The need for early angiography in patients with penetrating renal injuries

Muir, Mark T.; Inaba, Kenji; Ong, Adrian W.; Barmparas, Galinos; Branco, Bernardino C.; Zubowicz, Elizabeth A.; Salhanick, Marc; Cohn, Stephen M.

doi:10.1007/s00068-011-0155-9

Cited by 6 publications

(8 citation statements)

References 33 publications

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“…The use of CT in trauma made its diagnosis more accurate and frequent, allowing the surgeon to study the renal function and establish the magnitude of the kidney injury. CT with intravenous contrast medium, including images of the late phase, is the best method for assessing renal lesions 9 . It provides important information, providing the classification of the lesion, assessing renal vascularization, verifying whether there is a ischemic segment or evidence of active bleeding, and mainly detecting the escape of contrast from the excretory system.…”

Section: Results Results Results Resultsmentioning

confidence: 99%

“…Unfortunately, NOM of renal vascular lesions is often unsuccessful, invasive procedures being necessary in most cases. In such cases, selective embolization of segmental arteries is highly effective 9 . However, angiography with or without embolization remains a rarely used procedure with renal penetrating trauma 9 .…”

Section: Results Results Results Resultsmentioning

confidence: 99%

“…In such cases, selective embolization of segmental arteries is highly effective 9 . However, angiography with or without embolization remains a rarely used procedure with renal penetrating trauma 9 . The treatment by interventional radiology in selected patients helped reduce the need for surgical treatment 3 .…”

Section: Results Results Results Resultsmentioning

confidence: 99%

“…In the present study, considering only the renal lesions, there was no need to operate any patient. In this sample the need for surgical intervention occurred exclusively from complications of the liver injury.In 2010, in a retrospective study from Muir et al 9 , one of every three patients with penetrating renal trauma underwent NOM, although one in five of these individuals needed, ultimately, angiographic or surgical treatment. Based on these data, we concluded that the routine use of angiography can reduce failures in NOM and improve the prognosis of patients undergoing this type of treatment.…”

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confidence: 99%

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Tratamento não operatório das lesões renais por arma de fogo

Cesar

Starling

Drumond

2013

Rev. Col. Bras. Cir.

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(FAP) in the right thoraco-abdominal region in patients with hemodynamic stability and no signs of peritoneal irritation, highlighting the assessment of the safety of this approach. Methods Methods Methods Methods Methods: This was a prospective study with patients sustaining injuries by FAP in the right thoraco-abdominal region and kidney lesions, treated at the João XXIII Hospital (FHEMIG) in Belo Horizonte, from January 2005 to December 2012. Inclusion criteria were: hemodynamic stability, renal morphofunctional study by CT and no signs of peritoneal irritation. Results Results ResultsResults Results: A total of 128 patients met the inclusion criteria of the protocol and underwent NOM for right thoraco-abdominal injury by FAP. Of these, 37 (28.9%) had renal injuries. Trauma indexes: RTS 7.8, ISS16, and TRISS 99%. Lesions grade II and grade III were the most frequent. The most commonly associated intra-abdominal injury was of the liver, present in 81.1% of cases. Two patients (5.4%) had failed nonoperative treatment. Conclusion Conclusion Conclusion Conclusion Conclusion: The nonoperative treatment of such renal lesions, when properly indicated, has a high success rate, low complication rate and increases the chance of renal preservation. It is safe for well-selected patients in trauma centers with adequate infrastructure, experienced professionals and use of a specific protocol. T he management of penetrating renal trauma has evolved, during the last decades, from the immediate surgical exploration to attempt to preserve kidney to the non-operative treatment (NOM) in selected patients 1 . The advance of imaging techniques and the development of an internationally validated classification of renal trauma 2 improved the severity staging of lesions and facilitated monitoring. In addition, the appreciation of the hemodynamic stability of patients led to better NOM outcomes 3 .Despite the supposed benefits of nonoperative treatment, a minority of penetrating renal injuries can be treated without surgery by NOM and currently the option is still controversial. However, there is increasing evidence that even high degree renal injuries can be treated safely without intervention in the hemodynamically stable patient [4][5][6] .Although renal injuries by firearms are uncommon, they tend to produce complex lesions of the urinary system 6 . By contrast, there are few services that have sufficient number of patients with penetrating renal injuries, especially those by firearms, which allows the study of such cases.The aim of this study was to analyze the NOM of patients with renal lesions caused by firearm projectiles (FAP) admitted with hemodynamic stability and no signs of peritoneal irritation, with emphasis on the evaluation of the safety of this approach. METHODS METHODS METHODS METHODS METHODSWe conducted a prospective study in patients victims of assault by firearm in the right thoraco-abdominal region, with kidney injury, treated at João XXIII Hospital The protocol of HJXXIII for this type of approach includes i...

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Section: Results Results Results Resultsmentioning

confidence: 99%

Section: Results Results Results Resultsmentioning

confidence: 99%

Section: Results Results Results Resultsmentioning

confidence: 99%

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confidence: 99%

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Tratamento não operatório das lesões renais por arma de fogo

Cesar

Starling

Drumond

2013

Rev. Col. Bras. Cir.

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“…Angioembolisation has been documented to reduce the failure of conservative management for renal injuries and improve patient outcomes. 9 This is particularly evident in specialised centres with expertise and experience with angioembolisation where it is hailed as a viable option to achieve haemorrhage control. 10 Emergency SAE is not available in our setting and, considering the injury severity and polytrauma nature of our patients on admission, it is doubtful whether this modality would have had an appreciable effect on our nephrectomy rate.…”

Section: Discussionmentioning

confidence: 99%

Renal trauma in a Trauma Intensive Care Unit population

Pillay

Pillay²,

Hardcastle

2019

S. Afr. j. surg.

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Background: For the majority of renal injuries, non-operative management is the standard of care with nephrectomy reserved for those with severe trauma. This study in a dedicated Trauma Intensive Care Unit (TICU) population aimed to assess the outcomes of renal injuries and identify factors that predict the need for nephrectomy, Methods: Patients, older than 18 years, admitted to TICU from January 2007 to December 2014 who sustained renal injuries had data extracted from the prospectively collected Class Approved Trauma Registry (BCA207-09). Patients who underwent surgical intervention for the renal injury or received non-operative management were compared. The key variables analysed were: patient demographics, mechanism of injury, grade of renal injury, presenting haemoglobin, initial systolic blood pressure, Injury Severity Score and Renal Injury AAST Grade on CT scan in patients who did not necessarily require immediate surgery, or at surgery in those patients who needed emergency laparotomy. Results: There were 74 confirmed renal injuries. There were 42 low grade injuries (grade I-III) and 32 high grade injuries (5 grade IV and 27 grade V). Twenty-six (35%) had a nephrectomy: 24 with grade V injuries and 2 with grade IV injuries required nephrectomy. Six patients in the high injury grade arm had non-operative management. A low haemoglobin, low systolic blood pressure, higher injury severity score, and a high-grade renal injury, as well as increasing age were positive predictors for nephrectomy in trauma patients with renal injury. Conclusion: Non-operative management is a viable option with favourable survival rates in lower grade injury; however, complications should be anticipated and managed accordingly. High grade injuries predict the need for surgery.

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Ballistic Genitourinary Trauma

Campbell

Sharma

2017

Ballistic Trauma

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The need for early angiography in patients with penetrating renal injuries

Cited by 6 publications

References 33 publications

Tratamento não operatório das lesões renais por arma de fogo

Tratamento não operatório das lesões renais por arma de fogo

Renal trauma in a Trauma Intensive Care Unit population

Ballistic Genitourinary Trauma

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