Safety and Efficacy of Transarterial Nephrectomy as an Alternative to Surgical Nephrectomy

Abstract

ObjectiveTo evaluate the safety and efficacy of transarterial nephrectomy, i.e., complete renal artery embolization, as an alternative to surgical nephrectomy.Materials and MethodsThis retrospective study included 11 patients who underwent transarterial nephrectomy due to a high risk of surgical nephrectomy or their refusal to undergo surgery during the period from April 2002 to February 2013. Medical records and radiographic images were reviewed retrospectively to collect information regarding underlying etiologies, clinical presentations and embolization outcomes.ResultsThe underlying etiologies for transarterial nephrectomy included recurrent hematuria (chronic transplant rejection [n = 3], arteriovenous malformation or fistula [n = 3], angiomyolipoma [n = 1], or end-stage renal disease [n = 1]), inoperable renal or ureteral injury (n = 2), and ectopic kidney with urinary incontinence (n = 1). The technical success rate was 100%, while clinical success was achieved in eight patients (72.7%). Subsequent surgical nephrectomy was required for three patients due to an incomplete nephrectomy effect (n = 2) or necrotic pyelonephritis (n = 1). Procedure-related complications were post-infarction syndrome in one patient and necrotic pyelonephritis in another patient. Of four patients with follow-up CT, four showed renal atrophy and two showed partial renal enhancement. No patient developed a procedure-related hypertension.ConclusionTransarterial nephrectomy may be a safe and effective alternative to surgical nephrectomy in patients with high operative risks.

Transcatheter arterial embolization for traumatic mesenteric bleeding: a 15-year, single-center experience

“…In our study, renal artery embolization was performed to control renal bleeding in one patient (Patient 6). TAE for traumatic hepatic, splenic, and renal injury and pelvic fracture was reported to be a safe and effective treatment (15,19,20).…”

Graft nephrectomy in children

“…RAE is also associated with reduced pain and length of stay in hospital [ 18 ]. However, RAE can be associated with other complications, such as post-embolisation syndrome (fever, graft pain, haematuria) and necrotic pyelonephritis, both affecting approximately 10% of patients [ 17 ]. These graft-related complications can be avoided by using RAE as a “neo-adjuvant” intervention, one or two days before GN.…”

Renal artery embolization before radical nephrectomy for complex renal tumour: which are the true advantages?

“…to induce necrosis in renal neoplasms. [4] The first indications for renal embolization without nephrectomy were limited to treatment of severe symptomatic hematuria and other palliative strategies for metastatic renal cancer [5, 6]; afterwards, it was performed before RN for renal masses in order to induce preoperative infarction and, consequently, to facilitate surgical intervention through decrease of intraoperative bleeding. Moreover, embolization with delayed RN has been carried out in metastatic RCC with the aim to stimulate tumour-specific antibodies, even if no established benefits in clinical response or survival have been reported [7].…”

“…Moreover, embolization with delayed RN has been carried out in metastatic RCC with the aim to stimulate tumour-specific antibodies, even if no established benefits in clinical response or survival have been reported [7]. Afterwards, the indications for renal embolization have been extended to different conditions such as persistent bleeding, treatment of hemorrhagic angiomyolipomas (AML), arteriovenous fistulae and vascular malformations, before endograft placement for abdominal aortic aneurysm repair, pseudo-aneurysm, medical renal disease as malignant hypertension and severe nephrotic syndrome [5, 6]. However, the role of preoperative renal artery embolization (PRAE) in management of renal masses has been often debated and its real benefit is still unclear.…”