Critical causes in severe bleeding requiring angioembolization after percutaneous nephrolithotomy

Hee Youn Kim,Dong Sup Lee,Kyu Won Lee

doi:10.1186/s12894-020-00594-6

Hee Youn Kim, Dong Sup Lee + Show 1 more

Open Access

https://doi.org/10.1186/s12894-020-00594-6

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Abstract

BackgroundTo identify the risk factors for severe bleeding requiring angioembolization among patients who received transfusions after PCNL, particularly those who underwent anatomically incorrect renal puncture.MethodsA total of 53 patients, who received transfusions after PCNL and simultaneously had a postoperative CT scan performed between November 2009 and May 2019 at two teaching hospitals, were retrospectively reviewed. The patients were divided into two groups: those who underwent angioembolization and those who did not. Patient, stone and procedural factors were compared between the two groups. Puncture correctness was evaluated using postoperative CT scans. Puncture was defined as being a correct puncture if the fornix or papilla of the posterior calyx was punctured and the trajectory of the tract was within 20 degrees posterior to the frontal plane of the kidney (i.e., within Brödel’s line).Results21 patients underwent angioembolization after PCNL. Incorrect puncture was seen in 14/21 (66.7%) patients who underwent angioembolization after PCNL, whereas it was seen in 11/32 (34.4%) patients who did not undergo angioembolization (p = 0.021). On multivariable regression analysis, puncture correctness was found to be the only significant factor, with an OR of 3.818, 95% CI of 1.192–12.231 and p value of 0.024.ConclusionsIncorrect renal puncture was related to severe bleeding requiring angioembolization after PCNL. Our results emphasize the importance of the basic principle of renal puncture for PCNL.

Highlights

To identify the risk factors for severe bleeding requiring angioembolization among patients who received transfusions after percutaneous nephrolithotomy (PCNL), those who underwent anatomically incorrect renal puncture
We aimed to identify risk factors of severe bleeding requiring angioembolization among patients who received transfusions after PCNL, those involved in anatomically correct renal puncture
There was no difference in age, body mass index (BMI) or American Society of Anesthesiologists (ASA) classification between the two groups

Summary

Introduction

To identify the risk factors for severe bleeding requiring angioembolization among patients who received transfusions after PCNL, those who underwent anatomically incorrect renal puncture. Brödel’s line of bloodless incision, the relatively avascular plane where the anterior and posterior segmental renal artery branches meet, is the key anatomical area [1]. Before the era of PCNL, when anatrophic nephrolithotomy was performed, When the puncture is made outside of Brödel’s line, the risk of arterial injuries increases, potentially leading to persistent and severe bleeding. Past reports that studied risk factors for angioembolization after PCNL did not consider whether anatomically correct puncture was performed [5, 6]. We aimed to identify risk factors of severe bleeding requiring angioembolization among patients who received transfusions after PCNL, those involved in anatomically correct renal puncture (i.e., through Brödel’s line)

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