Selective Renal Artery Embolization Research Articles

Safety and Efficacy of Selective Renal Artery Embolization in the Management of Postprocedural Acute Renal Bleeding: Experience of A Tertiary Care Center

Safety and Efficacy of Selective Renal Artery Embolization in the Management of Postprocedural Acute Renal Bleeding: Experience of A Tertiary Care Center

Amplatzer Vascular Plug in Renal Artery Embolization: Case Serial and Review of the Literature

Abstract: Embolization constitutes a safe and effective therapeutic possibility in the treatment of numerous renal pathologies whether election or urgency. The use of Amplatzer vascular plug (AVP) constitutes a more recent and less widespread therapeutic choice, and its use in the renal district is not yet widespread although potentially very valid. Perioperative renal artery embolization has been introduced to reduce the risk of oncological spread and intraoperative bleeding, in order to facilitate surgery, thus decreasing perioperative morbidity. Nevertheless, in recent literature the real usefulness of perioperative renal artery embolization is still debated. Some authors agree that the advantages of perioperative renal artery embolization are to decrease intraoperative bleeding with a lower transfusion rate and to reduce operative time. Therefore, we presented five cases of renal arterial embolizations (RAEs) performed with AVP from July to August 2022 at Prof. Dr. R. D. Kandou Hospital, Manado. In all cases, a single plug was used which perfectly adapted to the target artery resulting in complete occlusion of the vessel within a short period of time. Renal artery embolization was generally performed the day before surgery under local anesthesia. After confirmation of the tumor vascularization with a contrast study, the selective renal artery embolization was performed. In our experience, the use of AVP for the treatment of renal arteriovenous fistula and neoplastic masses had given excellent results without any complications during and after the treatment. In conclusion, RAE performed with AVP has growing potential and numerous advantages in terms of the time of the procedure, speed of embolization, and precision of occlusion, but with a relative increase in costs. Keywords: amplatzer vascular plugs; vascular surgery; endovascular surgery; renal artery embolization

Technical Feasibility of Renal Artery Embolization on a Transplanted Kidney Due to Intractable Unilateral Hydronephrosis After En Bloc Kidney Transplantation: Case Report.

En bloc kidney transplantation (EBKT) is a technique used to transplant pediatric kidneys to adult recipients, but can lead to certain complications seldom found in single-kidney transplantation. We report a case of renal artery embolization after EBKT due to intractable unilateral hydronephrosis and highlight the technical details and challenges of the procedure. An 18-year-old female with MELAS syndrome underwent EBKT from a 10-month-old male baby. Two months later, the patient developed unilateral hydronephrosis and recurrent urinary tract infections, which was intractable to conventional therapy. Therefore, we underwent embolization of the problematic transplanted left kidney. Owing to the complicated anatomy and multiple angulations, multiple microcatheters, wires and support catheters were needed to select the renal arteries. Repeated procedures were required due to remnant flow from small branches and accessory renal arteries that were not easily visualized by conventional angiography, which were eventually detected by adjunctive use of 3-dimensional rotational angiography. Selective renal artery embolization after EBKT is challenging due to the short renal artery length and multiple angulations, yet it can still be performed safely and effectively by use of meticulous catheter-wire interactions and adjunctive intraoperative imaging techniques to delineate the precise anatomy of the target arteries. Selective renal artery embolization, which is less invasive than nephrectomy, can be considered if the culprit kidney must inevitably be sacrificed in en bloc kidney transplantation.

Akut Renal Arter Kanamalarında Endovasküler Tedavi: Etkinliği ve Böbrek Fonksiyonlarına Etkisi

Aim: The aim of this study was to investigate the efficacy and complications of endovascular treatment of acute renal artery hemorrhage and the etiology of the condition. Material and Methods: Twenty-two patients who underwent endovascular embolization with renal acute artery hemorrhage between 2016 and 2020 were evaluated retrospectively. Etiologies of the acute renal artery hemorrhage were investigated. Laboratory and clinical follow-up information were analyzed for the efficacy and the complication of the treatment. The serum creatinine levels of the patients before and after the procedure were compared. Results: Selective renal artery embolization procedures were performed in a total of 22 patients. Of the 22 patients, 10 (45.5%) were male and 12 (54.5%) were female. The patients' ages ranged from 5 to 79 years, and the mean age of the patients was 51.5±18.6 years. Clinical success was achieved in 91.7% of embolization procedures. A statistically significant increase was seen in the serum creatinine levels of the patients after the procedure compared to 24 hours before the angiography procedure (median: 0.97 vs. 0.93, p=0.046). No significant change was observed in serum blood urea nitrogen and the estimated glomerular filtration rate levels (p=0.338, and p=0.067, respectively). Acute renal failure and postembolization syndrome were observed in only one patient as complications. The complication rate was found to be 4.5%. Conclusion: Selective embolization of the renal artery has high clinical success in acute renal artery hemorrhages without impairing renal function. The treatment has advantages such as no need for general anesthesia, and low complication rates.

Efficacy and safety of selective renal arterial embolization in renal angiomyolipoma: a prospective single-center study

BackgroundPreventing acute complication of renal angiomyolipoma (AML), preserving renal parenchyma, and improving long-term renal function are the treatment targets of renal angiomyolipoma. Treatment should be considered for symptomatic lesions or those who are at risk of complications, especially bleeding symptoms, which are linked to tumor size, angiogenic component grade, and presence of tuberous sclerosis complex (TSC). Selective arterial embolization (SAE) has become the new norm for preventive or emergency treatment of renal AMLs with minimally invasive selective targeting of small arterial feeders, we aimed to assess the efficacy and safety of selective renal arterial embolization (SAE) in the management of complicated renal angiomyolipoma and to detect the predictors of prophylactic SAE in cases of non-complicated AML.ResultsBleeding symptoms were significantly more frequent in patients with TSC-associated renal AMLs (C = 0.333 and p = 0.036) and patients with intra-lesional aneurysm > 3 mm (C = 0.387 and p = 0.013). Overall success rate: thirty-three (91.7%) renal AMLs were successfully embolized with no recurrence. While three (8.3%) renal AMLs were not; one (2.8%) renal AML was not embolized due to technical failure and two (5.5%) renal AMLs showed recurrence. Primary (technical) success rate: thirty-three (86.9%) successful embolization, five (13.1%) arteriographies were done with failed embolization. The maximum diameter and volume of the lesions after SAE showed statistically significant reduction (z = 4.25 and p < 0.001).ConclusionsSAE is an effective and safe technique to manage renal AMLs preoperatively or in an emergency. TSC-associated lesions, and intra-lesional aneurysms (aneurysms > 3 mm in diameter) were significantly more associated with bleeding symptoms, considering them significant predictors for prophylactic SAE in non-complicated AML.

Intrarenal pseudoaneurysm after percutaneous nephrolithotomy: a case report

ABSTRACT Background: Percutaneous nephrolithotomy (PNL) is the gold standard to treat large or complex renal stones. Intrarenal pseudoaneurysm is a rare, yet clinically significant, complication of PNL. Case summary: A 58-year-old man with a 3 cm calculus in the lower calyx of the left kidney was operated on by PNL 3 days before presentation to the emergency department. The patient presented with massive hematuria and dizziness. Upon presentation, the patient appeared uncomfortable and in distress. He was in hemorrhagic shock. The patient was resuscitated with intravenous fluids and blood transfusion. An urgent computed tomography scan showed multiple clots in the left renal pelvis and bladder with a retroperitoneal hematoma. The patient underwent angiography which revealed an inferior pole branch pseudoaneurysm. The pseudoaneurysm was treated by endovascular embolization with N-butyl-2-cyanoacrylate. No postoperative complications were seen. Conclusion: Selective renal artery embolization is an effective treatment for pseudoaneurysm post PNL with excellent outcomes.

Clinical outcome and safety of selective renal artery embolization using permanent occlusive agents for acute renal bleeding

BackgroundTo evaluate how far is selective renal artery embolization (RAE) using permanent agents effective in treating acute renal artery bleeding. We retrospectively reviewed the medical records of patients (n = 45) with renal bleeding who were managed by selective RAE using coils, N-butyl-cyanoacrylate glue (NBCA glue), and polyvinyl alcohol (PVA). Data retrieved included the cause, number, and type of the bleeding lesions as well as the results of the embolization for 1 year after RAE. Clinical success was the primary outcome while re-bleeding and complications were the secondary outcomes.ResultsThere were 55 bleeding lesions detected by angiography in the included 45 patients. Coils were used in 23/45 patients (51.1%), NBCA glue in 15/45 patients (33.3%), and PVA in 7 patients (15.6%). Bleeding could be controlled with embolization in a single session in 41/45 patients with primary clinical success 91.1%. Four patients needed re-embolization sessions to control bleeding and only one patient was controlled, giving secondary clinical success of 92.3%. Three patients failed to respond to embolization and nephrectomy was done. Iatrogenic dissection of the segmental branch was seen in one patient. Post embolization syndrome was seen in 14/45 patients (31.1%). Non-target embolization was seen in 2 patients: one during treatment with NBCA glue and the other with PVA. No other complications were recorded. No significant differences between clinical success among coil, NBCA glue, and PVA subgroups (P > 0.05).ConclusionSelective RAE using permanent agents is effective in controlling renal bleeding and no significant difference among coil, NBCA glue, and PVA.

Outcome of Selective Renal Artery Embolization in Managing Severe Bleeding after Percutaneous Nephrolithotomy

Objectives: The aim of this study was to evaluate the characteristics of the renal arterial segment bleeding and assess the outcome of selective renal artery embolization (SRAE). Methods: Data on 35 patients in whom SRAE was performed after percutaneous nephrolithotomy (PCNL) from January 2005 to December 2015 in our institute were retrospectively analyzed. All patients had severe bleeding but failed to respond to conservative therapy. Results: Forty-four SRAEs were performed in 35 patients (36 kidney units) after PCNL. The findings of 44 renal arteriographies before embolization revealed bleeding in 44 renal artery branch segments. Upper artery segment bleeding in 0, upper and anterior segment bleeding in 3, lower and anterior artery segment bleeding in 6, lower artery segment bleeding in 9, posterior artery segment bleeding in 24, and negative finding in 2 patients. Renal arteriography revealed pseudoaneurysms in 20 (45.5%) patients, arteriovenous fistulas in 6 (13.6%) patients, renal artery branch laceration in 16 (36.4%) patients, and negative angiography finding in 2 (4.5%) patients. Acute bleeding in 7 patients (20.0%) and delayed bleeding in 28 patients (80.0%) were observed. The target vascular lesions were successfully treated by embolization in the first time in 28 cases. Six patients underwent 2 sessions and 1 had 3 sessions. New vascular lesions were the most common cause of failure of initial SEAE in our hospital. Abnormal renal function was observed in 5 patients, and they recovered to preoperative or normal level within 3 weeks. Conclusions: The posterior artery segment of the kidney is the most common bleeding site due to the choice of puncture site. Delayed bleeding (>24 h) was the most common type of bleeding. SRAE is an effective and safe method to treat the severe bleeding after PCNL.

Initial Experience With the Microvascular Plug in Selective Renal Artery Embolization

To evaluate the safety and efficacy of the microvascular plug (MVP) for selective renal artery embolization. Retrospective review was performed on a cohort of 6 patients undergoing renal artery embolization using the MVP between July 2015 and August 2018. Patients' demographics, indication for embolization, technical details of the embolization procedure, and clinical events were gathered from the patients' electronic medical records. The patients underwent selective renal artery embolization with a MVP for iatrogenic vascular injuries (n = 3), traumatic vascular injuries (n = 2), and for elective embolization of an angiomyolipoma (n = 1), in native kidneys (n = 4) or in renal allografts (n = 2). Immediate occlusion of the feeding artery was achieved with 1 MVP device in 4 patients. In 1 patient, a second MVP was needed, and in another patient, additional 0.018-inch microcoils were used to completely occlude the injured artery. Technical success was achieved in all patients. The volume of the resulting renal infarction was estimated less than 5% of the renal volume. No other procedure-related complications occurred. The MVP is a safe and effective device allowing superselective renal artery embolization. Therefore, we recommend the MVP as a valuable embolic in superselective renal artery embolization. Additionally, a single device is sufficient in most cases, potentially reducing the cost, duration, and radiation exposure of the procedure.

Renal artery embolization: A minimally invasive technique in the treatment of acute intractable iatrogenic hematuria – Experience at a tertiary care center

Introduction: Hematuria following iatrogenic trauma or renal vascular malformations is less common but important causes warranting definite emergency procedure in cases not responding to conservative management. Endovascular embolization is accepted as an effective technique for the treatment of acute intractable hematuria. Considering the need of microcatheter for selective embolization, its use during the procedure increases the procedural cost significantly. The purpose of the present study is to assess the effectiveness and safety of selective renal artery embolization in patients with intractable hematuria using a 4-F glide catheter (GC). The microcatheter usage during our study was intended to be restricted to cases where the GC was not navigable to the optimal site for embolization. Materials and Methods: A retrospective analysis was done for 21 cases with acute intractable hematuria referred to our center between January 2015 and February 2019. Fifteen male and 6 female patients were included. Seventeen cases followed iatrogenic injury during a renal biopsy, 2 cases were due to renal neoplasm, and 1 each due to PCN and abdominal trauma. Embolization was carried out after selective catheterization of the feeding artery, with a 4-F GC using polyvinyl alcohol (PVA) particles in combination with pushable coils in all cases. Results: The source of bleeding was identified as arteriovenous fistula (AVF) in 14, AVF with pseudoaneurysm (PA) in 3, PA alone in 2, and abnormal tumor vascularity in 2 patients. In all but 2 cases, the hematuria stopped within 24 h after embolization. In the remaining 2 cases, hematuria stopped completely within 72 h. One patient developed minor puncture site bleed with no major procedural complications or recurrence on follow-up. Conclusion: Endovascular embolization is a highly effective minimally invasive technique for the treatment of acute intractable hematuria. Good results were achieved without using any microcatheter (hence cost-effective) with no clinically significant nontarget embolization.

Spontaneous rupture of renal angiomyolipoma during pregnancy: A report of two cases and literature review

Spontaneous rupture of renal angiomyolipoma (AML) during pregnancy is a rare but life‐threatening condition. In the present study, we report two of our cases and provide a literature review of 23 case reports. We retrospectively reviewed two pregnant women who presented with spontaneous ruptured AML; both failed conservative management. In our first case, a 36‐year‐old woman at 9 weeks’ gestation had selective renal arterial embolization with pelvic shield performed successfully. The pregnancy was continued to term, and the baby was delivered by elective Caesarean section. In our second case, a 33‐year‐old woman, pregnant with twins, at 32 weeks’ gestation had emergency Caesarean section performed uneventfully. On‐table selective renal arterial embolization was performed immediately afterwards, and the patient stabilized afterwards. Taken together with the 23 case reports in the literature, we conclude that embolization is a safe option of active intervention for ruptured AML in pregnancy when conservative management fails. It has the advantages of being minimally invasive and nephron‐sparing. The risk of radiation to the foetus is acceptable if proper measures are taken to minimize foetal radiation exposure.

Long-Term Outcomes of Selective Renal Artery Embolization for Renal Arteriovenous Fistulae with Dilated Venous Sac

PurposeTo retrospectively evaluate the role of selective renal artery embolization for renal arteriovenous fistulae (AVFs) with dilated venous sac. Materials and MethodsBetween 2002 and 2015, 14 patients (7 men and 7 women; mean age, 60 years) with a single renal AVF with dilated venous sac underwent selective renal artery embolization. Three patients presented with gross hematuria, 4 presented with occult blood in urine, and 1 presented with chronic heart failure. Five patients had a history of renal biopsy or partial nephrectomy. Embolic agents used included pushable fibered coils, detachable microcoils, hydrogel coils, N-butyl 2-cyanoactylate, and/or absolute ethanol. Technical success was defined as complete angiographic occlusion of the renal AVF without visualization of the venous sac. Clinical success was defined as the disappearance of the AVF on ultrasound and contrast-enhanced computed tomography, without any symptoms. ResultsFifteen sessions of selective renal artery embolization were performed. Technical success was achieved in 13 sessions (86.7%). Clinical success was achieved in 13 patients (92.9%) after a mean follow-up of 48 months (range, 6-155 months). Two major complications occurred—renal vein thrombosis (n = 1) and renovascular hypertension (n = 1)—and were successfully managed with warfarin and an angiotensin-II receptor blocker, respectively. The former patient required re-embolization because of recanalization. No significant changes were observed in the mean serum creatinine level (.86 mg/dL vs .85 mg/dL; P = .67) and the mean estimated glomerular filtration rate (66.0 mL/min/1.73m2 vs 67.4 mL/min/1.73m2; P = .4) after 6 months. ConclusionsSelective renal artery embolization is a safe and effective treatment for renal AVFs with dilated venous sac.

Managing penetrating renal trauma: experience from two major trauma centres in the UK.

To present our series of patients with penetrating renal trauma treated at two urban major trauma centres and to discuss the contemporary management of such injuries. We reviewed prospective urological trauma databases for all patients presenting with penetrating renal trauma between January 2005 and October 2016. Patient demographics, clinical characteristics, imaging, management and follow-up data were analysed. Over the 11-year period, 63 patients presented with penetrating renal injuries. The vast majority of patients were male (n = 61; 96.8%), with a mean (range) age of 27.4 (14-71) years. Injuries were equally common on either side (31 left, 32 right). The most common mechanism of injury was stabbing (n = 55; 87.3%), followed by gunshot (n = 7; 11.1%) and crossbow injuries (n = 1; 1.6%). All patients underwent contrast-enhanced computed tomography. Using the American Association for the Surgery of Trauma renal injury grading system, 11 (17.5%) had grade II, 26 (41.3%) had grade III and 26 (41.3%) had grade IV injury. The most common associated injuries were thoracic (n = 23; 36.5%), liver (n = 11; 17.5%), splenic (n = 10; 15.9%), gastrointestinal tract (n = 8; 12.7%) and musculoskeletal (n = 6; 9.5%). At presentation, 16 patients (25.4%) were haemodynamically unstable. The majority of patients did not require blood transfusion (n = 56; 88.9%), while transfusion of >5 units was rare (n = 4; 6.3%). Fifty-two patients (82.5%) were managed by observation alone, while 10 (15.9%) underwent emergency angiography and embolization. Patients with grade IV injury were more likely to require embolization than those with grade III injury; however, the difference was not significant (26.9% vs 15.4%; P = 0.29). One patient (1.6%) underwent retroperitoneal exploration of their renal injury and was managed conservatively. Eight patients underwent laparotomy for other visceral injuries while their renal injury was managed conservatively. Renal artery pseudoaneurysm developed in five patients (7.9%) and one patient (1.6%) developed renal arteriovenous malformation. No patients underwent nephrectomy and no mortality was reported. The vast majority of patients with penetrating renal injuries can be safely managed non-operatively in this setting. Selective renal artery embolization is an effective option for patients in an unstable condition, with excellent outcomes. Associated thoracic or visceral injuries requiring operative management are common in penetrating renal trauma, while urologists should limit or have a high threshold for surgical intervention.

Diagnostic accuracy of computed tomography angiography in detection of post traumatic renal vascular injury

ObjectivesTo evaluate accuracy of computed tomography angiography (CTA) in evaluation of post traumatic renal vascular injury. Patients and methods38 patients were presented with post traumatic intermittent or persistent hematuria. Renal CTA and digital subtraction angiography (DSA) were done for all patients. ResultsCTA demonstrated pseudoaneurysm (PA) in 30 patients (78.9%) and no vascular lesions in 8 patient (21.1%). CTA had 86.11% sensitivity and 50% specificity in detection of post traumatic renal pseudoaneurysms, CTA missed diagnosis of renal arteriovenous fistula (RAVF) in 10 patients which discovered later by DSA. ConclusionCTA with MIP as non invasive technique widely replaced renal DSA in detection of posttraumatic renal pseudoaneurysm. Renal DSA is still best modality in detection of RAVF and also has the upper hand in planning of selective renal artery embolization for the management of persistent or delayed hemorrhage from renal vessels.

Varicocele due to renal arteriovenous malformation mimicking a renal tumor: a case report

BackgroundRenal arteriovenous malformation is an aberrant vascular connection between the renal artery and vein. Acquired renal arteriovenous malformation (arteriovenous fistulae) accounts for approximately 70% of renal arteriovenous abnormalities. Congenital renal arteriovenous malformation, relatively rare, can result in significant hematuria which may require arterial embolization or nephrectomy.Case presentationA 64-year-old Asian man presented to the Urology department in our hospital with gradual left scrotal swelling for 2 years. Ultrasound and computed tomography showed an irregular mass in the upper pole of his left kidney. Digital subtraction angiography confirmed cirsoid-type left renal arteriovenous malformation combined with left renal vein ostial stenosis. After digital subtraction angiography and selective segmental renal artery embolization, the varicocele was obviously alleviated.ConclusionsThe etiology diagnosis of varicocele is not always straightforward, and renal arteriovenous malformation should be considered in the differential diagnosis of varicocele and renal mass. Renal arteriovenous malformation is difficult to distinguish from renal tumor according to varicocele and computed tomography presentation, while magnetic resonance imaging and digital subtraction angiography help to make a definite diagnosis and selective renal angiographic embolization is one of the best treatments for renal arteriovenous malformation.

The effect of renal denervation in an experimental model of chronic renal insufficiency, The REmnant kidney Denervation In Pigs study (REDIP study)

BackgroundRenal denervation (RDN) is a promising therapeutic method in cardiology. Its currently most investigated indication is resistant hypertension. Other potential indications are atrial fibrillation, type 2 diabetes mellitus and chronic renal insufficiency among others. Previous trials showed conflicting but promising results, but the real benefits of RDN are still under investigation. Patients with renal insufficiency and resistant hypertension are proposed to be a good target for this therapy due to excessive activation of renal sympathetic drive. However, only limited number of studies showed benefits for these patients. We hypothesize that in our experimental model of chronic kidney disease (CKD) due to ischemia with increased activity of the renin–angiotensin–aldosterone system (RAAS), renal denervation can have protective effects by slowing or blocking the progression of renal injury.MethodsAn experimental biomodel of chronic renal insufficiency induced by ischemia was developed using selective renal artery embolization (remnant kidney porcine model). 27 biomodels were assessed. Renal denervation was performed in 19 biomodels (denervated group), and the remaining were used as controls (n = 8). The extent of renal injury and reparative process between the two groups were compared and assessed using biochemical parameters and histological findings.ResultsViable remnant kidney biomodels were achieved and maintained in 27 swine. There were no significant differences in biochemical parameters between the two groups at baseline. Histological assessment proved successful RDN procedure in all biomodels in the denervated group. Over the 7-week period, there were significant increases in serum urea, creatinine, and aldosterone concentration in both groups. The difference in urea and creatinine levels were not statistically significant between the two groups. However, the level of aldosterone in the denervated was significantly lower in comparison to the controls. Histological assessment of renal arteries showed that RDN tends to produce more damage to the arterial wall in comparison to vessels in subjects that only underwent RAE. In addition, the morphological damage of kidneys, which was expressed as a ratio of damaged surface (or scar) to the overall surface of kidney, also did not show significant difference between groups.ConclusionsIn this study, we were not able to show significant protective effect of RDN alone on ischemic renal parenchymal damage by either laboratory or histological assessments. However, the change in aldosterone level shows some effect of renal denervation on the RAAS system. We hypothesize that a combined blockade of the RAAS and the sympathetic system could provide more protective effects against acute ischemia. This has to be further investigated in future studies.

Discussion on the operative time of two stage soft ureteroscope lithotripsy for hemorrhagic embolism after percutaneous nephrolithotomy

Objective To investigate the the operative time of two stage soft ureteroscope lithotripsy for hemorrhagic embolism after percutaneous nephrolithotomy(PCNL). Methods The clinical data of 1 patient with massive hemorrhage after PCNL who treated with superselective renal artery embolization and ureteral soft lens were analyzed. Results The patient with postoperative bleeding after PCNL was treated with superselective renal artery branch embolization, after 30d embolization, the holmium laser lithotripsy under the soft ureteroscope for ureteral calculi was performed, and the renal pelvis mucosa smooth, no bleeding and scar formation were intraoperative visible. After operation, the stone was removed basically, and the double J tube was removed 2 weeks after operation. The patient had no special discomfort and the renal function was normal. Conclusion Postoperative 14-30d is a relatively safe time to perform flexible ureteroscopic lithotripsy for super selective renal artery embolization in the treatment of patient with massive hemorrhage after PCNL. Key words: Nephrostomy, percutaneous; Postoperative hemorrhage; Embolization therapeutic; Ureteroscopes; Lrthoripsy

Recurrent bleeding following the renal artery embolization treating post-percutaneous nephrolithotomy hemorrhage: causes and countermeasure

Objective: To explore the causes and countermeasure in recurrent bleeding following the selective renal artery embolization treating post-percutaneous nephrolithotomy hemorrhage. Methods: A total of 334 patients of severe renal hemorrhage associated with percutaneous nephrolithotomy (PCNL) from March 2011 to April 2015 were analyzed retrospectively.All the patients underwent super selective angiography and renal artery embolization.The causes of recurrent hemorrhage were analyzed and principles for diagnosis and embolization were studied. Results: The initial embolization was performed in 329 cases hospitalized in the First Affiliated Hospital of Guangzhou Medical University and 318 cases were successfully stopped bleeding with a hemostatic rate of 96.7 %(318/329). Of total 334 consecutive cases, there were 16 cases of recurrent renal hemorrhage, 11 cases were initially embolized in this hospital, and otherwise the other 5 cases were in other hospitals. Causes of recurrent hemorrhage were missed embolization of tiny pseudoaneurysm (n=12), and two cases of 12, the tiny pseudoaneurysm were feeding by accessory renal arteries, undetected arteriovenous fistula(n=2), recanalization of the embolized arteries (n=2). Conclusion: The causes of recurrent bleeding fallowing the initial selective renal artery embolization treating post-percutaneous nephrolithotomy hemorrhage are varied, and missed embolization of tiny pseudoaneurysm is the major cause of unsuccessful initial renal artery embolization. To strengthen the understanding of tiny pseudoaneurysm is helpful to improve the success rate of hemostasis.

Clinical efficacy of transcatheter arterial embolization in the treatment of intractable hematuria

Objective To investigate the clinical effect of interventional embolization in the treatment of intractable hematuria after percutaneous nephrolithotripsy. Methods A retrospective analysis of the First Affiliated Hospital of Kunming Medical University from February 2014 to March 2016 after percutaneous nephrolithotomy appears intractable hematuria patients in 36 cases was conducted.All patients were treated with conservative treatment but invalid, then lesion was confirmed by renal artery angiography, after that, line embosphere microspheres or polyvinyl alcohol particles combined with spring ring interventional the treatment was conducted.Postoperative urine color changes, postoperative complications and follow-up were observed whether have bleeding again. Results (1)The success rate: 36 cases patients all with successful embolization, the symptoms of hematuria in 1-3 days gradually disappeared, and the effective rate was 100%.(2)Complications: the complications after operation in 10 patients appeared different degree of embolism syndrome, given analgesic and antiemetic, the symptoms gradually ease after treatment.One case patient with a transient increase of creatinine after operation, renal function returned to normal 7 days after the treatment.(3)Follow up: there was no recurrence of hemorrhage after 3-6 months of follow-up. Conclusion Transcatheter embolization in the treatment of intractable hematuria has definite curative effect, less trauma, high safety, less complications and faster postoperative recovery. Key words: Intractable hematuria; Super selective renal artery embolization

The emergency treatment of renal angiomyolipoma with spontaneous rupture and hemorrhage (Report of 24 cases)

Objectives To investigate the emergency treatment of renal angiomyolipoma with spontaneous rupture and hemorrhage. Methods A retrospective analysis was made on the clinical data and follow–up of 24 cases of renal angiomyolipoma with spontaneous rupture and hemorrhage.Preoperative ultrasonography and CT scanning had been underwent in all the cases. Renal angiomyolipoma with spontaneous rupture and hemorrhage was diagnosed in 22 patients and renal cell carcinoma with hemorrhage could not be ruled out in the other 2 patients. 3 patients were treated conservatively and 4 patients were treated with selective renal arterial embolization. The other 17 patients were managed with emergency surgical intervation. Results In 3 cases of conservative treatment, 1 case was stable, other 2 cases failed and received sugical intervation. 4 cases were embolized successfully, then hemorrhage disappeared. Operation was performed in 17 patients.Nephrectomy was performed in 4 cases. 13 cases were treated with nephron–sparing surgery (NSS).5 caess underwent retroperitoneal laparoscopic surgery and 8 cases were performed open surgery.All the patients were confirmed to be renal angiomyolipoma with rupture and hemorrhage by pathological examination after operation. 24 cases were followed up for 3 to 72 months, no case was recurred and metastasized. Conclusions Ultrasonography and CT scanning are important methods to diagnose renal angiomyolipoma with rupture. The management of renal angiomyolipoma with rupture includes conservative methods, selective renal arterial embolization and emergency surgical intervation. Key words: Kidney Neoplasms; Angiomyoma; Lipoma; Rupture, Spontaneous; Hemorrhage