Transcatheter Renal Artery Embolization Research Articles

Super-selective renal artery embolization (SRAE) for iatrogenic and traumatic renal hemorrhage

PurposeTo present the radiological and clinical outcomes of super-selective transcatheter renal artery embolization in patients with renal injury hemorrhage, and share our experience.Methods43 patients with renal injury hemorrhage who underwent 46 SRAEs were enrolled in this retrospective review study. Records, images, and outcomes were reviewed. The individual embolic method and its observed effects were investigated.ResultsAngiography showed free extravasation in 25 angiograms, pseudoaneurysm in 15 angiograms, and arteriovenous fistulas in 1 angiogram. Most patients achieved initial clinical success (38/43, 88.4%), and 41 patients achieved final clinical success (41/43, 95.3%). 9/11 patients who adopted empirical embolization achieved initial clinical success (81.8%). In our study, the combination of PVA particles and micro-coils has emerged as the most commonly utilized material combination (24/46, 52.2%). Significant differences in hemoglobin levels were observed before and after the embolization procedure (p = 0.026, 95%CI: 1.03–15.54). Post-embolization clinical follow-up showed no evidence of recurrent hematuria, progression of hematoma, hypertension, and no reflux of the embolic agent.ConclusionThough SRAE showed satisfactory results across a broad range of renal injury hemorrhage, there are still some aspects that need attention: (1) Surgical procedure should be understood, including the surgical site, access routes, and placement of implants, such as double-J stents. (2) In cases where identifying the bleeding point proves challenging, consider the possibility of an accessory renal artery.Trial registrationChinese Clinical Trial Registry ChiCTR2400085050, Registration Date: 30 May 2024, retrospectively, non-randomized.

Depiction rate of feeding arteries of renal cell carcinoma on four-dimensional computed tomography angiography

PurposeTo retrospectively evaluate the depiction rate of feeding arteries in biopsy-proven clear cell renal cell carcinoma (CCRCC) on four-dimensional computed tomography angiography (4D-CTA) images.Materials and methodsThis study included 22 patients with 22 CCRCC and 30 feeding arteries treated with transcatheter renal artery embolization. The depiction rate of the feeding arteries on preprocedural 4D-CTA was evaluated. Images were acquired by 320-row multi-detector computed tomography (CT) 15‒36 s after starting to inject a contrast agent (600 mg/kg iodine) intravenously into patients at 2.1 s intervals (11 phases). Two board-certified radiologists retrospectively assessed the feeder depiction rate in all 11 phases with reference to the procedural images as the gold standard. Discrepancies were resolved by consultation with a third radiologist.ResultsAmong the feeders, 11 (36.7%) were segmental or lobar, and 19 (63.3%) were interlobar or arcuate arteries. The feeder depiction rate was the highest (25 [83.3%] of 30) in the 5th phase (delay, 23.4 s) where the gap in contrast enhancement between the renal artery and cortex was the largest. This was followed by the 6th (23 [76.7%] of 30), 4th (22 [73.3%] of 30]), and 7th (21 [70.0%] of 30) phases. The overall rate of depicting feeding arteries in the 11 phases of 4D-CTA was 28 (93.3%) of 30.ConclusionsThe depiction rate of CCRCC feeding arteries including lobar or smaller artery branches by 4D-CTA was favorable. The feeding arteries were optimally visualized during the phase with the largest contrast gap between the renal artery and cortex.

Serum lactate dehydrogenase concentration after transcatheter renal artery embolization correlates with reduction in renal angiomyolipoma volume.

The extent of renal angiomyolipoma (AML) volume reduction after renal transcatheter arterial embolization (TAE) varies between patients, with no predictive measure available. To determine whether the serum lactate dehydrogenase (LDH) concentration shortly after TAE correlates with the extent of tumor shrinkage. In a cohort of 36 patients undergoing prophylactic renal TAE for unruptured renal AML, we retrospectively acquired data from patient medical records, including serum LDH before and within 7 days after TAE and the tumor volume before and 12-36 months after TAE. The relationship between the serum level of LDH and reduction in tumor volume was evaluated using Spearman correlation analysis. The median LDH concentration was significantly higher after TAE than before (909.0 U/L vs. 186.5 U/L). This early post-TAE serum LDH level and LDH index (post-TAE LDH / pre-TAE LDH) correlated significantly and positively with the absolute decrease in tumor volume (both P < 0.0001). We observed no significant correlation between the relative tumor volume reduction and serum LDH level or LDH index. Serum LDH elevation occurs shortly after TAE and correlates with the extent of absolute decrease in AML volume at 12-36 months after TAE. Further large-scale studies are warranted to confirm the predictive role of post-TAE serum LDH level and LDH index in tumor shrinkage in patients with unruptured renal AML.

Unilateral nephrectomy versus renal arterial embolization and technique survival in peritoneal dialysis patients with autosomal dominant polycystic kidney disease

Autosomal dominant polycystic kidney disease (ADPKD) is a common genetic disorder associated with progressive enlargement of the kidneys and liver. ADPKD patients may require renal volume reduction, especially before renal transplantation. The standard treatment is unilateral nephrectomy. However, surgery incurs a risk of blood transfusion and alloimmunization. Furthermore, when patients are treated with peritoneal dialysis (PD), surgery is associated with an increased risk of temporary or definitive switch to haemodialysis (HD). Unilateral renal arterial embolization can be used as an alternative approach to nephrectomy. We performed a multicentre retrospective study to compare the technique of survival of PD after transcatheter renal artery embolization with that of nephrectomy in an ADPKD population. We included ADPKD patients treated with PD submitted to renal volume reduction by either surgery or arterial embolization. Secondary objectives were to compare the frequency and duration of a temporary switch to HD in both groups and the impact of the procedure on PD adequacy parameters. More than 700 patient files from 12 centres were screened. Only 37 patients met the inclusion criteria (i.e. treated with PD at the time of renal volume reduction) and were included in the study (21 embolized and 16 nephrectomized). Permanent switch to HD was observed in 6 embolized patients (28.6%) versus 11 nephrectomized patients (68.8%) (P = 0.0001). Renal artery embolization was associated with better technique survival: subdistribution hazard ratio (SHR) 0.29 [95% confidence interval (CI) 0.12-0.75; P = 0.01]. By multivariate analysis, renal volume reduction by embolization and male gender were associated with a decreased risk of switching to HD. After embolization, a decrease in PD adequacy parameters was observed but no embolized patients required temporary HD; the duration of hospitalization was significantly lower [5 days [interquartile range (IQR) 4.0-6.0] in the embolization group versus 8.5 days (IQR 6.0-11.0) in the surgery group. Transcatheter renal artery embolization yields better technique survival of PD in ADPKD patients requiring renal volume reduction.

Role of Intervention Radiology in Renal Vascular Injuries

Background: Trans-catheter renal artery embolization has a role in the management of iatrogenic and traumatic renal vascular injuries. Objective: To assess the technical success and short term clinical efficacy of renal artery Embolization in patients with iatrogenic and traumatic renal vascular injuries. Methodology: All cases were done at interventional radiology unit Ain Shams University. Conclusion: Renal artery embolization plays a great role in the management and treatment of renal vascular injuries either traumatic or iatrogenic.

Renal artery embolization in severe nephrotic syndrome.

Introduction Severe nephrotic syndrome is associated with increased morbidity and mortality. Renal artery embolization (RAE) has been used in a number of renal diseases such as renal tumors, arteriovenous fistulas etc. However, data regarding benefits of RAE in patients with symptomatic severe proteinuria is limited. We decided to evaluate role of RAE in the setting of severe symptomatic nephrotic syndrome. Methods Eight patients who had undergone transcatheter renal artery embolization with polyvinyl alcohol (PVA) were included. Clinico-demographic characteristics as well as baseline laboratory data including level of proteinuria, serum albumin, C-reactive protein and LDL cholesterol levels were recorded for each patient. After RAE, outpatient clinic control laboratory values were also assessed. Findings All patients except one underwent bilateral RAE (four simultaneous or three sequential). Two patients experienced postembolization syndrome characterized by flank pain, fever, and leukocytosis, which was self-limited and responded to analgesics in all patients. There was no technical complications associated with RAE procedure. All patients became anuric except one. Serum albumin levels increased and serum LDL-cholesterol levels decreased considerably in treated patients. Discussion Renal artery embolization with the purpose of amelioration in nephrotic syndrome complications was effective and free of major technical complications in our patients.

Superselective transcatheter renal artery embolization for the treatment of hemorrhage from non-iatrogenic blunt renal trauma: report of 16 clinical cases

ObjectiveTo explore the therapeutic efficacy and outcome of superselective transcatheter renal artery embolization for the treatment of hemorrhage from non-iatrogenic blunt renal trauma (BRT).MethodsSixteen patients who received superselective transcatheter renal artery embolization for non-iatrogenic BRT hemorrhage between January 2003 and December 2012 were reviewed retrospectively. Spring steel coils with gelatin sponge particles were used to embolize branches of the renal artery in 15 patients with injuries to the segmental or distal renal arteries; super-selective internal iliac artery branch embolization was used to occlude hemorrhage from the branch of the renal artery in two patients with pelvic fracture complicated with internal iliac artery branch laceration; and balloon catheter occlusion was used to embolize the branch of the renal artery in one patient with renal artery trunk laceration.ResultsEmbolization was achieved successfully in a one-stop procedure in all cases. The patient who received balloon catheter occlusion for renal artery trunk laceration was transferred immediately to surgery for emergency nephrectomy. Another patient died of intracranial trauma 1 day after surgery, although macroscopic hematuria disappeared at the time. Macroscopic hematuria disappeared within 1 day after surgery in the other 14 patients. Follow-up visits at times ranging from 6 months to 9 years after the procedure showed normal renal function without evidence of complications in all surviving patients.ConclusionSuperselective transcatheter renal artery embolization is an effective minimally invasive therapy for the treatment of BRT hemorrhage.

2:34 PM, Abstract No. 116 - Renal volume reduction by transcatheter renal artery embolization with N-butyl cyanoacrylate for symptomatic polycystic kidney disease

The purpose of this study was to evaluate the feasibility and effectiveness of renal artery embolization using a mixture of N-butyl cyanoacrylate [NBCA] and iodized oil with low density for symptomatic autosomal dominant polycystic kidney disease [ADPKD] .

Therapy-resistant nephrolithiasis following renal artery coil embolization

BackgroundTranscatheter renal artery embolization is an effective and minimally invasive treatment option for acute renal bleeding. Early post-interventional complications include groin hematoma, incomplete embolization, coil misplacement and coil migration. Late complications are rare and mostly related to coil migration.Case presentationA 22-year-old woman with a history of recurrent stone disease and a lumbal meningomyelocele underwent bilateral open pyelolithotomy for bilateral staghorn calculi. Post-operatively, acute hemorrhage of the left kidney occurred and selective arterial coil embolization of a lower pole interlobular renal artery was performed twice.Four years after this intervention the patient presented with a new 15.4 mm stone in the lower calyx of the left kidney. After two extracorporeal shock wave lithotripsy treatments disintegration of the stone was not detectable. Therefore, flexible ureterorenoscopy was performed and revealed that the stone was adherent to a partially intraluminal metal coil in the lower renal calyx. The intracalyceal part of the coil and the adherent stone were successfully removed using the holmium laser.ConclusionTherapy-resistant nephrolithiasis was caused by a migrated metal coil, which was placed four years earlier for the treatment of acute post-operative renal bleeding. Renal coils in close vicinity to the renal pelvis can migrate into the collecting system and trigger renal stone formation. Extracorporeal shock wave lithotripsy seems to be inefficient for these composite stones. Identification of these rare stones is possible during retrograde intrarenal surgery. It also enables immediate stone disintegration and removal of the stone fragments and the intraluminal coil material.

Transcatheter renal artery embolization improves lung function in patients with autosomal dominant polycystic kidney disease on hemodialysis

Since 1996, transcatheter renal artery embolization (renal TAE) has been performed to reduce the volume of the kidneys in patients with autosomal dominant polycystic kidney disease (ADPKD) and complications of nephromegaly at our hospital. Respiratory dysfunction is often a serious problem in these patients before TAE. Between January 2006 and October 2008, renal TAE was performed and lung function testing [percent vital capacity (%VC) and percent forced expiratory volume in 1 s (%FEV(1.0))] was done by spirometry in 28 patients on maintenance hemodialysis who had respiratory symptoms. Renal volume was 6,330.5 ± 3,126.5 cm(3) (range 1,771-12,761 cm(3)) before TAE, and decreased significantly to 2,892.2 ± 1,841.7 cm(3) (range 622-6,961 cm(3)) by 12 months after TAE (p = 0.0001). The percent decrease of renal volume at 12 months after TAE versus baseline was 45.6 ± 14.6% (range 6.6-67.3%). %VC showed a significant increase from 95.9 ± 14.8% (range 63-127%) before renal TAE to 100.1 ± 11.7% (range 78-120%) at 12 months after TAE (p < 0.01). %FEV(1.0) was also significantly increased from 87.9 ± 15.0% (range 55-110%) before renal TAE to 92.5 ± 14.4% (range 58.0-115.0%) at 12 months after TAE (p < 0.01). The changes of VC (ΔVC%) and FEV(1.0) (ΔFEV(1.0)%) both showed a significant positive correlation with the reduction of renal volume (Δ renal volume) (p = 0.001 and p = 0.004, respectively). Since TAE not only led to a significant decrease of renal volume in ADPKD patients with nephromegaly, but also improved lung function (both %VC and %FEV(1.0)), pulmonary dysfunction should be recognized as one of the extrarenal complications of ADPKD.

Comparative Study of Transcatheter Renal Arterial Embolization with and without Closed Renal Circuit: Pharmacokinetic and Histologic Assessment in Pigs

To assess the degree of renal necrosis and the leakage of absolute ethanol by using two methods: transcatheter renal artery embolization (TAE) and TAE performed with a closed renal circuit (CRC) (TAE/CRC), both performed by using ethanol and iodized oil, in a pig model. All animal experiments were conducted in accordance with our university guidelines for animal care and experimentation. Fourteen pigs were classified in two groups: standard TAE and TAE/CRC groups. In the TAE/CRC group, the renal artery and vein were occluded with balloon catheters; in the TAE group, only the renal artery was occluded. An emulsion of absolute ethanol (0.5 mL per kilogram of body weight) and iodized oil (emulsion ratio, 4:1) was injected in the renal artery in both groups. In the TAE/CRC group, we aspirated the blood containing the emulsion via the renal vein during arterial infusion. We measured the ethanol concentrations of the systemic circulation. Four days after embolization, the kidneys in both groups were removed and histopathologic examination was performed and results were compared. The mean systemic ethanol concentration was less than 0.1 mg/mL in the TAE/CRC group and 0.28 mg/mL +/- 0.15 (standard deviation) in the TAE group (P < .002). In both groups, about 90% of the kidney was shown histopathologically to have undergone coagulation necrosis (no significant difference). The frequency of venous thrombus formation was significantly lower (P = .009) in the TAE/CRC group. TAE/CRC dramatically reduces ethanol leakage to the systemic circulation without a decrease in embolization effect in the normal swine kidney, and it also reduces the likelihood of venous thrombus formation.

Transcatheter renal artery embolization: Indications and technical considerations

Renal artery embolization has become one of the more common vascular interventions of the kidney second only to renal artery angioplasty. Indications for embolizatin include control of bleeding due to trauma, obliteration of abnormal arteriovenous communications, tumor devascularization, obliteration of aneurysms and pseudoaneurysms, medical nephrectomy, and accessory renal artery embolization before abdominal aortic aneurysm stent graft repair. Various embolic agents are available depending on the rationale for embolization and physician preference. Selective cannulation of the involved vessel is preferred to spare as much renal parenchyma from devascularization as possible.

Renal embolization for ablation of function in renal failure and hypertension.

The results of transcatheter renal artery embolization are presented in a small group of patients with end-stage renal disease. Five of the patients were suffering from severe drug-resistant hypertension, one from rejection of a renal transplant and one had heavy haematuria from a transplant kidney. All seven patients benefited from the procedure with no significant morbidity. The procedure of renal artery embolization and its potential complications are discussed. It is concluded that renal ablation by transcatheter embolization is not only effective, but also has a significantly lower morbidity and mortality than surgical nephrectomy in this group of patients with end-stage renal disease and associated problems.

Transcatheter renal artery embolization in treatment of severe urgency and incontinence in bladder metastases

The palliative use of renal ablation by means of transcatheter embolization is described. A patient with inoperable bladder carcinoma suffered from severe urgency, strangury, and incontinence after a failed surgical procedure. The left kidney was embolized using coils and gelatin sponge (Gelfoam) with complete symptomatic relief.

Transcatheter renal artery embolization in treatment of ureterocutaneous fistula

We report a case of a critically ill patient who had a ureterocutaneous fistula develop after placement of a Dacron bypass graft from the aorta to the right popliteal artery and the left femoral artery. We describe a successful nonsurgical method to terminate renal function in this patient, who was a poor operative risk.