Total therapeutic embolization of the kidney for hypertension in a child with a mycotic aneurysm

Abstract

A 7-year-old boy with bacterial endocarditis developed renal artery mycotic aneurysm and diffuse distal occlusions of the renal branches. Blood pressure in the patient returned to normal after obliteration of flow to the left kidney with Gelfoam, Ivalon, and a Gianturco coil. An end loop of the coil used for embolization remained in the lumen of the aorta against its lateral side. Improper coil placement did not result in complications; the boy later died due to neurologic and pulmonary complications. We discuss the therapeutic potential of renal embolization, as well as the risks of particulate and ethanol embolization, in the treatment of renal vascular hypertension from mycotic aneurysms.

Therapeutic intervention in renal arterial injuries

“…It is possible that embolization results in infarction rather than ischemia. Renovascular hypertension has in fact been managed successfully with TCVO [47][48][49]. No hypertension resulted from TCVO in this series.…”

“…Since Margolies et al's report of successful TCVO in trauma patients in 1972 [41], TCVO has been used in many clinical circumstances [26,39,[42][43][44][45][46][47][48][49][50][51][52]. The most frequent clinical application of TCVO is the control of hemorrhage either as a s u r g i c a l a d j u v a n t or p r i m a r y p r o c e d u r e [26,39,41,43,[53][54][55].…”

Renal Aneurysm and Arteriovenous Fistula

“…A correct manipulation of particulate material in superselective embolization lies in the balance between the diameter of the catheter, the diameter of the target vessel, and the AVE An aneurysm of the main renal artery is best treated with surgery (6). Therefore embolization of the main renal artery must be limited to life-threatening ruptured aneurysms, or when a severe and extensive lesion of the kidney coexists (4).…”

Transarterial Nephrectomy: The Current Status of Experimental and Clinical Studies

“…52,53 The decision has to be made according to the relative invasiveness of the procedure and the postoperative course. 54,55 In case of renal cell carcinoma, the efficiency of adjuvant autologous vaccine therapy may again stimulate randomized clinical trials focusing on the oncological impact of preoperative renal tumor embolization. Although the palliative indication is widely accepted, the observed secondary effects of local tumor control as well as the impact of chemoembolization have to be assessed more in detail in the future.…”