Incidence of Renal Artery Pseudoaneurysm Following Open and Minimally Invasive Partial Nephrectomy: A Systematic Review and Comparative Analysis

Jain, Samay; Nyirenda, Themba; Yates, Jennifer; Munver, Ravi

doi:10.1016/j.juro.2012.11.170

Cited by 103 publications

(84 citation statements)

References 25 publications

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“…22 In general, the incidence of symptomatic RAP is reported to be approximately 2-5% after MIPN. [5][6][7] This suggests that some delayed hemorrhage without evidence of RAP is related to asymptomatic RAP. In fact, the cause of delayed hemorrhage due to unknown cause was often reported separately from RAP.…”

Section: Discussionmentioning

confidence: 98%

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Renal sinus exposure as an independent factor predicting asymptomatic unruptured pseudoaneurysm formation detected in the early postoperative period after minimally invasive partial nephrectomy

et al. 2015

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Objectives: To investigate the incidence of asymptomatic unruptured renal artery pseudoaneurysm detected by 3-D computed tomography arteriography in the early period after minimally invasive partial nephrectomy, including laparoscopic and robotic partial nephrectomy. Methods: From February 2012 to November 2013, 101 patients underwent minimally invasive partial nephrectomy for renal masses. Computed tomography arteriography was carried out 3-4 days after surgery; radiologists diagnosed renal artery pseudoaneurysm in a blinded manner. Factors influencing the occurrence of renal artery pseudoaneurysm were analyzed with the logistic regression model. Results: The incidence of renal artery pseudoaneurysm was unexpectedly high at 21.7% when detected by computed tomography arteriography during the early period after minimally invasive partial nephrectomy. The renal artery pseudoaneurysm group showed a significantly larger tumor size (P = 0.02), significantly higher N component score (P = 0.01) and higher incidence of renal sinus exposure or opening of the collecting system (P < 0.01) compared with the no renal artery pseudoaneurysm group. Although these aforementioned factors were found to be significant by univariate analysis, multivariate analysis showed that renal sinus exposure was the only significant independent predictive factor for occurrence of renal artery pseudoaneurysm. Tumor-related factors, such as the N component of the nephrometry scoring system or tumor size, did not show an independent influence on the occurrence of renal artery pseudoaneurysm.Conclusions: The present study shows an unexpectedly high incidence of asymptomatic unruptured renal artery pseudoaneurysm detected by computed tomography arteriography in the early period after minimally invasive partial nephrectomy. Renal sinus exposure is an independent significant factor predicting the occurrence of renal artery pseudoaneurysm. Avoidance of deep excision into the renal sinus could reduce the risk of renal artery pseudoaneurysm.

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Section: Discussionmentioning

confidence: 98%

“…Previous studies reported that RAP become symptomatic at 10-14 days after surgery. 4,5 Thus, screening for RAP needs to be carried out before it becomes symptomatic. The median hospital stay at our institution is currently 4-5 days after RAPN.…”

Section: Discussionmentioning

confidence: 99%

Renal sinus exposure as an independent factor predicting asymptomatic unruptured pseudoaneurysm formation detected in the early postoperative period after minimally invasive partial nephrectomy

et al. 2015

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“…Jain et al [12] summarized 105 cases of RAP following PN, and found that the incidence of RAP after OPN was 1.0%, while the incidence after LPN was 1.96%. Takagi et al [11] performed enhanced CT in 117 patients on the fourth postoperative day after PN and found 17 cases with RAP, indicating that the incidence of RAP was 15%.…”

Section: Discussionmentioning

confidence: 99%

“…Renal angiography can be used to confirm the diagnosis of RAP/RAVF and show the exact location of the lesions. When using super-selective renal arterial embolization, precise catheterization and localization of the tip of the catheter in the lesions were shown to reduce the involvement of healthy renal parenchyma, making it a first-line treatment for RAP/ RAVF, with a cure rate of up to 96% [12].…”

Section: Discussionmentioning

confidence: 99%

Renal Arterial Pseudoaneurysm and Renal Arteriovenous Fistula Following Partial Nephrectomy

Chen

Yang

et al. 2016

Urol Int

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Introduction: Renal arterial pseudoaneurysm (RAP) and renal arteriovenous fistula (RAVF) are rare but can cause fatal bleeding. Materials and Methods: A retrospective review was conducted for patients undergoing partial nephrectomy (PN) in our department. The clinical features and treatment methods were analysed, and the relationships between RAP/RAVF and the surgical methods and R.E.N.A.L. score were investigated. Results: Eleven patients were diagnosed with RAP/RAVF (9 with RAP and 2 with RAVF). The incidence of RAP/RAVF after laparoscopic PN showed no significant difference compared to that after open PN (p = 0.47). A low R.E.N.A.L. score was present in 6 patients, while an intermediate/high score was present in the other 5 patients. The major clinical manifestations included haematuria and haemorrhagic shock, and the median time of occurrence was 8 days after the operation. Six patients underwent an ultrasound examination. Of the 4 patients who underwent enhanced CT, 2 patients were diagnosed with RAP. All 11 patients were diagnosed by renal angiography and were cured after super-selective arterial embolization. The serum creatinine levels before and after embolization showed no significant differences (p = 0.14). Conclusions: RAP/RAVF may not have any relationship with the surgical procedure or R.E.N.A.L. score. Renal angiography and super-selective arterial embolization are the preferred methods for diagnosing and treating RAP/RAVF.

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“…RAP is reported in 1–1.96% of patients after partial nephrectomy, presenting on average on POD 15, with gross haematuria in 87.3% 6. RAP is thought to result from disruption of the arterial wall with sustained arterial pressures dissecting into the adjacent tissues forming a sac that is contained by media or adventitia and communicates with the feeder artery 7…”

Section: Discussionmentioning

confidence: 99%

Novel use of carbon dioxide arteriography in renal artery pseudoaneurysm in patients with poor renal function

et al. 2014

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Renal artery pseudoaneurysm (RAP) is a rare complication of partial nephrectomy, but is usually effectively managed with renal vessel embolisation. We report a particularly challenging case of a patient with chronic kidney disease (CKD) who developed a RAP following a laparoscopic heminephrectomy and was treated using superselective renal vessel coil embolisation with carbon dioxide (CO2) as the primary contrast agent for arteriographic localisation of the RAP and feeder artery. To the best our knowledge we report the first utilisation of CO2arteriography in the definitive diagnosis and treatment of RAP following heminephrectomy in a patient with severe CKD.

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Incidence of Renal Artery Pseudoaneurysm Following Open and Minimally Invasive Partial Nephrectomy: A Systematic Review and Comparative Analysis

Cited by 103 publications

References 25 publications

Renal sinus exposure as an independent factor predicting asymptomatic unruptured pseudoaneurysm formation detected in the early postoperative period after minimally invasive partial nephrectomy

Renal sinus exposure as an independent factor predicting asymptomatic unruptured pseudoaneurysm formation detected in the early postoperative period after minimally invasive partial nephrectomy

Renal Arterial Pseudoaneurysm and Renal Arteriovenous Fistula Following Partial Nephrectomy

Novel use of carbon dioxide arteriography in renal artery pseudoaneurysm in patients with poor renal function

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