Endovascular management of iatrogenic renal arterial lesions and clinical outcomes

Abstract

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...

Clinical efficacy and safety of transcatheter embolization for vascular complications after percutaneous nephrolithotomy

“…Percutaneous nephrolithotomy (PNL) is the preferred procedure for safe and effective surgical treatment of kidney stones [ 1 ]. Hemorrhage is the most serious complication of PNL, resulting from pseudoaneurysm (PA) or arteriovenous fistula (AVF), and can usually be controlled with conservative treatment [ 2 – 4 ]. After PNL, life-threatening hemorrhage requiring transfusion at a rate of 11.2–17.5% has been reported in the literature [ 5 ].…”

Renal Pseudoaneurysms and Arteriovenous Fistulas as a Complication of Nephron-Sparing Partial Nephrectomy: Technical and Functional Outcomes of Patients Treated With Selective Microcoil Embolization During a Ten-Year Period

“…However, this volume loss of renal parenchyma was not associated with a significant reduction of renal function, as proven by eGFR measurements. Only one recently published study has semiquantitatively assessed renal parenchymal volume loss after embolization [26].…”

Renal biopsy: Still a landmark for the nephrologist

“…Important signs that suggest this complication are the persistence of gross haematuria, the presence of abdominal bruit and palpable trill [38,39] but diagnosis confirmation requires Doppler ultrasound or magnetic resonance imaging, or angiography. The treatment of symptomatic cases is based on superselective transcatheter arterial embolization or, in rare cases, surgery [40] .…”