Renal Artery Embolization in Post Traumatic Vascular Lesions
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- Category: Vol. 81, March 2013
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Renal Artery Embolization in Post Traumatic Vascular Lesions,IHAB I. ALI, HESHAM BADAWY, AMR A. NASSEF and AHMED S. AWAD
Abstract
Background: Renal vascular injuries mostly result from interventional urologic procedures such as percutaneous biopsy and nephrostomy. Serious hemorrhagic complications associ-ated with percutaneous urologic procedures occur in 2.3-15% of the patients endangering patients' life. Conventional surgical treatment including partial and total nephrectomy carries great morbidity and results in remarkable renal parenchymal loss.
With the development of transcatheter endovascular interventional procedures, microcatheters and embolizing materials precise localization and superselective catheterization of the arterial bleeder followed by embolization gives a minimally invasive treatment option which is able to control bleeding with minimal parenchymal loss and complication compared to surgery.
Purpose: To evaluate the effectiveness of endovascular embolization as a therapeutic technique in post traumatic (iatrogenic and non iatrogenic) renal vascular injuries.
Patients and Methods: This is a single center prospective study from July 2004 to November 2009. Thirty two patients (25 males and 7 females) between the ages of 3 and 60 years (mean age 37 years) with suspected renal vascular injury after percutaneous renal intervention or stab injury underwent angiography and percutaneous transcatheter arterial emboliza-tion using coils, glue, poly vinyl alcohol (PVA) particles and absolute alcohol.
Results: The source of bleeding was identified and embo-lized in 87.5% of patients (pseudoaneurysm=17, pseudoaneu-rysm with arteriovenous fistula=7, arteriovenous fistula (AVF) alone=2 and extravasation=2).
Bleeding stopped in 26 of the 28 patients (92.8 %). In two patients (7%), recurrent bleeding occurred. Re-angiography and assessment was done and insertion of another coil was needed in one patient, while in the second one, glue was administrated.
None of the patients underwent embolization required further surgical intervention. No significant immediate or delayed complications related to angiography or embolization was recorded.
Conclusion: Transcatherter endovascular renal emboliza-tion is effective minimally invasive treatment option in iatro-genic and penetrating vascular renal injuries that allow control of bleeding with minimal renal parenchymal tissue loss and rapid recovery.