Abstract
Objectives:To evaluate the safety and effectiveness of transcatheter arterial embolization for controlling spontaneous hemorrhage in patients with acquired cystic kidney disease (ACKD).Methods:This retrospective study included 18 patients with ACKD (M:F=13:5; mean age, 56 years) who underwent renal artery embolization to control spontaneous hemorrhage between January 2001 and September 2020. The underlying etiology and clinical presentations were reviewed and previous computed tomography (CT) findings were analyzed. Furthermore, angiographic and embolization details, technical and clinical successes, and complications were assessed.Results:Subcapsular, perirenal, and pararenal hematomas were observed on CT scans for all patients. Contrast extravasation was observed in 15 / 17 patients (88%) on contrast-enhanced CT scans. Angiography showed active bleeding in 14 patients (78%; contrast extravasation [n=6], pseudoaneurysm [n=3], and both [n=5]), suspicious bleeding in 1 (5%), and no bleeding in 3 (17%). The technical and clinical success rates were 100% and 94% (17/18), respectively. Total and partial embolization was performed in 14 (78%) and 4 (22%) cases, respectively. Subsequent surgical nephrectomy was required for one patient with clinical failure due to recurrent bleeding despite total embolization. Procedure-related complications included mild post-embolization syndrome in one patient and contrast-induced nephropathy in five patients (28%) without long-term complications.Conclusions:Renal artery embolization is safe and effective for controlling spontaneous renal hemorrhage in patients with ACKD.
Highlights
Acquired cystic kidney disease (ACKD) refers to multiple cysts occurring in the bilateral kidneys of patients with chronic kidney disease without a hereditary cause and is known to be associated with the duration of dialysis.[1]
Total embolization was performed in the majority of patients, which probably led to the high technical success rate
Cortical hemorrhage is a rare complication of subcapsular hematoma, especially in chronic kidney disease, because an atrophied and scarred cortex may cause renal capsules to be less attached to the parenchyma, which facilitates the development of subcapsular hematoma.[12]
Summary
Acquired cystic kidney disease (ACKD) refers to multiple cysts occurring in the bilateral kidneys of patients with chronic kidney disease without a hereditary cause and is known to be associated with the duration of dialysis.[1] Bleeding in patients with ACKD is a well-known complication, and approximately 50% of these patients develop hemorrhagic cysts. With the emerging techniques of interventional radiology, transcatheter arterial embolization is considered the first-line therapy for lifethreatening arterial renal hemorrhage.[3] Conservative interventional treatment and imaging follow-up are suggested to avoid unnecessary nephrectomy,[4] and several cases of successful interventional treatment have been reported.[5,6,7] to date, only case reports have been published, and no studies are specific to patients with ACKD regarding detailed angiographic findings and comprehensive analysis of its efficacy and clinical outcomes.
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