68 ANALYSIS OF DIAGNOSTIC ANGIOGRAPHY AND ANGIOEMBOLIZATION IN THE ACUTE MANAGEMENT OF RENAL TRAUMA UTILIZING A NATIONAL DATASET

Abstract

You have accessJournal of UrologyTrauma/Reconstruction: Trauma & Reconstructive Surgery II1 Apr 201068 ANALYSIS OF DIAGNOSTIC ANGIOGRAPHY AND ANGIOEMBOLIZATION IN THE ACUTE MANAGEMENT OF RENAL TRAUMA UTILIZING A NATIONAL DATASET James Hotaling, Mathew Sorensen, Thomas Smith, Hunter Wessells, and Bryan Voelzke James HotalingJames Hotaling Seattle, WA More articles by this author , Mathew SorensenMathew Sorensen Seattle, WA More articles by this author , Thomas SmithThomas Smith Houston, TX More articles by this author , Hunter WessellsHunter Wessells Seattle, WA More articles by this author , and Bryan VoelzkeBryan Voelzke Seattle, WA More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.115AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Data examining diagnostic angiography (DA) and angioembolization (AE) utilization after renal trauma has been limited to single-institution series. We used the National Trauma Data Bank (NTDB) to investigate national utilization trends of DA and AE as initial and subsequent management of blunt and penetrating renal trauma. METHODS The NTDB is a multi-institutional trauma registry dataset detailing the care of < 3 million inured persons from trauma centers in the U.S. from 2002-2007. All renal injuries were identified by AIS codes and converted to American Association for the Surgery of Trauma (AAST) injury grade. DA and AE trends were examined focusing on time to initial procedure, success with initial AE stratified by AAST grade, and need for operative intervention. AE was considered a failure if successive therapy was needed. Repeat DA was not considered a failure. RESULTS Of over 9000 patients with renal injury, 165 (2%) underwent DA after renal injury, of whom 77 (47%) had concomitant AE. The majority of renal injuries were due to blunt mechanisms (88% vs. 12% penetrating). Overall, initial AE was successful in 62% of patients, with 58% and 42% success in AAST IV and V injuries, respectively. Initial AE was more successful after penetrating renal injury (87% vs. 53% blunt, p=0.02). Open surgical intervention was performed after failed AE in 14 patients (18%), 13 of whom required nephrectomy. Ten of these 14 patients sustained AAST IV or V injury. Overall renal salvage was 92% and was 88% for grade 4 or 5 injuries. CONCLUSIONS Angiography is now used to manage roughly 2% of renal trauma. Our findings indicate that initial AE is not definitive therapy for most patients with high-grade renal injuries. Despite higher success for grade I-III injuries with AE, conservative therapy alone may have sufficed. An overall high renal salvage rate was achieved, although the success of AE when used as the sole mode of therapy for Grade 3, 4 and 5 injuries was only 48%. Table 1. Characteristics of Cohort Stratified by AAST Score Kidney AAST N(%) 1 2 3 4 5 Total Total 22(13) 28(17) 29(18) 68(41) 18(11) 165 Diagnostic Angio (% of total for Gr) 18(20) 15(17) 17(19) 32(36) 6(7.0) 88 Pts requiring Nephrectomy 0 0 0 0 0 0 Hypotensive(sbp<90) 17(94) 12(80) 16(94) 28(88) 6(100) 79(90) Level I Trauma Ctr 9(50) 13(87) 12(71) 23(72) 3(50) 60(68) Median ISS 14 17 19 25 36 21 Mortality 0 0 0 3(9.0) 2(33) 5(5.7) Median Time to 1st Procedure(h) 24 7 10 5 <1h 6 SSA (% of total for Gr) 4(5.1) 13(17) 12(16) 36(47) 12(16) 77 Pts requiring Nephrectomy 0 0 3(25) 8(22) 2(17) 13(17) Pts requiring second SSA 1(25) 4(31) 4(33) 8(22) 5(42) 22(29) Hypotensive(sbp<90) 4(100) 12(92) 11(92) 30(83) 10(83) 67(87) Level I Trauma Ctr 3(75) 11(85) 8(67) 17(47) 10(83) 49(63) Median ISS 14 27 20 25 45 25 Mortality 1(25) 0 0 2(6.0) 3(25) 6(7.8) Median Time to 1st Procedure(h) 2 10 44 <1h 2 2.5 © 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 183Issue 4SApril 2010Page: e29 Peer Review Report Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.MetricsAuthor Information James Hotaling Seattle, WA More articles by this author Mathew Sorensen Seattle, WA More articles by this author Thomas Smith Houston, TX More articles by this author Hunter Wessells Seattle, WA More articles by this author Bryan Voelzke Seattle, WA More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...