Effects of Superselective Embolization for Renal Vascular Injuries on Renal Parenchyma and Function

Chatziioannou, Achilles; Brountzos, Elias; Primetis, Elias; Malagari, Katerina; Sofocleous, Constantinos T.; Mourikis, D; Kelekis, Dimitrios

doi:10.1016/j.ejvs.2004.05.003

Cited by 61 publications

(39 citation statements)

References 18 publications

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“…In the present study, there was no statistical difference in eGFR values before the percutaneous renal procedure and those measured 7 days after TAE (43.4 ± 24.4 to 44.6 ± 25.1 mL/min/1.73 m 2 ; P = 0.189), which might be influenced by several factors, such as resolution of underlying obstructive uropathy after the procedure, severity of procedure‐related bleeding or additional supportive therapies. In addition, there were no major complications during the follow‐up period, which is compatible with the few major complications reported in recent studies using super‐selective TAE . Although localized parenchymal atrophic change was observed on follow‐up CT scans, this change does not seem to affect renal function .…”

Section: Discussionsupporting

confidence: 88%

“…In addition, there were no major complications during the follow‐up period, which is compatible with the few major complications reported in recent studies using super‐selective TAE . Although localized parenchymal atrophic change was observed on follow‐up CT scans, this change does not seem to affect renal function . This indicates that TAE for percutaneous renal procedure‐related bleeding can be carried out in a safe manner.…”

Section: Discussionsupporting

confidence: 87%

“…Iatrogenic renal vascular injury can cause profuse bleeding, resulting in significant morbidity . When there is profuse bleeding with a nephrostomy catheter, catheter clamping and forced diuresis are usually effective.…”

Section: Discussionmentioning

confidence: 99%

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Angiographic management of percutaneous renal procedure‐related bleeding: A single‐center experience

et al. 2018

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Objectives To present the radiological and clinical results of transcatheter arterial embolization in patients with active bleeding after percutaneous renal procedures. Methods A total of 79 consecutive patients who underwent angiography for percutaneous renal procedure‐related bleeding were included in the present retrospective analysis. Patient characteristics, angiographic management and clinical outcomes were analyzed. Results On angiography, bleeding foci were observed in 81.0% of the patients (64/79), all of whom underwent transcatheter arterial embolization. Among the 15 patients (19.0%) with negative angiographic findings, empirical transcatheter arterial embolization was carried out in six patients (40.0%). The technical success rate in 64 patients with positive angiographic findings was 100%, and the clinical success rate in 70 patients who underwent transcatheter arterial embolization was 85.7% (60/70). A total of 14.3% (10/70) of patients with clinical failure underwent repeat transcatheter arterial embolization and all achieved clinical recovery. There were no major complications. There was no statistical difference in estimated glomerular filtration rate values before the percutaneous renal procedure and those measured 7 days after transcatheter arterial embolization (43.4 ± 24.4 to 44.6 ± 25.1 mL/min/1.73 m2; P = 0.189). Clinical failure was not associated with age, sex, type of renal procedures, bleeding tendency, presence of active bleeding on angiography, latency time and embolic agents used (P > 0.05). Conclusions Transcatheter arterial embolization is a safe and effective method of treating percutaneous renal procedure‐related bleeding without renal function deterioration.

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Section: Discussionsupporting

confidence: 88%

Section: Discussionsupporting

confidence: 87%

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Angiographic management of percutaneous renal procedure‐related bleeding: A single‐center experience

et al. 2018

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“…The main concerns of embolization are the adverse effects that can result from devascularization of a portion of the renal parenchyma, with subsequent loss of its function. The reported series discussing the effects of superselective embolization on renal function and morphology are scant, with few kidneys assessed, and including heterogeneous groups of patients [5–10].…”

Section: Introductionmentioning

confidence: 99%

Long‐term functional and morphological effects of transcatheter arterial embolization of traumatic renal vascular injury

Mohsen¹,

El‐Assmy²,

El-Diasty³

2007

BJU International

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OBJECTIVE To assess the long‐term morphological and functional outcome of superselective transarterial embolization (TAE) for treating traumatic renal vascular injury. PATIENTS AND METHODS The surgical records of 124 patients with traumatic renal vascular injury managed by TAE between 1990 and 2004 were reviewed, of whom 81 completed a long‐ term follow‐up and were included in the final analysis. Patients were followed using serum creatinine levels, grey‐scale ultrasonography, intravenous urography (IVU) and radioisotopic renography using 99mTc‐mercapto‐acetyl triglycine (MAG3) and 99mTc‐dimercaptosuccinic acid (DMSA). RESULTS Embolization resulted in the cessation of haematuria in all patients but two (97.5%). At 3 months, serum creatinine levels increased in four of nine patients with a solitary kidney, but only one of them required haemodialysis. After a mean follow‐up of 4.6 years, IVU showed a normal calyceal configuration in 70% of renal units, pyelonephritic changes in 26% and no dye excretion in 4%. DMSA scans showed no evidence of photopenic areas in 17 renal units (21%). The mean (sd) percentage of DMSA uptake by the corresponding kidney improved from 24 (9)% at the 3‐month scans to 32 (10)% at the last follow‐up scan (P < 0.001). Using MAG3, the mean (sd) glomerular filtration rate improved significantly from 26 (11) mL/min at the 3‐month scan to 32 (9) mL/min at the last follow‐up (P < 0.05). CONCLUSIONS Superselective TAE is safe and effective for traumatic renal vascular injury. The short‐term deleterious effects were more pronounced in patients with a solitary kidney. The long‐term follow‐up showed functional and morphological improvements in the embolized renal units.

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“…[29] Hagiwara et al ., believe that transarterial embolization of the culprit lesion, diagnosed on angiography, should be the first line of treatment in cases of renal arterial bleeding, whenever the clinical situation allows. [10] These authors postulate that super- selective embolization reduces the extent of the initial ischemic area and offers a rapid, precise, and effective treatment, allowing the highest possible level of preservation of renal function.…”

Section: Discussionmentioning

confidence: 99%

Gelatin-thrombin hemostatic matrix injection to salvage refractory post-renal graft biopsy bleed

et al. 2013

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Post-renal biopsy bleeding refractory to angioembolization usually requires graft nephrectomy as a life-saving measure. Gelatin-thrombin hemostatic matrix injection in the needle tract is a novel attempt to control bleeding in such cases and to salvage the allograft. We hereby describe two cases of post-graft biopsy bleed. Both these patients continued to bleed even after angioembolization. They were shifted to the operating room upon developing hypotension, having received multiple blood transfusions with the intention of performing graft nephrectomy to save their lives. However, bleeding was successfully controlled by using Gelatin-thrombin hemostatic matrix injection in the biopsy needle tract. Patients improved hemodynamically after the procedure. Graft function returned to normal in both the cases. At an average follow-up of 10.4 months, both the patients have shown stable graft functions.

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Effects of Superselective Embolization for Renal Vascular Injuries on Renal Parenchyma and Function

Abstract: Superselective embolization resulted in permanent cessation of bleeding. Serious parenchymal infarction was prevented and serum creatinine level returned to the pre-bleeding values. Embolization should be considered as the treatment of choice in this patient population.

Cited by 61 publications

References 18 publications

Angiographic management of percutaneous renal procedure‐related bleeding: A single‐center experience

Angiographic management of percutaneous renal procedure‐related bleeding: A single‐center experience

Long‐term functional and morphological effects of transcatheter arterial embolization of traumatic renal vascular injury

Gelatin-thrombin hemostatic matrix injection to salvage refractory post-renal graft biopsy bleed

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