Renal artery embolisation: indications and utilisation at Tygerberg Hospital

Abstract

Background: To evaluate the indications, efficacy and outcomes of endovascular renal artery embolisation (RAE) in the management of renal haemorrhage, specifically in cases of non-iatrogenic origin. Methods: This is a retrospective case note review of 92 patients who underwent RAE in the period from August 1999 to August 2014 at Tygerberg Hospital. Results: Renal artery embolisation was performed in a total of 92 patients. The indication was traumatic renal injury in 60 patients (65.2%), with mean age 28.2 years. The mechanism of injury was stabbing (55.4%), blunt trauma (7.6%) and gunshot (2.2%). Digital subtraction angiography (DSA) showed pseudo-aneurysm in 32.6%, arteriovenous fistula in 19.6% and segmental artery injury in 13%. Embolisation success: 85% after one, 88.9% after a second attempt, with an overall success rate of 98.3% after two attempts. In 20 of the 92 patients (mean age 50.2 years) the indication was malignancy (21.7%). Other cases included iatrogenic haematuria (4.3%) and angiomyolipoma (3.3%). Embolisation was repeated in 16.3%, with eventual success rate of 93.8%. Post-embolisation syndrome was the most common complication, seen in 9.8% of all cases. Of the 9 patients who returned for follow-up with renogram imaging, 4 had a differential function of > 20% of the embolised kidney. Conclusion:Renal artery embolisation remains a very successful method of managing renal haemorrhage at this hospital, whether this results from trauma, malignancy, iatrogenic or other causes.

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

“…Finally, more common clinical complications are transient and self-limiting, such as post-embolisation syndrome, post-procedural pain, arterial hypertension, haematuria and renal impairment. [18][19][20]22,23,35,47,50,59 Patients' post-procedural status should be monitored appropriately so these complications can be managed. Appropriate monitoring will also alert clinicians to more serious complications such as intra-abdominal abscess formation, urosepsis, evidence suggestive of non-target embolisation or persistent bleeding which may warrant repeat embolisation or surgery.…”

“…The severity depends on the volume of parenchyma involved and is usually self-limiting. 59 Patients should receive appropriate pre-, intra-and post-procedure analgesia. 60…”