (range) follow-up of 10.5 (1-97) months TAE there was permanent control of bleeding in 19 (43%) patients. A second TAE session was use in five (11%) patients and it was successful in two of them. There were 24 patients (55%) who required a mean of 4 (1-17) transfusion units before embolization; only 13 (30%) required more blood products after TAE. The mean haematocrit level before and after TAE was 27% and 31% ( P < 0001), and the respective haemoglobin level were 8.7 and 10.3 g/dL ( P < 0001). During the follow-up there were no major complications related to TAE; minor complications were post-TAE syndrome in 12 (27%) patients, fever (11%), gluteus pain (14%), nausea (2%), and exterior genital oedema (5%). The 6-and 12-month mortality rates were 66% (29 patients) and 18% (eight), respectively. CONCLUSIONSTAE should be considered as an alternative less-invasive palliative measure and the treatment of choice in these situations. TAE should always be bilateral, the catheter should advance distally to the origin of the superior gluteal artery and the artery embolized with unresorbable particles. Our study confirms the efficacy and safety of TAE in patients with pelvic malignancy, and indicates that this technique should be considered before surgery. The procedure combines the benefits of a minimally invasive approach in decreasing the cost of surgery and operating time, while maintaining low blood loss and analgesia requirement. OBJECTIVETo determine the feasibility and efficacy of transarterial embolization (TAE) in haemorrhagic urological emergencies, and to assess the perioperative morbidity, effect of timing of intervention on the requirement for blood transfusion, and the long-term follow-up.

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Section: Discussionsupporting

confidence: 84%

Intractable haematuria: long‐term results after selective embolization of the internal iliac arteries

et al. 2010

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“…5–7,13,14 These reports consist of single institution case series of fewer than 40 patients with conflicting outcomes. 5,7,13,15–17 Some groups recommended that DA and AE be used for injuries up to and including AAST renal grade IV while others advocated DA/AE after AAST grade V injuries.…”

Section: Discussionmentioning

confidence: 99%

Analysis of Diagnostic Angiography and Angioembolization in the Acute Management of Renal Trauma Using a National Data Set

et al. 2011

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Purpose To our knowledge data on diagnostic angiography and angioembolization after renal trauma have been limited to single institution series with small numbers. We used the National Trauma Data Bank® to investigate national patterns of diagnostic angiography and angioembolization after blunt and penetrating renal trauma. Materials and Methods All renal injuries treated between 2002 and 2007 were identified in the National Trauma Data Bank by Abbreviated Injury Scale codes and converted to American Association for the Surgery of Trauma renal injury grades. Diagnostic angiography and angioembolization were identified by ICD-9 codes and examined. Initial angioembolization was considered a failure if subsequent therapy was needed. Repeat diagnostic angiography was not considered a failure. Results A total of 9,002 renal injuries were available for analysis. A total of 165 patients (2%) underwent diagnostic angiography after renal injury, including 77 (47%) who underwent concomitant angioembolization. Of the patients 78% sustained grade III–V renal injuries. Of the 77 patients with initial angioembolization 68 required successive therapy. Repeat angioembolization was the most common management choice (29% of patients). Secondary angioembolization was durable during the index hospitalization with success in 35 of 36 cases. Successive therapy was required after initial angioembolization for all grade IV and V renal injuries in 48 patients. The overall renal salvage rate was 92%, including 88% for grade IV and V injuries. Conclusions Successive therapy is common after initial management of renal injury by angioembolization. Close observation is highly recommended after initial angioembolization for grade IV–V renal injuries. National agreement on the use of diagnostic angiography and angioembolization is needed since these procedures may be overused after grade I–III renal injuries.

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“…Renal vascular lesions may be secondary to iatrogenic injuries during medical procedures accounting for the majority of renal vascular lesions [1,2]. In our case a simple, standardized medical procedure of evacuation of hemothorax led to a nearly-fatal complication as a result of a direct puncture of the branch of renal artery, which was even more unexpected since it occurred on the right side.…”

Section: Discussionmentioning

confidence: 77%

Polymer-glue as a life and kidney function saver: a life-threatening hemorrhage in the ruptured upper pole artery of the kidney managed by percutaneous embolization — a case report and literature review

Antoniewicz¹,

Wojtkowska

Dziekiewicz

et al. 2013

Open Medicine

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AbstractIn this paper we report the case of a nearly fatal hemorrhage in the artery of the renal upper pole that occurred in a 84-year-old woman on anticoagulation treatment in connection with aortic valve replacement 4 days prior to the incident. The artery was injured during the evacuation of a hematoma of the right pleural cavity. While the patient was in the intensive care unit recovering from cardiac valve surgery, the consulting urologist was summoned in order to cope with massive hematuria and acute urine retention. Unfortunately, conservative urological management based on catherization via a three-way catheter and constant transurethral lavage with saline was unsuccessful. Angio-computed tomography revealed a ruptured branch of the renal upper pole artery. A highly selective embolization using histoacryl injection during percutaneous angioplasty was performed. There were no complications in the following days. The patient was subject to postoperative follow-up at 3, 6 and 9 months and renal scintigraphy was performed at 6 months revealing symmetrical function of both kidneys without any changes in the upper pole of the right kidney.

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Endovascular control of haemorrhagic urological emergencies: an observational study

Cited by 26 publications

References 18 publications

Intractable haematuria: long‐term results after selective embolization of the internal iliac arteries

Intractable haematuria: long‐term results after selective embolization of the internal iliac arteries

Analysis of Diagnostic Angiography and Angioembolization in the Acute Management of Renal Trauma Using a National Data Set

Polymer-glue as a life and kidney function saver: a life-threatening hemorrhage in the ruptured upper pole artery of the kidney managed by percutaneous embolization — a case report and literature review

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