Superselective Angioembolization Research Articles

Preoperative Super-Selective Embolization versus "On-Clamp" Laparoscopic Partial Nephrectomy for T1 Renal Tumors- A Prospective Randomized Study.

To analyze and compare the intraoperative and post-operative outcomes of "on-clamp" laparoscopic partial nephrectomy (LPN) with "preoperative super-selective angioembolization" before LPN. This randomized clinical study was conducted at Gauhati Medical College Hospital, Guwahati, India, between November 2021 and November 2023. Adult patients of either gender diagnosed with T1 renal tumors were included in the study. All patients underwent diethylenetriamine pentaacetate scan preoperatively and at 1-month follow-up. The patients were randomized using a parallel group design with an allocation ratio of 1:1 to receive either preoperative angioembolization followed by LPN or conventional "on-clamp" LPN. Demographic and baseline parameters were recorded along with pre- and post-operative data. There was no significant difference between the two groups in terms of age (P = 0.11), gender distribution (P = 0.32), body mass index (P = 0.43), preoperative hemoglobin (P = 0.34), and preoperative estimated glomerular filtration rate (eGFR; P = 0.64). One patient in the embolization group required radical nephrectomy because of accidental backflow of glue into the renal artery during embolization whereas four patients required clamping due to inadequate embolization. Preoperative super-selective embolization yielded significantly less blood loss, compared to "on-clamp" LPN (145 [50.76 mL] vs. 261 [66.12 mL], P < 0.01). There was no significant difference between post-operative eGFR (at 1 month) between the two groups (P = 0.71). Preoperative embolization offers improved outcomes in the dissection plane, total operative time, and blood loss, compared to conventional "on-clamp" LPN but has no significant effect on change in eGFR.

Post-Traumatic Renal Artery Pseudoaneurysm Managed Successfully with Angioembolization

Renal artery pseudoaneurysm is a rare complication of blunt renal trauma. Super-selective angioembolization is aminimally invasive, effective procedure to manage traumatic renal artery pseudoaneurysm, in patients who are hemodynamicallystable. We report our experience in the management of patients with post-traumatic bleeding pseudoaneurysm withangioembolization. Materials and methods: We retrospectively reviewed the inpatient and outpatient records and imagingdata of our hospital, of all patients with history of blunt injury to kidneys, admitted with massive hematuria and underwentangioembolization to control the bleeding. Results: During the study period, 3 patients (all male) with a mean age of 26.66 yearspresented to us with blunt injury abdomen. Contrast computed tomography (CT) revealed Grade IV renal injury in 2 patientsand Grade V injury in 1 patient. Focal intensively enhancing areas were noted at the site of renal parenchymal lacerationssuggestive of pseudoaneurysms. Super-selective catheterization was performed and embolization done using 50% N-butyl-2-cyanoacrylate (NBCA) + Lipiodol. Conclusions: Angioembolization, a radiographic intervention, is an effective and minimallyinvasive technique to stop active bleeding from renal artery pseudoaneurysms.

Predictors for severe hemorrhage requiring angioembolization post percutaneous nephrolithotomy: A single-center experience over 3 years.

Context and Aim:About 1% of the patients undergoing percutaneous nephrolithotomy (PCNL) have bleeding severe enough to require angioembolization. We identified factors which could predict severe bleeding post-PCNL and reviewed patients who underwent angioembolization for the same.Settings and Design:This is a single-institutional, retrospective study over a period of 3 years.Subjects and Methods:We retrospectively studied 583 patients undergoing PCNL at our institute from 2013 to 2016. We analyzed nine patients (three from our institute and six referred patients) who underwent angioembolization for severe bleeding post-PCNL. We analyzed the preoperative characteristics, intraoperative findings, and postoperative course of these patients and compared this with those patients who did not have a severe post-PCNL bleeding.Statistical Analysis Used:Fischer's exact test and Chi-square test were used in univariate analysis. Logistic regression analysis was used in multivariate analysis with a value of P < 0.05 considered statistically significant.Results:Three of the 583 patients (0.51%) who underwent PCNL at our institute required embolization to control bleeding. Preoperative characteristics that were significant risk factors for severe bleeding were a history of ipsilateral renal surgery (P = 0.0025) and increased stone complexity (P = 0.006), while significant intraoperative factors were injury to the pelvicalyceal system (P = 0.0005) and multiple access tracts (P = 0.022). Angiography revealed arteriovenous fistula in two patients and a pseudoaneurysm in seven patients. All patients underwent successful superselective angioembolization with preserved renal perfusion in six patients on control angiography postembolization.Conclusions:History of ipsilateral renal surgery, increased stone complexity, multiple access tracts, and injury to the pelvicalyceal system are risk factors predicting severe renal hemorrhage post-PCNL. Early angiography followed by angioembolization should be performed in patients with severe post-PCNL bleeding who fail to respond to conservative measures.

Laparoscopic cryoablation of angiomyolipomas in adolescents and young adults: A report of four cases associated with tuberous sclerosis and 1 case of sporadic origin

Renal angiomyolipomas (AMLs) can be of sporadic origin or associated with tuberous sclerosis (TS). TS-associated AMLs often present in childhood, tend to be bilateral and multiple, and often exhibit a faster growth rate with an increased risk of hemorrhage. Renal cryoablation is well described in adults, whereas experiences with adolescents and young adults are limited. We present here for the first time a series of renal AMLs within adolescents and young adults treated with laparoscopic assisted cryoablation (LCA). The aim was to evaluate whether LCA of AMLs in adolescents and young adults is a safe and feasible treatment modality. From October 2009 to September 2013 a total of five patients at our institution were diagnosed with AMLs requiring treatment. Four patients had TS and one had AML of sporadic origin, all five patients underwent LCA. Data were retrospectively collected by a systematic review of patient material and reassessment of renal imaging. The median age was 16 years (range 13-27 years). Eight AMLs with a median size of 3.9cm (range 2.1-7.7cm) were treated in five patients because of tumor size and rapid growth. Follow-up was a median 37 months (range 20-62 months), and all tumors showed a reduction in tumor size, and no regrowth was recognized (see summary table). The procedure was well tolerated, with only few perioperative complications and no postoperative complications. When considering the indication for treating AMLs, the origin (sporadic or TS associated) and size of the tumor are the decisive factors. To preserve renal function and prevent spontaneous hemorrhage caution should be intensified when tumors reach 4cm, particularly if TS is present. After the diagnosis is established, patients should be monitored with renal imaging at regular intervals to identify rapid-growing tumors. As an alternative to current treatment modalities such as partial nephrectomy and super selective angioembolization, cryoablation is an emerging approach, although experience with pediatric patients is limited. For patients not requiring immediate surgery, pharmacological treatment with mTOR inhibitors is now being evaluated as an alternative treatment option or as neo-adjuvant therapy to ablative techniques. Prophylactic treatment of large or rapid growing AMLs with LCA appears to be a safe and feasible nephron-sparing approach in adolescents and young adults. The low perioperative complication rate and promising effect on outcome might allow treatment of subclinical AMLs in order to minimize the risk of potentially life-threatening complications and preserve renal function.

Postpercutaneous nephrolithotomy bleeding

Postpercutaneous nephrolithotomy (PCNL) bleeding is the most dreaded complication following PCNL. In this article, we refer to risk factors contributing to post-PCNL bleeding and the criteria to decide the line of management in such cases. We further discuss the treatment algorithm for the management of the complication. A perfect puncture is a 'key' to avoid post-PNL bleeding. Superselective angioembolization (SAE) is an efficacious and well tolerated method of controlling post-PCNL bleeding, and the success rate of SAE is found to be greater than 80%. Pseudoaneurysm is the commonest finding of SAE, which is responsible for post-PCNL bleeding. A recent study suggested that multiple percutaneous accesses, more than two bleeding sites identified during renal angiography, and the use of gelatine sponge alone as the embolic material were high-risk factors for the failure of SAE. A significant number of patients experience postinfarction syndrome in varying degree of severity after SAE. Post-PCNL bleeding is a life-threatening complication. Most of the post-PCNL bleeds subside with conservative management, and SAE is an effective means of controlling post-PCNL bleeding. A skilled interventionist can achieve successful control of bleeding with a variety of agents available. Multiple punctures and evidence of more than two lesions predict high risk of failure of SAE.

Outcomes following “rescue” superselective angioembolization in hemodynamically unstable patients

Outcomes following “rescue” superselective angioembolization in hemodynamically unstable patients

Outcomes following “rescue” superselective angioembolization for gastrointestinal hemorrhage in hemodynamically unstable patients

Therapeutic angioembolization is a relatively new "rescue treatment" modality for gastrointestinal hemorrhage (GIH) for unstable patients who fail primary treatment approaches; however, the effectiveness of this treatment and the incidence of ischemic necrosis following embolization for acute GIH are poorly described. The purpose of this study was to evaluate the effectiveness and safety of "rescue" transcatheter superselective angioembolization (SSAE) for the treatment of hemodynamically unstable patients with GIH. A 10-year retrospective review of all hemodynamically unstable patients (systolic blood pressure < 90 mm Hg and ongoing transfusion requirement) who underwent "rescue" SSAE for GIH after failed endoscopic management was performed. All patients with evidence of active contrast extravasation were included. Data were collected on demographics, comorbidities, clinical presentation, and type of intravascular angioembolic agent used. Outcomes included technical success (cessation of extravasation), clinical success (no rebleeding requiring intervention within 30 days), and incidence of ischemic complications. Ninety-eight patients underwent SSAE for GIH during the study period; 47 were excluded owing to lack of active contrast extravasation. Of the remaining 51 patients, 22 (43%) presented with a lower GIH and 29 (57%) with upper GIH. The majority underwent embolization with a permanent agent (71%), while the remaining patients received either a temporary agent (16%) or a combination (14%). The overall technical and clinical success rates were 98% and 71%, respectively. Of the 14 patients with technical success but clinical failure (rebleeding within 30 days) and the 1 patient with technical failure, 4 were managed successfully with reembolization, while 2 underwent successful endoscopic therapy, and 9 had surgical resections. Only one patient had an ischemic complication (small bowel necrosis) requiring resection. SSAE, with reembolization if necessary, is an effective rescue treatment modality for hemodynamically unstable patients with active GIH. Of the patients, 20% will fail SSAE and require additional intervention. Ischemic complications are extremely rare. Therapeutic study, level IV.

The Impact of Percutaneous Nephrolithotomy in Patients with Chronic Kidney Disease

The impact of percutaneous nephrolithotomy (PCNL) in chronic kidney disease (CKD) patients was retrospectively analyzed in this study. We analyzed the factors that can impair renal function and predict the need for renal replacement therapy (RRT) after PCNL. Ninety-one chronic kidney patients with a mean age of 52.5 +/- 13 involving 117 renal units underwent PCNL in our institution for 5 years. A mean of 1.6 +/- 1.1 tracks and 1.3 +/- 0.6 sittings per renal unit was required for PCNL. The estimated glomerular filtration rate (eGFR) pre-PCNL (postdrainage), peak eGFR on follow-up, and eGFR at last follow-up were recorded. The CKD stage pre-PCNL was compared with the CKD stage at last follow-up. Complete clearance, auxiliary procedure, and complication rates were 83.7%, 2.5%, and 17.1%, respectively. The mean eGFR pre-PCNL and peak eGFR at follow-up were 32.1 +/- 12.8 and 43.3 +/- 18.8 mL/minute/1.73 m(2), respectively (p < 0.0001). At a mean follow-up of 329 +/- 540 days, deterioration with up-migration of CKD stage was seen in 12 patients (13.2%). Eight patients (8.8%) required RRT in the form of either maintenance hemodialysis or renal transplantation. Postoperative bleeding complication requiring blood transfusions was seen in seven (5.9%) and two (1.7%) of the renal units subsequently required super selective angioembolization. There were two mortalities in the postoperative period. Postoperative complications and peak eGFR (less than 30 mL/minute/1.73 m(2)) at follow-up are two factors that predict renal deterioration and RRT. Renal parenchymal thickness (<8 mm) also predicts the need for RRT. PCNL has a favorable impact in CKD patients with good clearance rates and good renal functional outcome. PCNL in this high-risk CKD population is to be done with care and full understanding of its complications.

Safety and efficacy of superselective angioembolization in control of lower gastrointestinal hemorrhage

Safety and efficacy of superselective angioembolization in control of lower gastrointestinal hemorrhage

Safety and efficacy of superselective angioembolization in control of lower gastrointestinal hemorrhage

Background We evaluated the safety and efficacy of angioembolization to control lower gastrointestinal hemorrhage. Methods Retrospective chart review of patients undergoing angiography for lower gastrointestinal hemorrhage from January 2000 to December 2002. Results Seventy-seven patients with lower gastrointestinal hemorrhage underwent mesenteric angiography. Angioembolization was performed in 11 patients. Sixty-six patients were not embolized; 47 of these were treated medically and 19 surgically. Mortality rate was not significantly different in patients treated surgically (3 of 19, 16%) versus those managed medically (6 of 47, 13%; P = 0.746). Of the 11 patients who were embolized, 10 had immediate cessation of hemorrhage, 7 had gastrointestinal ischemia, and 6 died (55%). Overall mortality in non-embolized patients was 9 of 66 (14%; P = 0.002 versus mortality in embolized patients). Conclusions Angioembolization, though effective at controlling hemorrhage, is associated with ischemic complications and a high mortality rate. Our data support surgical or medical management for lower gastrointestinal hemorrhage.