Selective Arterial Embolization for Pseudoaneurysms and Arteriovenous Fistula of Renal Artery Branches Following Partial Nephrectomy

Ghoneim, T.; Thornton, Raymond H.; Solomon, Stephen B.; Adamy, Ari; Favaretto, Ricardo L.; Russo, Paul

doi:10.1016/j.juro.2011.02.049

Cited by 96 publications

(84 citation statements)

References 29 publications

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“…When the PA becomes larger and blood leakage occurs into the collecting system, macroscopic hematuria may occur (26). In the literature, macroscopic hematuria and/or flank pain were reported in almost all cases with PA (25,27). In line with previously reported studies, all patients were symptomatic in the present series.…”

Section: Discussionsupporting

confidence: 88%

“…In the literature, PA rate was about 0.43% for open partial nephrectomy (4) and 1.7% for laparoscopic partial nephrectomy (3). Ghoneim et al (25) reported their complication rates as 0.6% for open partial nephrectomy and 2.6% for laparoscopic partial nephrectomy. In a multicenter study of 998 patients who underwent minimally invasive partial nephrectomy, Hyams et al (1) found the frequency of iatrogenic vascular lesions and PA as 2% and 1.7%, respectively.…”

Section: Discussionmentioning

confidence: 99%

“…In line with previously reported studies, all patients were symptomatic in the present series. Albani and Novick (4) reported one asymptomatic patient with PA, and Ghoneim et al (25) reported two asymptomatic patients with PA.…”

Section: Discussionmentioning

confidence: 99%

“…An AVF is an abnormal communication between the arterial and venous systems without an intervening capillary bed (25). AVF may be asymptom- atic, but may cause macroscopic hematuria, hypertension or cardiac failure (in rare cases), and renal transplant dysfunction due to "intrarenal steal phenomenon" (27).…”

Section: Discussionmentioning

confidence: 99%

“…Six patients underwent reembolization because of early recurrence, and one of these six patients expired a few hours after reembolization. Ghoneim et al (25) demonstrated that 14 of 15 patients (93%) were successfully treated by embolization and the remaining patient with hemophilia underwent surgery. Sildiroglu et al (29) stated that thrombin and coils can be used for embolization of large and central PAs with minimal parenchymal loss.…”

Section: Discussionmentioning

confidence: 99%

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Endovascular management of iatrogenic renal arterial lesions and clinical outcomes

Güneyli¹,

Gök²,

Bozkaya³

et al. 2015

Diagn Interv Radiol

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ORIGINAL ARTICLE PURPOSE We aimed to evaluate iatrogenic renal arterial lesions, including pseudoaneurysm, arteriovenous fistula, and arteriocaliceal fistula, their management by endovascular embolization, and the clinical results. METHODSFifty-five patients (forty males, fifteen females) with a median age of 40 years (range, 8-85 years), who underwent endovascular embolization of iatrogenic renal arterial lesions between March 2003 and December 2013 were included in this retrospective study. Types of iatrogenic lesions and details of embolization procedures were reported. Estimated glomerular filtration rate (eGFR), renal function tests, hemoglobin, and hematocrit levels before and after embolization were recorded and compared. RESULTSMedian follow-up was 24 months. We identified 53 pseudoaneurysms, 30 arteriovenous fistulas, and 11 arteriocaliceal fistulas in 55 patients, after percutaneous nephrolithotomy (n=26), renal biopsy (n=21), nephrostomy (n=3), renal surgery (n=3), and extracorporeal shock wave lithotripsy (n=2). Median number of pseudoaneurysms was 1 (range, 1-4) with a median size of 7 mm (range, 1.5-35 mm). Fifty-one patients underwent coil embolization. Median number of coils was 5 (range, 2-21) and median renal parenchymal loss was 5% (range, 1%-50%). There were no significant differences between pre-and postoperative eGFR and serum parameters. CONCLUSION Iatrogenic renal arterial lesion can be a life threatening condition. Superselective coil embolization is a safe, minimally invasive treatment option with minimal renal parenchymal loss and without significant change in renal function. Iatrogenic renal arterial lesions including pseudoaneurysm (PA), arteriovenous fistula (AVF), and arteriocaliceal fistula (ACF) are rare, but life-threatening conditions (1). The chief symptom usually includes macroscopic hematuria (2, 3). Catheter angiography is the gold standard for both diagnosis and treatment (1).Previous studies have evaluated the iatrogenic renal arterial lesions following partial nephrectomy (1, 3-7), but there were only a few studies on iatrogenic renal arterial lesions following any iatrogenic renal interventions (2). In the present study, to the best of our knowledge, we report the largest series of iatrogenic renal arterial lesions following various renal interventions such as biopsy, percutaneous nephrolithotomy (PCNL), percutaneous nephrostomy, and partial nephrectomy. We focused on clinical presentations, imaging findings, management, and outcomes. Methods PatientsData regarding iatrogenic renal arterial lesions treated by endovascular embolization performed at our institution between March 2003 and December 2013 were evaluated retrospectively. A total of 55 patients with iatrogenic renal arterial lesions, who underwent endovascular embolization were included in the study. There were 40 males and 15 females with a median age of 40 years (range, 8-85 years). Patients with traumatic renal arterial lesions treated with endovascular embolization were excluded from the study. Informed con...

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Section: Discussionsupporting

confidence: 88%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 3 more Smart Citations

Endovascular management of iatrogenic renal arterial lesions and clinical outcomes

Güneyli¹,

Gök²,

Bozkaya³

et al. 2015

Diagn Interv Radiol

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Complications of Laparoscopy Including Robotics

Rundstedt

Chen

Link

2018

Smith's Textbook of Endourology

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Arteriovenous fistula after robot‐assisted laparoscopic prostatectomy: A rare case report

et al. 2019

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Abbreviations & Acronyms AVF = arteriovenous fistula CECT = contrast-enhanced computed tomography CT = computed tomography POD = postoperative day POM = postoperative month PSA = prostate-specific antigen RALP = robot-assisted laparoscopic prostatectomy TAE = transarterial embolization Correspondence: Takahiro Introduction: Arteriovenous fistula after radical prostatectomy is very uncommon. We report a rare case of pseudoaneurysm associated with arteriovenous fistula following robot-assisted laparoscopic prostatectomy. Case presentation: A 67-year-old man diagnosed with prostatic adenocarcinoma underwent robot-assisted laparoscopic prostatectomy. He had a fever and lower abdominal pain with sign of peritoneal irritation, and his blood hemoglobin level dropped on postoperative day 11. Hemorrhage in the pelvic space with extravascular leakage was detected by contrast-enhanced computed tomography, and he underwent emergency angiography. An aneurysmal dilatation with early venous drainage was confirmed in a branch of the left internal iliac artery, and we diagnosed arteriovenous fistula. Transcatheter arterial embolization was performed, and the aneurysmal structure subsequently disappeared. Conclusion: Arteriovenous fistula may occur as a complication of robot-assisted laparoscopic prostatectomy. Transcatheter arterial embolization appears to be a useful and minimally invasive treatment.

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Selective Arterial Embolization for Pseudoaneurysms and Arteriovenous Fistula of Renal Artery Branches Following Partial Nephrectomy

Cited by 96 publications

References 29 publications

Endovascular management of iatrogenic renal arterial lesions and clinical outcomes

Endovascular management of iatrogenic renal arterial lesions and clinical outcomes

Complications of Laparoscopy Including Robotics

Arteriovenous fistula after robot‐assisted laparoscopic prostatectomy: A rare case report

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