The Efficacy and Safety of Transcatheter Arterial Embolization to Treat Renal Hemorrhage after Percutaneous Nephrolithotomy

Du, Nan; Ma, Jingqin; Luo, Jianjun; Liu, Qingxin; Zhang, Zi-Han; Yang, Mei; Yu, Tianzhu; Yun, Tae-Jin; Liu, Rong; Zhong, Wen; Yan, Zhenlin

doi:10.1155/2019/6265183

Cited by 26 publications

(35 citation statements)

References 24 publications

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“…This agreed with Limtrakul et al who reported clinical success of 91.5% for their 94 patients treated with RAE [17]. Moreover, Du et al reported clinical success of 100% of RAE compared to conservative therapy that was 73.6% in their cases of bleeding after PCNL [18]. Regarding treatment failure, RAE failed to control bleeding in 3 cases of our patients.…”

Section: Discussionsupporting

confidence: 90%

Clinical outcome and safety of selective renal artery embolization using permanent occlusive agents for acute renal bleeding

Alwarraky

Abdallah

Elgharbawy

2020

Egypt J Radiol Nucl Med

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Background To evaluate how far is selective renal artery embolization (RAE) using permanent agents effective in treating acute renal artery bleeding. We retrospectively reviewed the medical records of patients (n = 45) with renal bleeding who were managed by selective RAE using coils, N-butyl-cyanoacrylate glue (NBCA glue), and polyvinyl alcohol (PVA). Data retrieved included the cause, number, and type of the bleeding lesions as well as the results of the embolization for 1 year after RAE. Clinical success was the primary outcome while re-bleeding and complications were the secondary outcomes. Results There were 55 bleeding lesions detected by angiography in the included 45 patients. Coils were used in 23/45 patients (51.1%), NBCA glue in 15/45 patients (33.3%), and PVA in 7 patients (15.6%). Bleeding could be controlled with embolization in a single session in 41/45 patients with primary clinical success 91.1%. Four patients needed re-embolization sessions to control bleeding and only one patient was controlled, giving secondary clinical success of 92.3%. Three patients failed to respond to embolization and nephrectomy was done. Iatrogenic dissection of the segmental branch was seen in one patient. Post embolization syndrome was seen in 14/45 patients (31.1%). Non-target embolization was seen in 2 patients: one during treatment with NBCA glue and the other with PVA. No other complications were recorded. No significant differences between clinical success among coil, NBCA glue, and PVA subgroups (P > 0.05). Conclusion Selective RAE using permanent agents is effective in controlling renal bleeding and no significant difference among coil, NBCA glue, and PVA.

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Section: Discussionsupporting

confidence: 90%

Clinical outcome and safety of selective renal artery embolization using permanent occlusive agents for acute renal bleeding

Alwarraky

Abdallah

Elgharbawy

2020

Egypt J Radiol Nucl Med

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“…Currently, SRAE has become a recognized treatment for severe and persistent renal bleeding after PCNL that fails to achieve a satisfactory outcome through conservative treatment (1,19). The technical and clinical success rates of embolization for renal hemorrhage have been reported to be 87-100% and 57-100%, respectively (18).…”

Section: Discussionmentioning

confidence: 99%

“…In this study, we retrospectively evaluated the safety and efficacy of SRAE in the treatment of hemorrhage after PCNL. In addition, although renal artery embolization has been regarded as the treatment of choice for postoperative bleeding of PCNL (18)(19)(20), there are still reports of recurrent hemorrhage after embolization (1, 7), and even Mao et al reported that up to 17.3% of patients experienced initial treatment failure and underwent repeat SRAE (16). The failure of embolization may be partly due to immature embolization techniques and improper selection of embolization materials.…”

Section: Introductionmentioning

confidence: 99%

Superselective Renal Artery Embolization Management of Post-percutaneous Nephrolithotomy Hemorrhage and Its Methods

et al. 2020

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Objective: The purpose of this study was to evaluate the therapeutic efficacy and safety of superselective renal arterial embolization (SRAE) in the treatment of patients with renal hemorrhage after percutaneous nephroscopy (PCNL). In addition, embolization techniques and embolization materials during operation were also worthy of further discussion.Methods: From February 2015 to December 2019, clinical data of 49 consecutive patients with renal hemorrhage after PCNL were retrospectively analyzed. Demographic and clinical data of patients were recorded, changes in serum creatinine values were analyzed, and the safety and efficacy of TAE were evaluated. Clinical experience was also recorded.Results: A total of 49 patients underwent angiography, of which 46 patients received SRAE due to positive hemorrhagic foci detected by angiography, and the technical success rate of 46 patients was 100%. Among the three patients who did not receive embolization, one patient underwent nephrectomy, and two patients improved with conservative treatment, with a clinical success rate of 98%. There was no statistically significant difference between serum creatinine before PCNL and 7 days after SRAE (101.6 ± 36.5 to 100.5 ± 27.1 μmol/L; P = 0.634), and no significant change was observed in serum creatinine at the last follow-up (99.4 ± 34 μmol/L, P = 0.076). No major complications occurred after embolization.Conclusions: SRAE is safe and effective in patients with renal hemorrhage after PCNL. The experience of interventional therapy and the choice of embolization materials in this study may provide certain benefits for the treatment of patients with renal hemorrhage after PCNL.

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“…In most patients, bleeding after the procedures is controlled by conservative treatment, but severe bleeding requires emergency management. The risk factors for severe bleeding are huge stones, lower puncture site, number and type of stones, operative history of ipsilateral renal stones, intraoperative perforation of the renal pelvis, and no tube drainage [ 4 ]. At present, there is no standard protocol for risk assessment of postoperative complications after PCNL and PN.…”

Section: Discussionmentioning

confidence: 99%

“…Hematuria is a severe life-threatening complication of these procedures, requiring timely treatment. Temporary clipping of the nephrostomy tube, application of hemostatic drugs, and blood transfusion are necessary conservative treatment measures [ 4 ]. It is recommended that angiography and embolization be performed by conservative treatment as early as possible in patients with severe hemorrhage [ 5 – 7 ].…”

Section: Introductionmentioning

confidence: 99%

Value of Angioembolization in the Treatment of Iatrogenic Renal Vascular Injury Assisted by 3-Dimensional Digital Subtraction Angiography

Liao

Fan

et al. 2020

Med Sci Monit

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Background This study was conducted to investigate the reliability and efficacy of polyvinyl alcohol combined with coils in the embolization of iatrogenic renal vascular injury with the assistance of 3-dimensional digital subtraction angiography (3D-DSA). Material/Methods Twenty-six patients with minimally invasive renal bleeding who underwent transarterial embolization from January 2012 to January 2019 in our hospital were included in the study. We obtained demographic data from these patients, as well as information on clinical presentation, renal procedures used for treatment, and perioperative details. The changes in renal function tests, serum hemoglobin, serum hematocrit, and technetium Tc 99m dimercaptosuccinic acid (99mTc-DMSA) levels pre- and postembolization were compared. In addition, the embolic area and the technical and clinical success rates were analyzed. Finally, an angiographic manifestation of the renal artery, 3D-DSA, and the effect of embolization were analyzed retrospectively. Results All patients achieved technical and clinical success after embolization (100%, 26/26). There were no significant differences between pre- and postoperative estimated glomerular filtration rate, serum parameters, and 99mTc-DMSA. The embolic area was 12%±10%. Patients did not exhibit severe complications during the follow-up period. Conclusions Proximal embolization technique assisted by 3D-DSA for renal iatrogenic hemorrhage and vascular lesions is both safe and efficacious, offering high rates for both clinical and technical success. It maximizes the protection of the kidney and reduces the rate of renal resection.

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The Efficacy and Safety of Transcatheter Arterial Embolization to Treat Renal Hemorrhage after Percutaneous Nephrolithotomy

Cited by 26 publications

References 24 publications

Clinical outcome and safety of selective renal artery embolization using permanent occlusive agents for acute renal bleeding

Clinical outcome and safety of selective renal artery embolization using permanent occlusive agents for acute renal bleeding

Superselective Renal Artery Embolization Management of Post-percutaneous Nephrolithotomy Hemorrhage and Its Methods

Value of Angioembolization in the Treatment of Iatrogenic Renal Vascular Injury Assisted by 3-Dimensional Digital Subtraction Angiography

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