La radiologia medica

, Volume 119, Issue 4, pp 261–268 | Cite as

Transcatheter embolisation of iatrogenic renal vascular injuries

  • Anna Maria Ierardi
  • Chiara Floridi
  • Federico Fontana
  • Ejona Duka
  • Antonio Pinto
  • Mario Petrillo
  • Elias Kehagias
  • Dimitrios Tsetis
  • Luca Brunese
  • Gianpaolo Carrafiello
Vascular and Interventional Radiology

Abstract

Purpose

The aim of our study was to review our experience and long-term follow-up in the treatment of iatrogenic renal vascular injuries using transcatheter embolisation.

Materials and methods

Our retrospective analysis of cases collected in two interventional centres consists of a total of 21 patients who underwent renal arterial embolisation (RAE) for iatrogenic arterial kidney bleeding. Biopsy (n = 4), percutaneous nephrolithotomy (n = 4), nephron-sparing surgery (n = 4), guidewire-induced arterial perforation during coronary angiography or renal stenting (n = 3), percutaneous nephrostomy (n = 3), renal endopyelotomy/pyeloplasty (n = 2) and surgical nephrectomy were the iatrogenic causes. Seven patients presented with haemodynamic instability requiring blood transfusion (33.3 %), the remaining were haemodynamically stable (66.7 %). Diagnostic renal angiography revealed 9 actively bleeding vessels, 6 pseudoaneurysms, 4 arteriovenous fistulas and 1 arterio-calyceal fistula. In one patient selective renal arteriography was negative probably because the bleeding observed at CT angiography was self-limited. Twenty-one embolisation procedures were performed in 20 patients; one patient required a second embolisation 3 h after the first one. Embolisation was performed with microcoils, polyvinyl alcohol particles, embospheres, spongostan emulsion and vascular plug.

Results

The technical success rate was 100 %. The overall clinical success rate was 95 %. Apart from a patient who died due to disseminated intravascular coagulation, no major complications requiring intensive care treatment were encountered during or after the procedures. No patient required emergency surgery or subsequent surgical treatment. No statistically significant differences in eGFR or renal function stage appeared after RAE.

Conclusions

Percutaneous treatment can be proposed as a first-line treatment in iatrogenic renal arterial injuries, resulting in a safe and effective procedure.

Keywords

Transarterial embolization Iatrogenic renal vascular injuries Emergency embolization 

Notes

Conflict of interest

Gianpaolo Carrafiello, Anna Maria Ierardi, Monica Mangini, Federico Fontana, Chiara Floridi, Jessica Lanza, Antonio Pinto, Elias Kehagias, Dimitrios Tsetis declare no conflict of interest.

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Copyright information

© Italian Society of Medical Radiology 2013

Authors and Affiliations

  • Anna Maria Ierardi
    • 1
  • Chiara Floridi
    • 1
  • Federico Fontana
    • 1
  • Ejona Duka
    • 1
  • Antonio Pinto
    • 2
  • Mario Petrillo
    • 3
  • Elias Kehagias
    • 4
  • Dimitrios Tsetis
    • 4
  • Luca Brunese
    • 5
  • Gianpaolo Carrafiello
    • 1
  1. 1.Interventional Radiology, Department of RadiologyInsubria UniversityVareseItaly
  2. 2.Department of RadiologyCardarelli HospitalNaplesItaly
  3. 3.Department of RadiologySecond University of NaplesNaplesItaly
  4. 4.Interventional RadiologyHeraklion University HospitalHeraklionGreece
  5. 5.Department of RadiologyUniversità degli Studi del MoliseCampobassoItaly

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