Factors Predictive of Selective Angioembolization Failure for Moderate- to High-grade Renal Trauma: A French Multi-institutional Study

The Role of Renal Artery Embolisation in the Management of Blunt Renal Injuries: A Review

“…[23][24][25] In some cases, there was an occasional need for nephrectomy and even exploratory laparotomy following failed embolisation, although these were in older studies. 6,14,22,24,25,[34][35][36][37] The most common indication for postembolisation surgery was a failure to control bleeding, regardless of whether embolisation was repeated or not. 22,35,38 Other indications reported include pain, acute coronary syndrome and increased free fluid on CT. 6,38 RAE during a hospital stay may also be more frequent in patients later requiring nephrectomy due to more severe renal injuries.…”

“…6,14,22,24,25,[34][35][36][37] The most common indication for postembolisation surgery was a failure to control bleeding, regardless of whether embolisation was repeated or not. 22,35,38 Other indications reported include pain, acute coronary syndrome and increased free fluid on CT. 6,38 RAE during a hospital stay may also be more frequent in patients later requiring nephrectomy due to more severe renal injuries. 9 Still, timely nephrectomy remains an important last resort despite advancements in RAE.…”

“…Adjunctive endoscopic procedures such as retrograde ureteric stent placement were used in patients with urosepsis, symptomatic ureteral clot obstruction or significant urine extravasation on subsequent CT (3-5 days post-procedure) in patients with high-grade blunt renal trauma. 9,12,22,23,38 The effectiveness of adjunctive stenting is currently unknown, but this subgroup of patients may represent those who have more severe injuries and are therefore at higher risk of poor long-term functional renal outcomes. With the current evidence available, patients with radiological markers of urinomas or urinary extravasation, lower urinary tract symptoms or uroseptic features may therefore require more consistent or extended follow-up to rationalise the need for ureteric stenting.…”

“…[9][10][11][12] RAE in Grade V BRIs has been reported in the literature. 6,9,[13][14][15][16][17][18][19][20][21][22][23] However, the optimal strategy for Grade V kidney trauma remains uncertain as success rates have been variable and repeat embolisation may be necessary. 6,9,15,17,22,24 More promising results show that when used in the…”

“…management of Grade V parenchymal and renovascular lesions, RAE can result in minimal complications and retains an excellent likelihood of preserving the maximal amount of functional renal parenchyma without the need for further intervention, even despite haemodynamic instability. [16][17][18]22 Vascular injury with shattered kidneys in the presence of no suspicions of a pedicle injury using CT could be an indication for RAE. 17,25 Grade V renal pedicle avulsion is usually managed with surgery as it is technically demanding, but advances in angioembolisation have likely shifted practice patterns.…”