Is postoperative Doppler ultrasonography useful for the early detection of asymptomatic pseudoaneurysm and prevention of haemorrhagic complications after partial nephrectomy?

Abstract

ObjectiveTo assess the clinical utility of systematic Doppler ultrasonography (DUS) after robot-assisted partial nephrectomy (PN) for the detection of renal artery pseudoaneurysm (PA) and to allow pre-emptive arterial embolization to reduce the postoperative bleeding risk. Materials and MethodsA retrospective study was conducted including all consecutive patients treated with robot-assisted PN for renal tumours between 2015 and 2017. Every patient underwent renal DUS in the early postoperative period. The presence of PA, arteriovenous malformation or collection on the DUS, as well as the incidence of haemorrhagic complications and need for transfusion/embolization were assessed. ResultsEighty-three patients were included, with a median (range) age of 58 (19-80) years. The median (range) follow-up was 5 (1-30) months. The mean (AESD) tumour size was 31 (AE13.1) mm, the median (range) RENAL nephrometry score was 6 (4-11), and the mean (AESD) warm ischaemia time was 22 (AE7) min. A haemostatic agent was used in 12 patients (14.5%). No patient encountered haemorrhagic complications postoperatively, and no patient required transfusion. The median (interquartile range) time to DUS postoperatively was 7 (6-8) days. DUS revealed one asymptomatic PA (1.2%), which was treated with pre-emptive embolization. This was the only patient who encountered a Clavien grade III complication, while 20 patients (24%) had a complication grade I/II. ConclusionsNo haemorrhagic complications occurred in the present study population, although one asymptomatic PA was found. It was diagnosed early with DUS, allowing pre-emptive management with embolization. These results suggest the potential clinical utility of early postoperative DUS in order to screen for PA to reduce the risk of post-PN haemorrhagic complications.

Natural history of asymptomatic renal artery pseudoaneurysm after robot-assisted partial nephrectomy

“…Conversely, routine postoperative CE-CT may carry greater risk of overimaging, overdiagnosis, and overtreatment of asymptomatic RAP, as in our two patients who underwent prophylactic RAE for asymptomatic RAP diagnosed by routine CE-CT 7 days after RAPN. Further, the usefulness of Doppler ultrasonography for the early detection of significant asymptomatic RAP has been reported (30). Against this background, we found that RAPs of 15 mm or less disappear spontaneously after 3 months, suggesting that routine early postoperative imaging including CE-CT is not required in the absence of clinical signs or symptoms such as gross hematuria.…”

Doppler ultrasonography as a screening test for the detection of asymptomatic renal artery pseudoaneurysms following partial nephrectomy: A 15‐year single‐institution experience

“…Doppler ultrasonography (DUS), unlike CECT, is a simple, secure, and cost‐effective tool. Nevertheless, its diagnostic ability to identify RAP as a screening test has only been evaluated in a small number of patients 2,3 . Here, we evaluated the diagnostic ability of DUS for the detection of asymptomatic RAP using a relatively large consecutive patient cohort spanning 15 years at a single institution.…”

Open partial nephrectomy: current review

“…If the patient experiences rapid clinical deterioration or has required blood transfusion of greater than two units, early consideration of angioembolization should be sought for control of potential segmental arterial bleeding (64). Uncommonly, delayed presentation of arteriovenous fistulas and renal artery pseudoaneurysms can present with hematuria, wound site bleeding or flank pain and are potentially life-threatening (69). This may also be managed with embolization (65).…”