Radiographic Predictors of Need for Angiographic Embolization After Traumatic Renal Injury

Abstract

Background: Although the American Association of the Surgery for Trauma Organ Injury Scale is the gold standard for staging renal trauma, it does not address characteristics of perirenal hematomas that may indicate significant hemorrhage. Angiographic embolization has become well established as an effective method for achieving hemostasis. We evaluated two novel radiographic indicators-perirenal hematoma size and intravascular contrast extravasation (ICE)-to test their association with subsequent angiographic embolization. Methods: Among 194 patients with renal trauma between 1999 and 2004, 52 having a grade 3 (n = 33) or grade 4 (n = 19) renal laceration were identified. Computed tomography scans were reviewed by a staff radiologist and urologist blinded to outcomes. ICE was defined as contrast within the perirenal hematoma during the portal venous phase having signal density matching contrast in the renal artery. Hematoma size was determined in four ways: hematoma area (HA), hematoma to kidney area ratio (HKR), difference between hematoma and kidney area (HKD), and perirenal hematoma rim distance (PRD). Results: Of the 52 patients, 8 had ICE and 4 of these (50%) required embolization, whereas none of the 42 (0%) patients without ICE needed embolization (p = 0.001). Likewise, all four measures of perirenal hematoma size assessed were significantly greater in patients receiving embolization [HA (128.3 vs. 75.4 cm, p = 0.009), HKR (2.75 vs. 1.65, p = 0.008), HKD (76.5 vs. 30.2 cm, p = 0.006), and PRD (4.0 vs. 2.5 cm, p = 0.041)]. Conclusion: Perirenal hematoma size and ICE are readily detectible radiographic features and are associated with the need for angiographic embolization.

Selective angioembolization for traumatic renal injuries: a survey on clinician practice

“…These investigators reviewed AAST OIS grade, complexity of laceration, hematoma size, continuity of Gerota’s fascia, and presence of ICE and suggested angiography be performed with presence of ICE, but in the absence of ICE, only be considered when hematoma size is 25 mm or larger. Nuss et al [16] reviewed CT images of 52 patients who underwent AE for grade III–IV renal trauma, noting that perirenal hematoma size >40 mm and ICE provided for two readily identifiable CT features associated with the need for embolization. Other measurements, including hematoma area ≥128 cm 2 , hematoma/kidney ratio ≥2.75, hematoma/kidney diameter ≥76.5 cm 2 , were associated with need for embolization.…”

Renal trauma

“…42 Nuss et al also reported that the size of the perirenal haematoma and the presence of intravascular contrast extravasation were associated with the need for angiographic embolisation. 43 There is an expanding role for renal arterial embolisation and in some situations, the procedure can be performed intraoperatively in cases of poly-trauma where intraperitoneal injuries are repaired during laparotomy and the associated renal injury is managed by interventional radiology techniques.…”

Current Approachs to Urogenital System Injuries in High Energy Trauma Exposed

“…Anjiyografinin başlıca endikasyonları, aktif hemoraji, psödoanevrizma ve vasküler fistüller için embolizasyontur (26) . Renal hasarın derecesinin ilerlemesi anjioembolizasyonun ilk denemedeki başa-rısını düşürür ve yine müdahale gereksinimini arttırır.…”