Radiographic predictors of need for angiographic embolization after traumatic renal injury

Computed tomographic imaging in determining the need of embolization for high-grade blunt renal injury

“…Despite our study and the study of Nuss et al 15 showing that patients without CE did not require TAE, other studies have reported that 7% to 8% of patients with no CE had a TAE. 16,17 Shanmuganathan et al 19 demonstrated that active bleeders can be missed when using suboptimal CT contrast medium enhancement techniques.…”

“…It is therefore important to evaluate the presence of active bleeding for patients with massive hematomas, especially in those with arterial bleeding or bleeding from a proximal segment of a vessel that has a higher risk for continued or recurrent bleeding. 7 Nuss et al 15 demonstrated that a PRD of greater than 4 cm combined with CE was associated closely with the need for TAE. Dugi et al 17 and Charbit et al 16 reported similar results using a different cutoff value for PRD.…”

“…In addition, not all patients in the TAE group received more than 4 U of blood, suggesting that some patients may have been embolized unnecessarily. However, these positive angiographic findings have been used by many previous studies 3,15,16 to indicate the need for renal embolization. The TAE rate in our study was not excessive (27%), indicating that CE is still a sensitive indicator for the procedure.…”

“…13,14 Some CT criteria, such as long perirenal hematoma rim distance (PRD), discontinuity of Gerota's fascia, or active intravascular contrast extravasation (CE), indicate the possibility of persistent and potentially life-threatening renal bleeding for patients with high-grade renal injury who would be likely to benefit from embolization. 8,15,16 The aim of this study was to reevaluate the need for embolization in high-grade renal trauma patients by comparing the findings of CT and angiography and examining the correlation between these findings and management and clinical outcome of the patients.…”

The associations between initial radiographic findings and interventions for renal hemorrhage after high-grade renal trauma: Results from the Multi-Institutional Genitourinary Trauma Study

“…2,3 For example, vascular contrast extravasation and large peri-renal hematomas have been shown to be highly associated with the need for endovascular or open procedures. [4][5][6][7][8][9][10] However, most data are from singlecenter studies with a small number of interventions. Validation of these findings in a multi-center setting with a larger cohort is needed.…”