Abstract
PurposeTo retrospectively evaluate the mid-term outcome of transarterial embolization (TAE) of renal artery pseudoaneurysm (RAP) including arteriovenous fistula (AVF) after partial nephrectomy screened by early postoperative contrast-enhanced CT (CE-CT).Materials and methodsEighty-two patients (7.0%) who underwent TAE after partial nephrectomy were reviewed, from 1166 partial nephrectomies performed over 6 years. In 18 patients (22.0%), TAE was performed emergently on the median postoperative day (POD) seven. In the remaining patients, elective TAE was performed on the median POD six for RAP detected by early postoperative CE-CT or that emerged on follow-up CE-CT.ResultsIn one patient (1.2%), TAE was performed twice because one of two RAPs could not be embolized during the first TAE, being successfully embolized at the second TAE after readmission with hematuria. Otherwise, no bleeding recurrence or RAPs were observed during the median 1354 follow-up days. Thus, the primary and secondary success rates of TAE were 98.8% (81 of 82 patients) and 100% (82 of 82 patients), respectively. On angiography, the average number of lesions was 1.7 ± 0.9 and the average RAP size was 12.8 ± 6.0 mm. The shapes of the lesions varied: oval-round 60, oval-round + AVF 36, irregular + AVF 14, AVF 12, irregular 10, disruption 4, and extravasation 3. No major complications were observed. The median inpatient days after TAE were two. No estimated glomerular filtration rate deterioration was observed (64.6 ± 18.6 vs. 64.2 ± 18.4 mL/min/1.73 m2, p = 0.902).ConclusionTAE is largely effective and safe for treating bleedings or RAPs, including AVFs, after partial nephrectomy, as screened by early postoperative CE-CT.
Highlights
Partial nephrectomy is a standard surgical procedure for small renal tumors to preserve renal function after surgery (Campbell et al 2009; Ljungberg et al 2010)
We show that transarterial embolization (TAE) of Renal artery pseudoaneurysm (RAP) detected on early postoperative screening by contrast-enhanced computed tomography (CE-CT) can prevent delayed hemorrhage, which occurred in 4.6%–4.7% of cases without CE-CT screening and in 0.6% with CE-CT screening and TAE (Morita et al 2015)
In one patient (1.2%), TAE was performed twice because one of the two RAPs could not be embolized during the first TAE on postoperative day (POD) eight but was successfully embolized at the second TAE after readmission with hematuria on POD 22 (Fig. 2)
Summary
Partial nephrectomy is a standard surgical procedure for small renal tumors to preserve renal function after surgery (Campbell et al 2009; Ljungberg et al 2010). Studies have reported a higher incidence of hemorrhage after laparoscopic surgery, 1.2% to 7.5% (Yang et al 2014; Netsch et al 2010; Gill et al 2007; Montag et al 2011; Nadu et al 2009; Takagi et al 2014; Omae et al 2015), when compared with that in open partial nephrectomy, 0.4% to 1.6% (Netsch et al 2010; Gill et al 2007; Albani and Novick 2003; Ghoneim et al 2011). It has been shown that the incidence of RAP, 15%–20%, is higher than that previously reported, when screening by contrast-enhanced computed tomography (CE-CT) in the early postoperative period (Takagi et al 2014; Omae et al 2015). We show that transarterial embolization (TAE) of RAP detected on early postoperative screening by CE-CT can prevent delayed hemorrhage, which occurred in 4.6%–4.7% of cases without CE-CT screening and in 0.6% with CE-CT screening and TAE (Morita et al 2015)
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
