Renal Angioembolisation in the Management of Bleeding Post Percutaneous Nephrolithotomy- A Retrospective Study

Abstract

Introduction: Renal Angioembolisation (RAE) plays a vital role in the treatment of renal bleeding after Percutaneous Nephrolithotomy (PCNL). Renal pseudoaneurysm and arteriovenous fistulas following extended haemorrhages after PCNL are the most serious complications of this operation. Aim: To retrospectively analyse the patients for the management of bleeding post PCNL and to analyse the efficacy of renal angioembolisation. Materials and Methods: This was a retrospective study conducted from from May 2019 to June 2020, on a total of 32 patients, who underwent PCNL for nephrolithiasis, experienced haematuria and were referred to interventional Radiology Department of tertiary care teaching hospital for renal angioembolisation. The patients who underwent a postoperative Computed Tomography (CT) scan to assess the cause of bleeding were included. Past medical records of all 32 patients were collected in terms of patient particulars, surgical details of PCNL, development of post PCNL haematuria between 5th and 14th postoperative days as a complication necessitating a hospital admission, digital subtraction angiographic findings, types of embolisation materials used and follow-up information. Data was analysed statistically using Sigmaplot software version 10.0 and represented in the form of percentages for all the study parameters. Results: Of the 32 patients who were referred for renal angioembolisation in management of bleeding after PCNL, there were 21 males and 11 females with average age of 45.6±11.2 years. Right kidney was involved in 14 cases (43.7%) and left kidney was involved in 18 cases (56.3%). A total of 31 patients revealed abnormal angiographic findings with Pseudoaneurysms (PA) in 29 (90.6%), arteriovenous fistula in 2 (6.3%) patients. One patient (3.1%) showed negative findings. A total of 31 patients underwent successful embolisation and haemostasis achieved. A total of 28 patients were embolised with metallic coils, Polyvinyl Alcohol Particles (PVA) with gelatine sponge, one patient with metallic coils and liquid embolic agent and two patients with metallic coils and gelatine sponges. There was 100% success rate and the patients were followed from first to 18 months for any recurrence of bleeding. Conclusion: Renal angioembolisation is minimally invasive, extremely safe and effective to stop renal bleeding after PCNL.