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Predictive factors of selective transarterial embolization failure in acute renal bleeding: a single-center experience

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Abstract

Purpose

Transarterial embolization of renal artery branches (RTE) is a minimally invasive procedure commonly performed in life-threatening renal bleeding of different etiologies. Despite the widespread use of RTE, no consensus guidelines are currently available. Our aim was to investigate clinical and technical efficacy and to identify potential predictors for clinical failure of this procedure.

Methods

All the RTE procedures performed in our Interventional Radiology unit in last 10 years were retrospectively collected and analyzed. All selected patients underwent both pre-procedural computed tomography angiography (CTA) and post-procedural CTA within 30 days. Clinical success was considered as primary endpoint. Demographic, laboratory, and diagnostic findings predictive of clinical failure of RTE were identified.

Results

Over a total of 51 patients enrolled, 27 (53%) were females and 33 (64.7%) had a renal bleeding of iatrogenic origin. Technical and clinical success was 100% and 80.4%, respectively. Hematoma volumes > 258.5 cm3 measured at CTA, higher pre- and post-procedural serum creatinine (Scr) levels, an increase in Scr value > 0.135 mg/dl after the procedure, a worse post-procedural estimated glomerular filtration rate (eGFR), a post-procedural reduction of eGFR < 3.350 ml/min, and a post-procedural reduction of platelet count (PLT) > 46.50 × 103/mmc showed a significantly higher rate of clinical failure.

Conclusion

RTE is a safe and effective procedure in the management of acute renal bleeding of various origins. Hematoma volume, Scr, PLT, and eGFR values were found to be predictive factors of poor clinical outcome and should be closely monitored.

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Data Availability

The data that support the findings of this study are available from the corresponding author [N.R.], upon reasonable request.

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Author notes

  1. R. Candelari and A. Giovagnoni contributed equally to join last co-authorship.

Authors and Affiliations

  1. Department of Clinical, Special and Dental Sciences, University Politecnica Delle Marche, 60126, Ancona, Italy

    C. Floridi, N. Rossini & A. Giovagnoni

  2. Division of Radiology, Department of Radiological Sciences, University Hospital “Azienda Ospedaliero Universitaria Delle Marche”, 60126, Ancona, Italy

    C. Floridi & A. Giovagnoni

  3. Division of Interventional Radiology, Department of Radiological Sciences, University Hospital “Azienda Ospedaliero Universitaria Delle Marche”, 60126, Ancona, Italy

    C. Floridi, L. M. Cacioppa, M. Macchini, M. Rosati, P. Boscarato, M. Torresi & R. Candelari

  4. UOC Radiology, AST Fermo, Marche Region, 63900, Fermo, Italy

    C. Ventura

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  1. C. Floridi
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Contributions

Conceptualization: Chiara Floridi, Nicolo’ Rossini, Claudio Ventura; methodology:Chiara Floridi, Laura Maria Cacioppa, Nicolo’ Rossini, Claudio Ventura; formal analysis and investigation:Laura Maria Cacioppa, Claudio Ventura; writing — original draft preparation: Marco Macchini, Marzia Rosati, Pietro Boscarato, Mario Torresi; writing — review and editing: Chiara Floridi, Laura Maria Cacioppa, Nicolo’ Rossini, Claudio Ventura; funding acquisition:Roberto Candelari, Andrea Giovagnoni; resources:Chiara Floridi, Roberto Candelari, Andrea Giovagnoni; supervision: Roberto Candelari, Andrea Giovagnoni.

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Correspondence to N. Rossini.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed written consent was obtained before the procedures, and verbal consent was obtained from the study participants for their data to be used and published in this retrospective study. An internal Institutional Review Board (IRB) approved this study.

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Floridi, C., Cacioppa, L.M., Rossini, N. et al. Predictive factors of selective transarterial embolization failure in acute renal bleeding: a single-center experience. Emerg Radiol 30, 597–606 (2023). https://doi.org/10.1007/s10140-023-02159-0

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