Failure of initial superselective renal arterial embolization in the treatment of renal hemorrhage after percutaneous nephrolithotomy: A respective analysis of risk factors

Abstract

Superselective renal arterial embolization (SRAE) is a well-established method for the treatment of severe hemorrhage following percutaneous nephrolithotomy (PCNL). However, there remains a significant rate of failures requiring repeat SRAE or nephrectomy. To identify risk factors for initial treatment failure of SRAE, the data of patients who had undergone SRAE for severe bleeding due to PCNL between August 2005 and June 2016 were retrospectively analyzed. A total of 98 patients required SRAE for bleeding control following PCNL. Renal arteriography revealed pseudoaneurysm in 65 patients, arteriovenous fistula in 6 patients, and a combination of both in 11 patients. Free extravasation was observed in 11 patients; 8 of these patients exhibited coexisting pseudoaneurysm. Vascular aberration/tortuosity was identified in 10 patients. A total of 17 patients (17.3%) experienced initial treatment failure and underwent repeat SRAE. Multivariate analysis identified percutaneous tract size, number of bleeding sites and vascular aberration/tortuosity as significant predictors of initial treatment failure. The results from the present study suggested that repeated SRAE is preferred for patients who have experienced initial treatment failure with recurrent hemorrhage following PCNL. Large tract size, multiple bleeding sites and renal vascular aberration/tortuosity were significantly associated with increased risk of initial treatment failure of SRAE. These data may assist interventional radiologists in the planning and execution of SRAE in the treatment of PCNL.

Superselective Renal Artery Embolization Management of Post-percutaneous Nephrolithotomy Hemorrhage and Its Methods

“…Recently, with the introduction of new interventional devices and embolization materials, embolization technology has been further developed (14). In order to minimize the damage of renal function, superselective renal arterial embolization (SRAE) has been widely performed (14)(15)(16)(17).…”

“…In this study, we retrospectively evaluated the safety and efficacy of SRAE in the treatment of hemorrhage after PCNL. In addition, although renal artery embolization has been regarded as the treatment of choice for postoperative bleeding of PCNL (18)(19)(20), there are still reports of recurrent hemorrhage after embolization (1, 7), and even Mao et al reported that up to 17.3% of patients experienced initial treatment failure and underwent repeat SRAE (16). The failure of embolization may be partly due to immature embolization techniques and improper selection of embolization materials.…”

Intraparenchymal renal artery pseudoaneurysm following nephrostomy tube insertion in a patient with a solitary kidney: A case report

“…Nowadays, it is possible to perform superselective renal arterial embolization (SRAE), which minimizes the loss of renal function. 3 After selective angioembolization, hemoglobin levels should be monitored closely.…”

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“…Authors opined carefully selecting patients for multitract percutaneous nephrolithotomy, making an extra effort to identify all bleeding vessels during angiography and not using gelatin sponge as the only embolic material could potentially decrease the risk of failure of initial superselective renal arterial embolization after percutaneous nephrolithotomy [13]. Another study identified large tract size, multiple bleeding sites, renal vascular aberration/tortuosity as significant risk factors for increased risk of initial treatment failure of superselective renal arterial embolization [14]. All our patients were successfully managed by initial embolization.…”