Transarterial Embolization of the Renal Arteries for the Management of Iatrogenic Renal Vascular Injuries: Two Centers Experience in 150+ Patients

Abstract

obtained to provide a target for fluoroscopic access into a retroclavicular collateral from above, facilitating large sheath insertion and endobronchial forceps retrieval of the filter, which required surprisingly little force. Following retrieval, contained extravasation was observed at the previous site of the filter struts. Despite balloon-tamponade and an attempt at flow diversion using a bare-metal stent, the pseudoaneurysm continued to fill. A catheter was advanced through the stent interstices into the pseudoaneurysm, which was treated with balloon-controlled thrombin administration. After 5 min, repeat Intra vascular Ultrasound (IVUS) showed pseudoaneurysm thrombosis. The final venogram revealed no further contrast extravasation and a patent IVC. The patient was discharged on postoperative day 2. At the 5-month postoperative followup visit, the patient reported resolution of previous abdominal pain and CT scan re-demonstrated patent IVC. Conclusion: Extended dwell times and penetrating IVC filters increase the risk of retrieval complications. While conservative treatment options should be considered first, physicians performing high-risk retrievals should understand and be prepared for rare complications.