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

Abstract

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.

Risk factors and clinical management of haemorrhage after open nephron‐sparing surgery

“…However, even after TAE and surgery there is only a minor decline in GFR. A good functional outcome is reported for TAE [27] and our data suggest that both interventions are equally effective for sparing kidney function, as long as the organ can be preserved.…”

“…Some variance is explained by the generally few cases. There is good evidence [14,27] of excellent functional results and a very low rate of side-effects after TAE.…”

Management of severe blunt renal trauma in adult patients: a 10‐year retrospective review from an emergency hospital

“…Persistent or delayed bleeding in a stable patient is managed successfully with TSE in up to 80% of cases [12–16]. After its introduction in 2006, none of our patients with grade 3–4 BT needed a laparotomy for uncontrolled bleeding.…”

Hemostatic Sandwich to Control Percutaneous Nephrolithotomy Tract Bleeding

“…15 In this study, the median age was 54, with one of the four patients having hypertension and diabetes. Preservation of renal function in this population is important, because a glomerular filtration rate (GFR) < 60 is associated with a higher hospitalization rate, increased cardiovascular events, and higher risk of mortality.…”