The role of angioembolization in the management of blunt renal injuries: a systematic review

Abstract

Background Recently, renal angioembolization (RAE) has gained an important role in the non-operative management (NOM) of moderate to high-grade blunt renal injuries (BRI), but its use remains heterogeneous. The aim of this review is to examine the current literature on indications and outcomes of angioembolization in BRI. Methods We conducted a search of MEDLINE, EMBASE, SCOPUS and Web of Science Databases up to February 2021 in accordance with PRISMA guidelines for studies on BRI treated with RAE. The methodological quality of eligible studies and their risk of bias was assessed using the Newcastle–Ottawa scale Results A total of 16 articles that investigated angioembolization of blunt renal injury were included in the study. Overall, 412 patients were included: 8 presented with grade II renal trauma (2%), 97 with grade III renal trauma (23%); 225 with grade IV (55%); and 82 with grade V (20%). RAE was successful in 92% of grade III–IV (294/322) and 76% of grade V (63/82). Regarding haemodynamic status, success rate was achieved in 90% (312/346) of stable patients, but only in 63% (42/66) of unstable patients. The most common indication for RAE was active contrast extravasation in hemodynamic stable patients with grade III or IV BRI. Conclusions This is the first review assessing outcomes and indication of angioembolization in blunt renal injuries. The results suggest that outcomes are excellent in hemodynamic stable, moderate to high-grade renal trauma.

Management of Adult Blunt Renal Injury: A 10-Year Retrospective Review at a Single Institution

“…These results are consistent with those of a multicenter AAST study that showed that a nephrectomy was the most common intervention for bleeding in advanced trauma in 13% of cases, whereas angioembolization was performed in only 6% of patients [22]. Angioembolization of renal injuries is associated with a high success rate, even in patients with high-grade injuries [3,24]. In the present study, nonoperative management was performed in 98.5% of all patients, and was successful in 97.8% of patients with high-grade renal injuries.…”

Salvation of a solitary kidney in a patient with grade IV renal trauma: a case report

“…According to recent protocols, the initial management of renal trauma depends on hemodynamic status rather than the grade of the injury. For hemodynamically stable patients, conservative management, including expectant management or angioembolization, is recommended [5,6]. According to the European Association of Urology, the World Society of Emergency Surgery (WSES) and AAST, surgical management should be considered for hemodynamically unstable patients [4,7].…”

Trauma renal cerrado de alto grado: el rol de la angioembolización en el manejo secuencial

“…El trauma renal corresponde a un 10% de todos los traumas abdominales; de ellos, un 90% comprende el trauma cerrado. Con respecto a las intervenciones asociadas, el manejo secuencial conservador o «paso a paso» ha logrado disminuir las tasas de nefrectomía innecesarias, ubicándose en un 28% en la actualidad 1,2 . Una de las herramientas disponibles en la actualidad como parte del tratamiento del paciente con trauma renal cerrado de alto grado es la angioembolización 2 .…”

“…Con respecto a las intervenciones asociadas, el manejo secuencial conservador o «paso a paso» ha logrado disminuir las tasas de nefrectomía innecesarias, ubicándose en un 28% en la actualidad 1,2 . Una de las herramientas disponibles en la actualidad como parte del tratamiento del paciente con trauma renal cerrado de alto grado es la angioembolización 2 . Consecuentemente, vale la pena conocer cuáles son los factores predictores para realizar una intervención temprana con fines de detener el sangrado, las tasas de éxito de la primera o segunda angioembolización y los predictores de falla.…”

“…La angioembolización de primera vez tiene un éxito de hasta el 85% y una efectividad del 100% en los pacientes que requieren una segunda angioembolización 2 . Entre los hallazgos radiográficos considerados como factores de riesgo se ubica el tamaño de hematoma perirrenal (> 3,5 cm), la extravasación del contraste y una lesión compleja (abarca porción lateral y medial del riñón simultáneamente) 3 .…”