Gelfoam Embolization of the Kidneys for Treatment of Malignant Hypertension

Abstract

Some chronic renal failure patients maintained on dialysis have uncontrollable hypertension. Those with elevated renin levels require bilateral nephrectomies prior to kidney transplant to avoid nephrosclerosis. The morbidity and mortality from surgical nephrectomies are high. In 2 such patients we embolized the renal arteries with gelfoam and successfully occluded all the major vessels. One patient became normotensive. The second remained hypertensive and had increased renin levels, probably on the basis of ischemia. Subsequent surgical nephrectomies demonstrated completely occluded segmental branches but only focal areas of infarction. Collateral blood supply determines the success of the procedure.

Experimental Basis of Angioinfarction for the Treatment of Renal Hypertension

“…They should be biologically inert with no local toxicity or canceroge-(1 nicity, sterilizable to avoid infection, and any tendency to recanalization is unwanted [1,15,22,31,36,45], How ever, if capillary embolization is aimed for, technical requirements should include that only liquids with a suit able radiodensity, viscosity, and controllable occlusion mechanism are used [45], Ethibloc and Gelfoam are inert, whereas Histoacryl causes severe specific inflammatory reactions and for eign-body granulomas [19,25,31,45,49]. The latter is discussed as a possible source of tumor induction, but this has never been proven clinically [42].…”

“…Both factors lead to hypoxia in the embolized area instead of anoxia thus supporting sus tained hypertension-active parenchyma [2,15,31,46,51,55], Several authors advocate a more peripheral prop agation of the embolization medium to achieve complete organ necrosis [1,2,13,32,41], However, up to now no medium that reaches the vascular periphery and avoids passage to the venous system as well has been found [3,22], Most of the embolic agents especially developed for angioinfarction, such as the GAW-coil [56], detachable balloons [28], bristle brush [22], etc., lead to occlusion of only the main renal artery. Particulate substances adapted for vaso-occlusion, i.e.…”

Therapeutic Percutaneous Renal Artery Occlusion with a Detachable Balloon

“…[3] and McCarron et al [4] reported the use of gelfoam embolization for the control of hypertension. Other embolized substances have included autologous clot, polyvinyl alcohol sponge and barium [5,11], Emboli lodge in vessels distal to the main renal artery and success is dependent upon complete renal infarction and the fail ure of development of collateral circulation [12], As it is difficult to visualize the emboli at the time of the proce dure, some segments of the kidney may continue to be perfused, or they may embolize to undesirable locations.…”

“…The balloons utilized in the patients described here were instilled with radiocontrast material and thus their loca tion was readily apparent under fluoroscopy, as well as on flat plate roentgenograms of the abdomen after the proce dure. Adler et al [3] have suggested that collateral circu lation is less likely to develop if complete occlusion of blood flow via the renal artery is accomplished quickly. This is fairly easy to accomplish with inflation of the bal loons.…”

“…Thus, alternative means of destroying renal tissue have been developed. Renal infarction has previously been reported with gelfoam embolization, coil-induced throm bosis and balloon occlusion [3][4][5][6][7], The success of these methods for controlling hypertension is dependent upon the lack of development of collateral blood supply and failure of the occluded vessels to recanalize.…”