Superselective Embolization Research Articles

Huge renal angiomyolipoma

Renal angiomyolipoma (AML) is a rare solid benign tumor composed of varying amounts of mature adipose tissue, smooth muscle, and thick-walled vessels. This article presents a clinical observation and immediate results of a two-stage treatment of giant renal AML (preliminary superselective embolization with further partial nephrectomy) in a 58-year-old woman.

Clinical experience with postpartum treatment of a patient with arteriovenous malformation of uterine vessels

Uterine arteriovenous malformation is a rare vascular dysplasia where the uterine veins communicate with the branches of arteries of varying calibers. Patient K., a 37-years-old patient, presented with genital tract bleeding. Her medical history included operative labor at 37 weeks with dichorionic diamniotic twins, with the placental site on the posterior uterine wall exhibited firm attachment. The uterine cavity walls were scraped, and the bleeding vessel in the placental site was sutured. The blood loss amounted to 750 mL, and reinfusion was conducted. Fourteen days after giving birth, a heavy bloody discharge with blood clots from the genital tract occurred. The blood tests revealed no abnormalities. Echography detected multiple tubular structures that were anechoic on the posterior wall of the uterus, from the endometrium to the serosa, with the CDC mode blood flow. Magnetic resonance angiography revealed hypervascularization with premature arteriovenous discharge. Superselective embolization was performed on uterine artery afferents, and complete blood flow reduction was achieved, leading to the cessation of bleeding. On postoperative day 17, the patient experienced considerable bloody discharge from the genital tract, causing the hemoglobin level to decrease to 88 g/L. The presence of an arteriovenous malformation in the uterine vessels accompanied by ineffective embolization necessitated uterine extirpation. The postoperative phase was uneventful, and the patient was discharged from the hospital in satisfactory condition, with no evidence of anemia (hemoglobin, 115 g/L).

Analysis of prognostic factors in patients diagnosed with bladder cancer complicated by hemorrhage treated by drug-eluting bead embolization.

Transcatheter bladder arterial chemoembolization (TACE) is an alternative treatment used to control bladder cancer (BC) with bleeding, especially in older adult patients with comorbidities. This retrospective observational study evaluated the effect and prognostic factors of transcatheter drug-eluting bead (DEB) embolization in patients with advanced BC. We assessed 39 patients diagnosed with BC with hemorrhage who were either inoperable or unwilling to undergo surgery at our hospital between January 2018 and October 2022. All patients underwent TACE by DEB loaded with epirubicin and imaging scans after 2 months to evaluate the curative effect according to the modified Response Evaluation Criteria in Solid Tumors (mRECIST) standard to determine treatment. Re-examination and follow-up were performed every 3-6 months to observe hematuria recurrence and the curative effect. A total of 95 interventional treatments were performed in 39 patients, and all participants achieved complete hemostasis within 5 days after the first intervention. Computed tomography or magnetic resonance imaging showed that the total effective rate [complete response (CR) + partial response (PR)] was 64.1%, and the disease benefit rate (CR +PR + stable disease) was 79.5%. A total of 30 patients (76.9%) had no hematuria recurrence. Logistic regression analysis indicated that the type of blood supply in BC may relate to whether the patients benefited from the intervention. Hematuria recurrence was significantly associated with the total number of tumors and the type of blood supply (P<0.05). Superselective embolization of bladder arteries with DEB can be used to treat BC with hemorrhage. However, hypovascular tumor blood supply may result in poor postoperative efficacy and hematuria recurrence. Additionally, multiple bladder tumors may be a risk factor for hematuria recurrence.

Influencing Factors of Massive Hemorrhage and High-Grade Renal Vascular Injury after PCNL: A Retrospective Comparative Study.

Severe hemorrhage after percutaneous nephrolithotomy (PCNL) is a rare but alerting event. In this study, we report the factors affecting massive hemorrhage after PCNL, various levels of vascular damage during renal angiography, and the therapeutic effect of superselective renal artery embolization (SRAE). Patients and Methods. A retrospective analysis was performed on the data of 69 patients with postoperative PCNL hemorrhage who underwent SRAE from January 2010 to March 2021. Inclusion criteria for all cases were failure of conservative treatment for severe renal hemorrhage after surgery and then treatment with SRAE. In addition, 98 patients without significant hemorrhage after PCNL were randomly selected as the control group. All clinical data are confirmed by imaging and laboratory examinations. We performed univariate and multivariate analyses to find risk factors of massive hemorrhage and high-grade renal vascular injury after PCNL. A total of 69 patients underwent angiography, 64 of which received SRAE due to positive hemorrhages detected by angiography. Urinary tract infection (OR (95% CI) = 11.214 (2.804∼44.842)), high blood pressure (OR (95% CI) = 5.686 (1.401∼23.083)), and no hydronephrosis (OR (95% CI) = 0.189 (0.049∼0.724)) are the most important factors leading to massive hemorrhage after PCNL. In patients who need SRAE after hemorrhage, high-grade vascular injury (grade III) is related to advanced age and decreased hemoglobin. During the perioperative period of PCNL, patients with a risk of hypertension, urinary tract infection, and no hydronephrosis should be strengthened to monitor their high risk of postoperative hemorrhage. For patients with postoperative hemorrhage, we can use the patient's age and decreased hemoglobin before and after operation for analysis. In this way, individualized assessment can greatly improve the efficiency of SRAE treatment.

Morphological changes in the abdominal organs after left gastric artery embolization in an experiment

Objective – to experimentally evaluate the morphological changes of internal organs (liver, spleen, duodenum, pancreas) after embolization of gastric arteries.Material and methods. To conduct the experiment, 10 Vietnamese pigs aged 4-5 months, female, were selected and fed a high-fat diet for 2 months to simulate obesity. Aorta contrast and celiacography with "Vazipak" solution (5-10 ml per injection) were performed on animals under general anesthesia. Superselective bariatric embolization of the left gastric artery was performed with a 3F microcatheter. After 3 weeks, a morphological (hematoxylin-eosin staining) examination of such organs as liver, duodenum, spleen, pancreas was performed. Photofixation of the histopreparations of the relevant organs was carried out using a trinocular microscope of laboratory class Nikon Eclipse Ci-E with 10x, 20x and 40x plan achromat objectives.Results. In general, no macroscopic signs of ischemia of adjacent organs were noted against the background of the performed selective embolization of the left gastric artery. Blood filling of the liver was uneven, the perisinusoidal spaces were expanded, which indicated its edema. In the duodenum, reactive disturbances of microcirculation were manifested by expansion and congestion of venous vessels and blood stasis. Microscopic changes in the spleen were characterized by congestion of the sinusoids, while the vessels of the pancreas were unevenly filled with blood, and at the same time, venous congestion prevailed.Conclusion. Microcirculation disorders, dystrophic changes, and signs of a shock reaction, which can be considered transient, occur in the examined organs after embolization of the gastric arteries. These data indicate the safety of performing selective embolization of gastric arteries and the absence of signs of critical redistribution of blood flow or ischemia "robbing".

The impact of superselective adrenal artery embolization on renal function in patients with primary aldosteronism: a prospective cohort study.

Superselective adrenal artery embolization (SAAE) is an effective treatment for patients with primary aldosteronism (PA). However, the impact of SAAE on renal function in the PA population remains uncertain. We investigated the estimated glomerular filtration rate (eGFR) and age, sex, body mass index, and diabetes-specific percentiles of eGFR residuals in 182 PA patients treated with SAAE in a prospective cohort from Nanchang SAAE in treating PA registry study. Data suggest that SAAE caused a significant decrease in eGFR from 91.9 ± 26.1 to 88.7 ± 24.1 ml/min/1.73 m2 (p < 0.05) after a median follow-up of 8 months in PA patients. Patients experienced a significant decrease in eGFR from 110.6 ± 18.9 to 103.8 ± 18.2 ml/min/1.73 m2 (p < 0.001) and a very slight increase from 71.1 ± 14.8 to 71.8 ± 17.8 ml/min/1.73 m2 (p = 0.770) with baseline eGFR ≥90 and <90 ml/min/1.73 m2, respectively. Patients with high eGFR residuals (glomerular hyperfiltration) experienced a significant decrease in their eGFR levels from 123.1 ± 22.6 to 105.0 ± 18.6 ml/min/1.73 m2 (p < 0.001). In contrast, there was no significant impact of SAAE on the eGFR of patients with normal or low eGFR residuals. The very early eGFR changes (24 h after SAAE) best predicted the effect of SAAE on eGFR changes after median of eight months in PA patients. On the whole, SAAE seems to have a beneficial impact on renal function in patients with PA, the results of which vary depending on the patient's baseline eGFR and glomerular hyperfiltration status.

Efficacy and safety of transcatheter arterial embolization for hemodynamically unstable bleeding after percutaneous transthoracic needle biopsy.

To evaluate the safety and efficacy of transcatheter arterial embolization (TAE) in controlling hemodynamically unstable bleeding following a percutaneous transthoracic needle biopsy (PTNB). A total of seven patients (four men and three women; mean age, 62 ± 12 years) who received TAE for post-PTNB bleeding between May 2007 and March 2022 were included. The observed types of bleeding were hemothorax (n = 3), hemoptysis (n = 2), and a combination of both (n = 2). In patients with active bleeding, the technical success of TAE was defined as superselective embolization of the target artery with no active bleeding visible on post-TAE angiography. Clinical success was defined as sustained cessation of bleeding without hemodynamic instability, requirement of repeat TAE, or the need for post-TAE hemostatic surgery during the initial admission. The metrics analyzed included technical and clinical success rates, complications, and 30-day mortality. All seven patients achieved technical success, with a clinical success rate of 86% (6/7). Six patients were discharged alive, while one patient died of respiratory failure accompanied by hemothorax 19 days post-biopsy. The angiographic findings associated with bleeding were contrast media extravasation or pseudoaneurysm (n = 3) and vascular hypertrophy with tortuosity (n = 2). The implicated bleeding arteries included the intercostal artery (n = 2), bronchial artery (n = 2), and internal thoracic artery (n = 1). In two cases, no clear bleeding foci were identified; nonetheless, prophylactic embolization was performed on the right intercostal artery (n = 1) and right intercostobronchial trunk (n = 1). The embolic agents utilized included microcoils (n = 1), gelatin sponge particles (n = 2), polyvinyl alcohol (PVA) with gelatin sponge particles (n = 1), PVA with microcoils (n = 1), microcoils with gelatin sponge particles (n = 1), and microcoils with n-butyl-2-cyanoacrylate and gelatin sponge particles (n = 1). The 30-day mortality rate was 14% (1/7). No ischemic complications related to TAE were observed. The study suggests that TAE is safe and effective for controlling hemodynamically unstable bleeding following a PTNB.

Indocyanine green-marked fluorescence-guided off-clamp versus intraoperative ultrasound-guided on-clamp robotic partial nephrectomy: Outcomes on surgical procedure.

To compare surgical and functional outcomes between off-clamp robot-assisted partial nephrectomy with indocyanine-green tumour marking through preliminary superselective embolization and on-clamp robot-assisted partial nephrectomy with intraoperative ultrasound identification of the renal mass. One hundred and forty patients with a single renal mass underwent indocyanine-green fluorescence-guided off-clamp robot-assisted partial nephrectomy with preoperative superselective embolization (Group A, 70 patients) versus intraoperative ultrasound-guided on-clamp robot-assisted partial nephrectomy without embolization (Group B, 70 patients). We assessed operative time, intraoperative blood loss, complications, length of stay, renal function, need for ancillary procedures and blood transfusions. Mean tumour size was 24 versus 25 mm in Group A versus Group B (p= 0.19). Mean operative time was 86.5 versus 121.8 min (p= 0.02), mean blood loss was 72.8 versus 214.2 mL (p= 0.02), and mean haemoglobin drop on postoperative day 1 was 1.1 versus 2.6 g/dL (p= 0.04) in Group A versus Group B. One-month creatinine, hospital stay and enucleated tumour volume were comparable. Ten postoperative complications occurred in Group A (13.3%) and 11 in Group B (15.3%). Following superselective embolization, no patients required blood transfusions versus two patients in Group B. Postoperative selective renal embolization was needed in one case per group. Preoperative superselective embolization of a renal mass with indocyanine-green before off-clamp robot-assisted partial nephrectomy significantly reduces operative time and intraoperative blood loss compared to on-clamp intraoperative ultrasound-guided robot-assisted partial nephrectomy. A longer follow-up is needed to establish the effect on renal function.

Vessel-Guided Mesohepatectomy for Liver Partition and Staged Major Parenchyma-Sparing Hepatectomies with Super-Selective Portal Vein Embolization or Enhanced ALPPS to Achieve R0 Resection for Colorectal Liver Metastases at the Hepatocaval Confluence.

Background. R0 minor parenchyma-sparing hepatectomy (PSH) is feasible for colorectal liver metastases (CRLM) in contact with hepatic veins (HV) at hepatocaval confluence since HV can be reconstructed, but in the case of contact with the first-order glissonean pedicle (GP), major hepatectomy is mandatory. To pursue an R0 parenchyma-sparing policy, we proposed vessel-guided mesohepatectomy for liver partition (MLP) and eventually combination with liver augmentation techniques for staged major PSH. Methods. We analyzed 15 consecutive vessel-guided MLPs for CRLM at the hepatocaval confluence. Patients had a median of 11 (range: 0-67) lesions with a median diameter of 3.5 cm (range: 0.0-8.0), bilateral in 73% of cases. Results. Grade IIIb or more complications occurred in 13%, median hospital stay was 14 (range: 6-62) days, 90-day mortality was 0%. After a median follow-up of 17.5 months, 1-year OS and RFS were 92% and 62%. In nine (64%) patients, MLP was combined with portal vein embolization (PVE) or ALPPS to perform staged R0 major PSH. Future liver remnant (FLR) volume increased from a median of 15% (range: 7-20%) up to 41% (range: 37-69%). Super-selective PVE was performed in three (33%) patients and enhanced ALPPS (e-ALPPS) in six (66%). In two e-ALPPS an intermediate stage of deportalized liver PSH was necessary to achieve adequate FLR volume. Conclusions. Vessel-guided MLP may transform the liver in a paired organ. In selected cases of multiple bilobar CRLM, to guarantee oncological radicality (R0), major PSH is feasible combining advanced surgical parenchyma sparing with liver augmentation techniques when FLR volume is insufficient.

Endoscopic ultrasound-guided super-selective partial splenic embolization: New embolic material and multiple safety precautions.

Endoscopic ultrasound-guided super-selective partial splenic embolization: New embolic material and multiple safety precautions.

Clinical application of superselective transarterial embolization of renal tumors in zero ischaemia robotic-assisted laparoscopic partial nephrectomy.

To assess the feasibility and safety of zero ischaemia robotic-assisted laparoscopic partial nephrectomy (RALPN) after preoperative superselective transarterial embolization (STE) of T1 renal cancer. We retrospectively analyzed the data of 32 patients who underwent zero ischaemia RALPN after STE and 140 patients who received standard robot-assisted laparoscopic partial nephrectomy (S-RALPN). In addition, we selected 35 patients treated with off-clamp RALPN (O-RALPN) from September 2017 to March 2022 for comparison. STE was performed by the same interventional practitioner, and zero ischaemia laparoscopic partial nephrectomy (LPN) was carried out by experienced surgeon 1-12 hours after STE. The intraoperative data and postoperative complications were recorded. The postoperative renal function, routine urine test, urinary Computed Tomography (CT), and preoperative and postoperative glomerular filtration rate (GFR) data were analyzed. All operations were completed successfully. There were no cases of conversion to opening and no deaths. The renal arterial trunk was not blocked. No blood transfusions were needed. The mean operation time was 91.5 ± 34.28 minutes. The mean blood loss was 58.59 ± 54.11 ml. No recurrence or metastasis occurred. For patients with renal tumors, STE of renal tumors in zero ischaemia RALPN can preserve more renal function, and it provides a safe and feasible surgical method.

A Case of Woakes' Syndrome With A Bilateral, Large Nasal Polyp.

Woakes' syndrome, first reported by Edward Woakes in 1885, is an extremely rare, recurrent sinonasal polyposis leading to bone erosion of the sinus walls with consequent nasal pyramid deformity and facial disfigurement. We report a 66-year-old man who presented with severe nasal obstruction. His external nose was deformed and distended with complete obstruction of the bilateral nasal cavities by nasal polyps. The normal structure of the nose was disrupted. Thus, super-selective embolization was performed before surgery to minimize bleeding. The day after the embolization, polypectomy was performed with the navigation system. The progression was uneventful, and the patient was discharged on postoperative day 7. Pathological examination revealed inflammatory polyps with no eosinophil infiltration. Thus, we diagnosed it as Woakes' syndrome. Although there have been few reports of Woakes' syndrome in the past, these are the largest polyps reported to the best of our knowledge.

Management of Mid-Facial Fracture Complicated by Pseudoaneurysm of Posterior Superior Alveolar Artery.

Facial fractures, particularly mid-facial fractures, can result in various complications, such as functional and esthetic problems. Prompt reconstruction of the fractured bones is crucial for restoring normal anatomy and function and preventing complications. However, such procedures can be complex and carry the risk of potential complications. The authors report the case of a 27-year-old man who underwent open reduction and internal fixation of the left zygomatic complex fracture and reconstruction of the left inferior orbital wall. During the surgery, heavy bleeding from the posterior superior alveolar artery due to a broken bone near the pterygomaxillary region caused a prolonged surgery time and the development of a pseudoaneurysm. The pseudoaneurysm was eventually treated with superselective transcatheter embolization using 25% N-Butyl cyanoacrylate glue. This case highlights the challenges in the management of mid-facial fractures and the potential complications that can arise during surgery, particularly when dealing with the pterygomaxillary region.

Comparison of laparoscopic partial nephrectomy performed with AirSeal® system vs. standard insufflator: results from a referral center.

To compare perioperative and oncologic surgical outcomes during laparoscopic partial nephrectomy (LPN) performed by standard carbon dioxide insufflation, with those from surgeries in which the AirSeal® intelligent insufflation system was used for renal tumors. A total of 27 patients with renal tumor were identified, 14 underwent LPN with AirSeal® (group A) and 13 LPN with standard insufflator (group B), respectively. Demographic baseline characteristics were similar in the two groups. The size of the tumor was largest in group B (29.64 vs. 32.1 mm). The mean operative time was shorter in the AirSeal® group [group A: mean 109.0 min, median 107.5 min, interquartile range (IQR) 85; group B: mean 121.0 min, median 120.0 min, IQR 50.0]. Positive margin rates were absent in the two groups. Estimated blood loss presented a difference in the perioperative period (group A: mean 1.5 g/dL, median 1.45 g/dL; group B: mean 2.15 g/dL, median 2.2 g/dL). Time to ischemia was found to be shorter in group A with a median of 18 min compared to a median of 20 min in group B. No subcutaneous emphysema, pneumothorax, and pneumomediastinum cases occurred in either group. A postoperative complication developed in one patient requiring superselective embolization. In selected patients, our preliminary surgical experience has shown that the LPN procedure performed with the aid of the AirSeal® intelligent insufflation system can be used to treat even medium-/high-complexity kidney lesions, with a reduction in operating times, lower rates of complications, and perioperative blood loss. AirSealV1.

Органосохраняющая хирургия локализованного рака почки с предварительной суперселективной эмболизацией ветви почечной артерии, питающей опухоль.

Introduction. Warm renal ischemia (WRI) is used during the organ-preserving surgery of localized renal cell carcinoma to reduce blood loss, improve the imaging quality, facilitate both accessing the cavitary system and suturing the parenchyma. However, WRI can lead to the ischemic reperfusion injury of the preserved nephrons. Superselective embolization (SSE) of the tumor-feeding branch of renal artery is currently being considered as the alternative method of intraoperative hemostasis. Aim. To evaluate the results of organ-preserving surgery of localized kidney cancer in the conditions of SSE. Materials and methods. Three patients who had undergone laparoscopic kidney resection (LKR) with SSE were included in the study. Parameters for assessment were as follows: surgery duration, surgery workflow, intraoperative blood loss volume, the degree of radical surgery according to the histological data, the presence of postoperative complications, and the duration of hospitalization. Results. Compared with the LKR with WRI (n=78, data from a previous own study), the features of the LRK with SSE (n=3) were as follows: 1) the same surgery duration; 2) three times less intraoperative blood loss; 3) the absence of infectious and inflammatory complications; 4) comparable duration of hospitalization. Also, additional advantages of the LKR with SSE were described: 1) the radicality of surgery; 2) the absence of the risk of renal pedicle injury; 3) the absence of the risk of ischemic reperfusion alteration of the preserved renal tissue. Conclusion. Preliminary SSE of the tumor-feeding branch of renal artery may improve functional results of the organ-preserving surgery of localized kidney cancer via reducing the intraoperative blood loss, exclusion the possibility of renal pedicle injury, and provision of the functional activity of the preserved nephrons.

Combined use of percutaneous and endovascular surgery in the diagnosis and treatment of arteriovenous malformation of the kidneys. Clinical observation

This article describes the causes of vascular abnormality of the upper urinary tract, arteriovenous malformation of the kidneys, its variants, possible clinical manifestations, methods of diagnosis of this condition, as well as ways to eliminate hemorrhagic complications caused by this pathology. The main method of correction of arteriovenous malformation is superselective embolization of vessels of the malformation zone. This clinical example presents a rare case of surgery in which embolization was unacceptable due to technical difficulties associated with the complexity of vascular angioarchitectonics, with the impossibility of superselective entry into varix through the arterial channel. In this regard, endovascular surgeons and urologists had to use a combined approach – percutaneous varix puncture with the introduction of a spiral and an embolizing substance through a puncture needle under the control of selective angiography of the branches of the renal artery.

Combined DSA- and US-guided management of acute bleeding: effectiveness of percutaneous glue embolization in six cases.

This study aims to report on safety and effectiveness of glue embolization of acute hemorrhages performed by US-guided percutaneous direct puncture, in patients where the standard endovascular approach is technically unfavourable. In this single center retrospective analysis, patients affected by traumatic or non traumatic acute hemorrhages were treated with glue embolization technically performed by US-guided direct puncture. Patients suffered from active bleeding detected at contrast-enhanced Computer Tomography and confirmed at Digital Subtracted Arteriography, with concomitant hemoglobin drop and blood pressure reduction. Six patients were reviewed; hemorrhages occurred in liver parenchima (1), gallbladder (1) and lower limbs (4). Bleedings etiologies were post-traumatic (5) and inflammatory (1); four had extraluminal blushes while 2 were pseudoaneurysms. In five cases (4 limbs and 1 hepatic bleedings) the direct-puncture approach was adopted because of technically unfavourable vascular anatomy for superselective embolization; in one case (cystic artery pseudoaneurysm), an endovascular embolization would entail a high risk of gallbladder ischemia because of its terminal arterial supply. Technical success was defined disappearance of bleeding signs at last arteriography; clinical success was considered stabilization and/or improvement of hemoglobin values and arterial pressure without additional interventions. Both technical and clinical successes were obtained in 100% of the cases without major complications. No needle occlusion occurred during glue injection. In this study percutaneous US-guided embolization by direct puncture was a safe and effective approach to manage acute bleedings; it could be considered as an alternative in patients with unfavourable vascular anatomy for the standard catheter-directed endovascular embolization.

Superselective renal arterial embolization for severe postpercutaneous nephrolithotomy haemorrhage: clinical characteristics and risk factors for initial failure.

To identify the clinical characteristics of patients who underwent superselective renal arterial embolization (SRAE) after percutaneous nephrolithotomy (PCNL) and to explore the risk factors for failed initial SRAE after PCNL. Patients who underwent SRAE for severe haemorrhage following PCNL between January 2014 and December 2020 were included in the study. The clinical data of those patients and the parameters and characteristics of the perioperative PCNL and SRAE procedures were collected and analysed. A total of 243 patients were included in this study. A total of 139 patients (57.2%) had a pseudoaneurysm, 25 (10.3%) had an arteriovenous fistula, 50 (20.6%) patients had both a pseudoaneurysm and an arteriovenous fistula, and 29 (11.9%) had an arterial laceration. In 177 patients with single percutaneous access, 125 (70.6%) patients exhibited nontract haemorrhage, and 55 (31.1%) patients exhibited multiple bleeding sites. In 66 patients with multiple percutaneous access, 44 (66.7%) patients exhibited nontract haemorrhage, and 32 (48.5%) patients exhibited multiple bleeding sites. The decrease in Hb before SRAE was 41.4 ± 19.8g/L. The mean time between PCNL surgery and initial SRAE was 6.4 ± 4.9days. Serum creatinine was increased after the SRAE procedure. Initial SRAE was successful in 229 (94.2%) patients and failed in 14 (5.8%) patients. Multivariate regression demonstrated that hydronephrosis < 20mm, total ultrasonographic guidance, solitary kidney, previous ipsilateral renal surgery, PCNL duration > 90min and multiple bleeding sites were potential risk factors for initial embolization failure. Percutaneous access was not the most important reason for post-PCNL severe haemorrhage. SRAE is effective for the treatment of severe haemorrhage following PCNL; however, several factors have an impact on the success of initial SRAE. Additionally, the SRAE procedure may affect renal function.

Retroperitoneoscopic resection with preoperative selective embolization and indocyanine green fluorescence visualization of vessels in kidney cancer

Background. Currently, kidney cancer is considered one of the most common oncological pathologies, accounting for 2–3 % of all cancers. In 2018, the total number of primary renal cell carcinoma patients in Ukraine was 4,805 cases, with 1,878 patients dying from this disease. Surgical treatment is the only way for 68 % of patients with localized kidney cancer. The main question remains unanswered — an effective surgical treatment of patients with localized renal cell carcinoma. Our aim was to study the kidney function parameters in localized kidney cancer after retroperitoneoscopic resection with preoperative selective embolization compared to standard kidney resection using thermal ischemia. Materials and methods. Data of 65 patients with localized kidney cancer who underwent nephron-sparing surgery were analyzed. They were divided into two groups. The first one included 40 people with localized kidney cancer who underwent standard organ-sparing surgery with duration of thermal ischemia of less than 20 minutes. The second group consisted of 25 patients with localized kidney cancer who underwent computed tomography with renal vessels reconstruction in the preoperative stage. Branch of the renal artery that feeds the area of the kidney with the tumor was identified. As a next step, selective embolization was performed. Retroperitoneoscopic resection was carried out the next day with fluorescence imaging in the infrared light using indocyanine green. Results. Analysis of the data shows that renal function after surgery for local cancer in case of retroperitoneoscopic resection with preoperative selective embolization of renal vessels is more functionally suitable compared to kidney resection using thermal ischemia. Conclusions. Our data suggest that superselective X-ray vascular embolization and intraoperative indocyanine green fluorescence in the surgical treatment of localized kidney cancer has significant advantages over the standard method of surgical treatment.

V07-09 URETHRAL PSEUDOANEURYSM CAUSING UNCONTROLLED URETHRORRHAGIA

You have accessJournal of UrologyCME1 Apr 2023V07-09 URETHRAL PSEUDOANEURYSM CAUSING UNCONTROLLED URETHRORRHAGIA Fábio Franco de Oliveira, André Canettieri Rubez, João Marcos Ibrahim de Oliveira, Caio de Oliveira, Natalia Dalsanter Avilez, Jefferson Douglas Camargos Moreira, Gabriel Chahade Sibanto Simões, Ivan Borin Selegatto, Bruno Ricardo Di Domenico, Arthur Degani Ottoiano, Lucas Mira Gon, and Cássio Luís Zanettini Riccetto Fábio Franco de OliveiraFábio Franco de Oliveira More articles by this author , André Canettieri RubezAndré Canettieri Rubez More articles by this author , João Marcos Ibrahim de OliveiraJoão Marcos Ibrahim de Oliveira More articles by this author , Caio de OliveiraCaio de Oliveira More articles by this author , Natalia Dalsanter AvilezNatalia Dalsanter Avilez More articles by this author , Jefferson Douglas Camargos MoreiraJefferson Douglas Camargos Moreira More articles by this author , Gabriel Chahade Sibanto SimõesGabriel Chahade Sibanto Simões More articles by this author , Ivan Borin SelegattoIvan Borin Selegatto More articles by this author , Bruno Ricardo Di DomenicoBruno Ricardo Di Domenico More articles by this author , Arthur Degani OttoianoArthur Degani Ottoiano More articles by this author , Lucas Mira GonLucas Mira Gon More articles by this author , and Cássio Luís Zanettini RiccettoCássio Luís Zanettini Riccetto More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003288.09AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Urethral pseudoaneurysm is a rare condition, the few case reports available relate its occurrence to pelvic trauma and related to the chronic use of a urinary catheter, in which the prolonged contact of the device to the mucosa, leads to necrosis and subsequent vascular injury. This condition usually manifests as persistent urethral bleeding, the presentation of uncontrollable urethrorrhagia is even rarer. Transurethral coagulation and superselective embolization are possible options to treat these patients, but the best management option is still not well established. The objective of this video is to present an effective treatment for urethral pseudoaneurysm in a patient undergoing chronic use of an indwelling urinary catheter (IUC). METHODS: A 37-year-old male with a neurogenic lower urinary tract dysfunction after spinal cord injury 5 years ago, using an IUC since the accident and no follow-up with urology. He was referred to the emergency after an episode of profuse urethral bleeding. It started after the routine catheter replacement. On clinical examination, there was gross hematuria in the collection bag. At first, we managed him conservatively with intravenous fluids and tranexamic acid injections, bed rest, and perineal compression dressing, but no sustained response was obtained. Transfusion of 4 red blood cell concentrates was required. We referred the patient to the operating room for flexible urethroscopy, which showed a friable hyperemic nodular lesion on the right lateral wall of the bulbar urethra. Magnetic resonance imaging (MRI) was performed considering the possibility of neoplastic injury and identified a hypervascularized polypoid lesion compatible with a pseudoaneurysm. Due to persistent bleeding, the patient was referred for arteriography, which visualized arterial blush arising from the transition between the internal pudendal artery and the bulbourethral artery. Selective embolization of the internal pudendal artery was performed with micro coils and cyanoacrylate successfully. RESULTS: There was a sustained improvement in bleeding after the procedure. The patient was discharged after 24 hours of observation, the IUC was removed in seven days and the patient started clean intermittent catheterization. On our follow-up for more than two months with no fresh bleeding. CONCLUSIONS: In the case of a pseudoaneurysm of the internal pudendal artery causing urethrorrhagia, endovascular embolization is an effective method to control the bleeding if conservative management fails. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e598 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Fábio Franco de Oliveira More articles by this author André Canettieri Rubez More articles by this author João Marcos Ibrahim de Oliveira More articles by this author Caio de Oliveira More articles by this author Natalia Dalsanter Avilez More articles by this author Jefferson Douglas Camargos Moreira More articles by this author Gabriel Chahade Sibanto Simões More articles by this author Ivan Borin Selegatto More articles by this author Bruno Ricardo Di Domenico More articles by this author Arthur Degani Ottoiano More articles by this author Lucas Mira Gon More articles by this author Cássio Luís Zanettini Riccetto More articles by this author Expand All Advertisement PDF downloadLoading ...