Treatment of Renal-Vascular Injury by Transcatheter Embolization: Immediate and Long-Term Effects on Renal Function

Poulakis, Vassilis; Ferakis, Nikolaos; Becht, E.; Deliveliotis, Charalabos; Duex, M.

doi:10.1089/end.2006.20.405

Cited by 68 publications

(53 citation statements)

References 20 publications

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“…Renal function can be negatively affected by nephrotoxic iodinated contrast media or devascularization of a part of the renal parenchyma secondary to embolization. Superselective embolization performed as distal as possible minimizes parenchymal loss of functional renal tissue to 0% to 15% (30). No deterioration of renal function after embolization was detected in previous series (12).…”

Section: Discussionmentioning

confidence: 77%

“…In case of a renal artery stenosis, embolization may be performed after the recanalization treatment of renal artery. Complications of endovascular embolization such as renal artery dissection, postembolization syndrome (21) and loss of renal function (30) are rare. Renal function can be negatively affected by nephrotoxic iodinated contrast media or devascularization of a part of the renal parenchyma secondary to embolization.…”

Section: Discussionmentioning

confidence: 99%

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Endovascular management of iatrogenic renal arterial lesions and clinical outcomes

Güneyli¹,

Gök²,

Bozkaya³

et al. 2015

Diagn Interv Radiol

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ORIGINAL ARTICLE PURPOSE We aimed to evaluate iatrogenic renal arterial lesions, including pseudoaneurysm, arteriovenous fistula, and arteriocaliceal fistula, their management by endovascular embolization, and the clinical results. METHODSFifty-five patients (forty males, fifteen females) with a median age of 40 years (range, 8-85 years), who underwent endovascular embolization of iatrogenic renal arterial lesions between March 2003 and December 2013 were included in this retrospective study. Types of iatrogenic lesions and details of embolization procedures were reported. Estimated glomerular filtration rate (eGFR), renal function tests, hemoglobin, and hematocrit levels before and after embolization were recorded and compared. RESULTSMedian follow-up was 24 months. We identified 53 pseudoaneurysms, 30 arteriovenous fistulas, and 11 arteriocaliceal fistulas in 55 patients, after percutaneous nephrolithotomy (n=26), renal biopsy (n=21), nephrostomy (n=3), renal surgery (n=3), and extracorporeal shock wave lithotripsy (n=2). Median number of pseudoaneurysms was 1 (range, 1-4) with a median size of 7 mm (range, 1.5-35 mm). Fifty-one patients underwent coil embolization. Median number of coils was 5 (range, 2-21) and median renal parenchymal loss was 5% (range, 1%-50%). There were no significant differences between pre-and postoperative eGFR and serum parameters. CONCLUSION Iatrogenic renal arterial lesion can be a life threatening condition. Superselective coil embolization is a safe, minimally invasive treatment option with minimal renal parenchymal loss and without significant change in renal function. Iatrogenic renal arterial lesions including pseudoaneurysm (PA), arteriovenous fistula (AVF), and arteriocaliceal fistula (ACF) are rare, but life-threatening conditions (1). The chief symptom usually includes macroscopic hematuria (2, 3). Catheter angiography is the gold standard for both diagnosis and treatment (1).Previous studies have evaluated the iatrogenic renal arterial lesions following partial nephrectomy (1, 3-7), but there were only a few studies on iatrogenic renal arterial lesions following any iatrogenic renal interventions (2). In the present study, to the best of our knowledge, we report the largest series of iatrogenic renal arterial lesions following various renal interventions such as biopsy, percutaneous nephrolithotomy (PCNL), percutaneous nephrostomy, and partial nephrectomy. We focused on clinical presentations, imaging findings, management, and outcomes. Methods PatientsData regarding iatrogenic renal arterial lesions treated by endovascular embolization performed at our institution between March 2003 and December 2013 were evaluated retrospectively. A total of 55 patients with iatrogenic renal arterial lesions, who underwent endovascular embolization were included in the study. There were 40 males and 15 females with a median age of 40 years (range, 8-85 years). Patients with traumatic renal arterial lesions treated with endovascular embolization were excluded from the study. Informed con...

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Section: Discussionmentioning

confidence: 77%

Section: Discussionmentioning

confidence: 99%

Endovascular management of iatrogenic renal arterial lesions and clinical outcomes

Güneyli¹,

Gök²,

Bozkaya³

et al. 2015

Diagn Interv Radiol

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show abstract

“…Renal vascular lesions may be secondary to iatrogenic injuries during medical procedures accounting for the majority of renal vascular lesions [1,2]. In our case a simple, standardized medical procedure of evacuation of hemothorax led to a nearly-fatal complication as a result of a direct puncture of the branch of renal artery, which was even more unexpected since it occurred on the right side.…”

Section: Discussionmentioning

confidence: 65%

Polymer-glue as a life and kidney function saver: a life-threatening hemorrhage in the ruptured upper pole artery of the kidney managed by percutaneous embolization — a case report and literature review

Antoniewicz¹,

Wojtkowska

Dziekiewicz

et al. 2013

Open Medicine

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AbstractIn this paper we report the case of a nearly fatal hemorrhage in the artery of the renal upper pole that occurred in a 84-year-old woman on anticoagulation treatment in connection with aortic valve replacement 4 days prior to the incident. The artery was injured during the evacuation of a hematoma of the right pleural cavity. While the patient was in the intensive care unit recovering from cardiac valve surgery, the consulting urologist was summoned in order to cope with massive hematuria and acute urine retention. Unfortunately, conservative urological management based on catherization via a three-way catheter and constant transurethral lavage with saline was unsuccessful. Angio-computed tomography revealed a ruptured branch of the renal upper pole artery. A highly selective embolization using histoacryl injection during percutaneous angioplasty was performed. There were no complications in the following days. The patient was subject to postoperative follow-up at 3, 6 and 9 months and renal scintigraphy was performed at 6 months revealing symmetrical function of both kidneys without any changes in the upper pole of the right kidney.

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“…The majority of vascular lesions are organ limited or of minor degree and in such cases TAE usually combines the use of liquids or particles for capillary embolization and coils for larger vessel occlusion. Some authors claim that the use of microcoils alone is sufficient in majority of the cases (8). Retroperitoneal hematomas, intrarenal pseudoaneurysms and arteriovenous fistulas, which may occur after nephron-sparing surgery, have been dealt with by means of coils except in one case where coils were combined with particles of PVA for distal embolization (9).…”

Section: Discussionmentioning

confidence: 99%

Embolization of insufficiently ligated renal artery after open nephrectomy with absolute ethanol injection

Marković

Markovic²,

Pejcic³

2009

Diagn Interv Radiol

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Treatment of Renal-Vascular Injury by Transcatheter Embolization: Immediate and Long-Term Effects on Renal Function

Cited by 68 publications

References 20 publications

Endovascular management of iatrogenic renal arterial lesions and clinical outcomes

Endovascular management of iatrogenic renal arterial lesions and clinical outcomes

Polymer-glue as a life and kidney function saver: a life-threatening hemorrhage in the ruptured upper pole artery of the kidney managed by percutaneous embolization — a case report and literature review

Embolization of insufficiently ligated renal artery after open nephrectomy with absolute ethanol injection

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