Management of Traumatic Hematuria by Selective Renal Artery Embolization

Uflacker, Renan; Paolini, R. M.; Lima, Swiany Silveira

doi:10.1016/s0022-5347(17)49810-7

Cited by 73 publications

(66 citation statements)

References 35 publications

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“…The presence of multiple arteries increases the complexity of kidney operations, its knowledge being vital for the operative planning [24][25][26] . In renal transplants with presence of multiple arteries, the rate of late arterial stenosis is higher (p = 0.0196) 27 .…”

Section: Discussion Discussion Discussion Discussion Discussionmentioning

confidence: 99%

Estudo do padrão arterial de 200 pedículos renais por meio de angiotomografias

Palmieri¹,

Petroianu²,

Silva

et al. 2011

Rev. Col. Bras. Cir.

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OBJETIVO: Verificar a prevalência e a distribuição das artérias renais e de seus ramos in vivo, relacionando as particularidades encontradas nas artérias renais com o sexo e sua lateralidade. MÉTODO: Duzentos pedículos renais foram estudados por meio de angiotomografias e suas artérias analisadas de acordo com número, posição de origem, calibre, comprimento e trajeto em relação aos segmentos renais. Sua frequência e lateralidade foram pesquisadas quanto ao sexo e idade. RESULTADOS: Foram observadas múltiplas artérias em 61,5% dos pedículos (56% à direita e 67% à esquerda), ocorrendo em 65% dos homens e 58% das mulheres. A origem aórtica para as múltiplas artérias foi mais frequente à direita e, com maior frequência, as artérias renais se originaram entre as vértebras L1 e L2 como divisões pré-hilares da artéria principal. O comprimento médio da artéria principal foi maior em rins direitos com artéria única. Não houve diferença entre o diâmetro da artéria renal principal. CONCLUSÃO: Existe maior prevalência das múltiplas artérias renais do que aquela descrita na literatura, sem diferença entre os sexos ou lateralidade. As artérias renais originaram-se com maior frequência entre as vértebras L1 e L2, como divisões pré-hilares da artéria principal e com trajeto ao hilo do rim. O comprimento médio da artéria principal é maior à direita e nos rins com artéria única. Não houve diferença no diâmetro da artéria renal principal entre rins com artérias únicas e múltiplas.

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Section: Discussion Discussion Discussion Discussion Discussionmentioning

confidence: 99%

Estudo do padrão arterial de 200 pedículos renais por meio de angiotomografias

Palmieri¹,

Petroianu²,

Silva

et al. 2011

Rev. Col. Bras. Cir.

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“…The efficiency of hyperselective embolization in our series was in 7 of 8 cases. The reported success rate of this technique in the literature is over 80% [7, 11, 12, 13]. Embolization compromises flow to at least a portion of the kidney because of embolic occlusion of intrarenal arterial branches.…”

Section: Discussionmentioning

confidence: 99%

Severe Bleeding after Nephrolithotomy: Results of Hyperselective Embolization

Martin¹,

Murat²,

Feitosa³

et al. 2000

European Urology

102

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“…The success rates for embolization of isolated renal artery branch injuries are 70% to 80%. 7,8 The risk of total renal loss may be lower with angioembolization than with surgical exploration. Currently, the small experience cannot lead to the same conclusions about transplanted kidneys.…”

Section: Discussionmentioning

confidence: 99%

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Sedigh

Lasaponara²,

Dalmasso³

et al. 2017

Exp Clin Transplant

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A 67-year-old man presented to the emergency department 22 hours after a trauma to his kidney graft. He was asymptomatic during the first 10 hours, then he became anuric. His serum creatinine level was 2.73 mg/dL (baseline, 0.7 mg/dL), and his hemoglobin concentration was 13.1 g/dL. Computer tomography showed a 4-cm subcapsular hematoma without active bleeding. He underwent urgent decompression of the hematoma, and we did not find any active bleeding or parenchymal laceration. Urinary output had already recovered by the end of surgery without early or late complications. In conclusion, subcapsular hematoma, complicating a traumatic event on a kidney graft, can lead to a progressive parenchymal compression resulting in anuria. So, although in the absence of anemia, such events require urgent surgical decompression. Symptoms cannot be immediate, so all the graft trauma should be investigated with early ultrasound. Little is known in the case of major renal trauma but mildly symptomatic. Probably surgical exploration is better than observation to prevent possible early and late complications such as organ rejection or a Page kidney. Key words: Bleeding, Kidney transplant, Surgery IntroductionRenal transplant is the preferred treatment for endstage renal disease. Because of its low abdominal location, renal allografts lose the structural support offered to the native kidney by the thoracic wall and paraspinal musculature. For this reason, the transplanted kidney seems to be more vulnerable to traumatic damage. But there is a paucity of reports that deal with managing such an event. Case ReportA 67-year-old man presented to the emergency department 22 hours after a bicycle accident. The patient had undergone a renal transplant into right iliac fossa in 2002 because of chronic glomerulonephritis. Serum creatinine stabilized at 0.7 mg/dL. The patient's immunosuppressive drug regimen included only tacrolimus. In the first 10 hours after the accident, he did not experience any particular symptoms, but upon arrival at the emergency department, the patient said he had mild abdominal pain and anuria in the last 12 hours. His blood pressure was 110/70 mm Hg, his hemoglobin concentration was 13.1 g/dL, and his renal function was significantly impaired, with a serum creatinine level of 2.73 mg/dL.A physical examination revealed diffuse moderate abdominal tenderness. An ultraso nography scan demonstrated extensive periallograft hematoma and high renal arterial resistive indexes, with an empty bladder and no dilation of the upper urinary tract. A computed tomography scan revealed a 4-cm subcapsular hematoma without active bleeding (Figure 1). Urgent decompression of the hematoma was indicated. Surgical exploration confirmed the radiologic findings. Incision of the renal capsula allowed eliminating parenchymal compression without showing active bleeding or other sources of compression. Prompt recovery of diuresis was noted already at the end of the intervention.There were no postoperative complications. The patient was di...

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Management of Traumatic Hematuria by Selective Renal Artery Embolization

Cited by 73 publications

References 35 publications

Estudo do padrão arterial de 200 pedículos renais por meio de angiotomografias

Estudo do padrão arterial de 200 pedículos renais por meio de angiotomografias

Severe Bleeding after Nephrolithotomy: Results of Hyperselective Embolization

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