Abstract No. 356 - Vascular urologic emergencies: image-guided interventions

Abstract

Modern imaging studies such as computerized topography (CT) and ultrasound (US) provide an advantage for the detection of vascular urological injuries because of their speed, while digital subtraction angiography (DSA) allows for the precision needed for effective intervention. Minimally invasive techniques offer potentially lower complication rates and faster recovery times than traditional methods. This study demonstrates the role of image-guided percutaneous angiography (PCA) in such emergencies through five cases that cover the scope of neoplastic, iatrogenic, post-operative, and traumatic hemorrhages as well as priapism. PCA has revolutionized vascular interventions. DSA provides both a detailed diagnosis and an avenue for precise interventions. Embolization of pathologic vessels or hemorrhage sites can be achieved using embospheres, microcoils or gel foam. These techniques are easily extrapolated in the context of vascular urologic emergencies. One such case was a 57 year-old woman with an acute hemorrhage following surgical resectioning for renal cellular carcinoma (RCC). The postoperative period was complicated by a difficult extubation followed by acute hemorrhagic shock. The patient’s hemoglobin dropped to 6.5 as her surgical drain emptied serosanguineous fluid. After requiring 6 units of PRBC, 4 units FFP and 1 unit of platelets, IR was consulted and emergent renal DSA was performed of the left main renal artery. Subselective left inferior renal segmental branch angiography showed two small pseudoaneurysms peripheral to the site of resectioning. Microcoil embolization of the left inferior segmental branch was performed, successfully occluding perfusion to the pseudoaneurysms. The patient’s hemodynamic status soon stabilized and she was transferred out of the ICU in the following days. The case above demonstrates the application of interventional radiologic techniques in just one urologic vascular emergency. Furthermore, the methods used in the above case are not dissimilar to those used in the following case reviews, which illustrate the unique treatment options image-guided interventions can offer in the urologic setting.