Endovascular Management of Iatrogenic Renal Vascular Injury: Experience in 28 Cases
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- Category: Vol. 79, June 2011
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Endovascular Management of Iatrogenic Renal Vascular Injury: Experience in 28 Cases,HANY M.A. SEIF and DIAA A. HAMEED
Abstract
Aim of the Work: To evaluate the feasibility and efficacy of endovascular techniques in the management of gross hematuria caused by iatrogenic renal vascular injury. Specif-ically, we aimed to assess different embolic agents, different methods of embolization and their impact on the renal paren-chymal loss and renal function.
Patients and Methods: This is a single institutional study carried out between May 2004 to January 2011 and included 28 patients. Records of all patients who underwent postpro-cedural renal angioembolisation were reviewed. Data on embolization technique and embolic agents, success rate, periprocedural complications, and the long-term morphological and functional outcomes of embolised organs was recorded.
Results: Twenty eight patients underwent angiography for diagnosis and treatment of gross hematuria caused by iatrogenic injury of renal vessels after surgical or percutaneous nephrolithotomy or renal biopsy. 96% were angiographically positive and underwent superselective embolization; of them pseudoaneurysm was noted 82%, AVF in 11%, and distorted renal branches in 7%. None of the 27 patients with successful embolisation developed recurrent bleeding or required post-procedural blood transfusion. There were no major procedure related post-embolisation complications.
Conclusion: The high success rate and low incidence of complications make endovascular management the first-choice treatment option in cases of severe postprocedural renal hemorrhage. Superselective embolization of the injured vessel minimizes the extent of renal parenchymal infarction and allows sparing of the renal parenchyma.