Abstract
Renal-artery pseudoaneurysm (RAP) is a well-described complication of partial nephrectomy. We aimed to evaluate the occurrence rate of delayed hemorrhage from RAP after partial nephrectomy, and to investigate the efficacy and safety of selective renal arterial embolization. Between January 2000 and December 2010, 426 partial nephrectomies were performed at our institution for treatment of small renal mass (SRMs). A retrospective review of these cases revealed that 14 patients developed a postoperative RAP (3.29 % incidence). We compared the clinical characteristics between the 14 patients with delayed renal hemorrhage and other 412 patients. RAP was diagnosed by renal angiography in 12 patients with delayed renal hemorrhage. Of the 12 patients, 10 patients were successfully treated with selective renal arterial embolization after presenting with symptoms postoperatively, 1 patient was treated with open surgery, and 1 patient was treated with nephrectomy. The other two patients showed no abnormalities in renal angiography, and the symptoms relieved by transfusion and hemostasis treatment. We found that tumor type, tumor size, tumor location, and surgical approach were significantly different between the 14 patients and other 412 patients. RAP showed a low incidence. The risk factors of RAP included renal cell carcinoma, tumor with large size, and tumor location. Most patients with delayed renal hemorrhage from RAP were successfully cured by selective renal arterial embolization. Therefore, selective renal arterial embolization can be used as the preferential therapy for RAP.
Similar content being viewed by others
References
McKiernan, J., Simmons, R., Katz, J., et al. (2002). Natural history of chronic renal insufficiency after partial and radical nephrectomy. Urology, 59, 816.
Albani, J. M., & Novick, A. C. (2003). Renal artery pseudoaneurysm after partial nephrectomy: Three case reports and a literature review. Urology, 62, 227.
Huang, W. C., Levey, A. S., Serio, A. M., et al. (2006). Chronic kidney disease after nephrectomy in patients with renal cortical tumours: A retrospective cohort study. Lancet Oncology, 7, 735.
Antonelli, A., Cozzoli, A., Nicolai, M., et al. (2008). Nephron-sparing surgery versus radical nephrectomy in the treatment of intracapsular renal cell carcinoma up to 7 cm. European Urology, 53, 803.
Zorn, K. C., Starks, C. L., Gofrit, O. N., et al. (2007). Embolization of renal-artery pseudoaneurysm after laparoscopic partial nephrectomy for angiomyolipoma: Case report and literature review. Journal of Endourology, 21, 763.
Henke, P. K., Cardneau, J. D., Welling, T. H., 3rd, et al. (2001). Renal artery aneurysms: A 35-year clinical experience with 252 aneurysms in 168 patients. Annals of Surgery, 234, 454.
Marszalek, M., Meixl, H., Polajnar, M., et al. (2009). Laparoscopic and open partial nephrectomy: A matched-pair comparison of 200 patients. European Urology, 55, 1171.
Campbell, S. C., Novick, A. C., Streem, S. B., et al. (1994). Complications of nephron sparing surgery for renal tumors. Journal of Urology, 151, 1177.
Ghoneim, T. P., Thornton, R. H., Solomon, S. B., et al. (2011). Selective arterial embolization for pseudoaneurysms and arteriovenous fistula of renal artery branches following partial nephrectomy. Journal of Urology, 185, 2061.
Moore, C. J., Rozen, S. M., & Fishman, E. K. (2004). Two cases of pseudoaneurysm of the renal artery following laparoscopic partial nephrectomy for renal cell carcinoma: CT angiographic evaluation. Emergency Radiology, 10, 193.
Shakhssalim, N., Nouralizadeh, A., & Soltani, M. H. (2010). Renal artery pseudoaneurysm following a laparoscopic partial nephrectomy: Hemorrhage after a successful embolization. Urology Journal, 7, 12.
Pasticier, G., Timsit, M. O., Badet, L., et al. (2006). Nephron-sparing surgery for renal cell carcinoma: Detailed analysis of complications over a 15-year period. European Urology, 49, 485.
Netsch, C., Bruning, R., Bach, T., et al. (2010). Management of renal artery pseudoaneurysm after partial nephrectomy. World Journal of Urology, 28, 519.
Gupta, A. D., Semins, M. J., Marx, J. K., et al. (2010). Renal artery pseudoaneurysm after partial nephrectomy. Journal of Urology, 183, 2390.
Montag, S., Rais-Bahrami, S., Seideman, C. A., et al. (2011). Delayed haemorrhage after laparoscopic partial nephrectomy: Frequency and angiographic findings. BJU International, 107, 1460.
Schwartz, M. J., Smith, E. B., Trost, D. W., et al. (2007). Renal artery embolization: Clinical indications and experience from over 100 cases. BJU International, 99, 881.
Chatziioannou, A., Mourikis, D., Awad, M., et al. (2000). Embolization of a segmental renal artery pseudoaneurysm after partial nephrectomy in a solitary kidney. Urologia Internationalis, 64, 223.
Guiu, B., Kermarrec, I., Ladoire, S., et al. (2011). Transcatheter embolization of a renal artery pseudoaneurysm after open partial nephrectomy. American Journal of Surgery, 202, e25.
Garcia-Roig, M., Gorin, M. A., & Jorda, M. (2012). Evaluation and management of small renal masses: Looking beyond the tumor margin. Current Urology Reports, 13, 1.
Reifsnyder, J. E., Ramasamy, R., Ng, C. K., et al. (2012). Laparoscopic and open partial nephrectomy: Complication comparison using the Clavien system. JSLS: Journal of the Society of Laparoendoscopic Surgeons, 16, 38.
Kavouras, A., Sfoungaristos, S., & Perimenis, P. (2011). Renal artery pseudoaneurysm after partial nephrectomy. Hippokratia, 15, 284.
Povo-Martin, I. J., Gallego-Vilar, D., Rodrigo-Aliaga, M., et al. (2010). Renal artery pseudoaneurysm after partial nephrectomy. Diagnosis, treatment and literature review. Actas Urologicas Espanolas, 34, 647.
Parsons, J. K., & Schoenberg, M. P. (2001). Renal artery pseudoaneurysm occurring after partial nephrectomy. Urology, 58, 105.
Negoro, H., Kawakita, M., & Koda, Y. (2005). Renal artery pseudoaneurysm after laparoscopic partial nephrectomy for renal cell carcinoma in a solitary kidney. International Journal of Urology, 12, 683.
Shapiro, E. Y., Hakimi, A. A., Hyams, E. S., et al. (2009). Renal artery pseudoaneurysm following laparoscopic partial nephrectomy. Urology, 74, 819.
Uberoi, J., Badwan, K. H., & Wang, D. S. (2007). Renal-artery pseudoaneurysm after laparoscopic partial nephrectomy. Journal of Endourology, 21, 330.
Singh, D., & Gill, I. S. (2005). Renal artery pseudoaneurysm following laparoscopic partial nephrectomy. Journal of Urology, 174, 2256.
Inci, K., Cil, B., Yazici, S., et al. (2010). Renal artery pseudoaneurysm: complication of minimally invasive kidney surgery. Journal of Endourology, 24, 149.
Shigeta, M., Mita, K., Shoji, K., et al. (2008). Renal artery pseudoaneurysm occurring after laparoscopic partial nephrectomy. Urologia Internationalis, 80, 332.
Tham, G., Ekelund, L., Herrlin, K., et al. (1983). Renal artery aneurysms. Natural history and prognosis. Annals of Surgery, 197, 348.
Chatziioannou, A., Gargas, D., Malagari, K., et al. (2012). Transcatheter arterial embolization as therapy of renal angiomyolipomas: The evolution in 15 years of experience. European Journal of Radiology, 81, 2308.
Ramon, J., Rimon, U., Garniek, A., et al. (2009). Renal angiomyolipoma: Long-term results following selective arterial embolization. European Urology, 55, 1155.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Zhu, Y., Liu, Y., Zhang, J. et al. Risk Evaluation of Selective Renal Arterial Embolization in the Treatment of Delayed Hemorrhage from Renal Artery Pseudoaneurysm After Partial Nephrectomy. Cell Biochem Biophys 70, 1833–1839 (2014). https://doi.org/10.1007/s12013-014-0140-0
Published:
Issue Date:
DOI: https://doi.org/10.1007/s12013-014-0140-0