Are iatrogenic renal artery pseudoaneurysms more challenging to embolize when associated with an arteriovenous fistula?
Iatrogenic injuries of the renal artery include pseudoaneurysms (PSA) and pseudoaneurysms with arteriovenous fistula (PSA + AVF). They can cause hematuria, anemization and flank pain. Endovascular treatment is recommended due to its effectiveness.
To assess the potential difference between the embolization of iatrogenic renal PSA and iatrogenic renal PSA + AVF, in terms of technical and clinical success rate, procedure complexity and impact on the renal function.
We retrospectively reviewed 30 embolization procedures of iatrogenic renal PSA and renal PSA + AVF in 27 patients in two centers between December 2006 and February 2017, comparing technical and clinical success rate, total procedural time, creatinine before and after the procedure and parenchymal ischemic area after the procedure. All patients underwent CT before embolization procedure and different embolization materials were used.
We identified 15 iatrogenic renal PSA and 15 iatrogenic renal PSA + AVF (causes: 23 nephron-sparing surgery, 2 nephrostomies, 1 lithotripsy, 1 ureteroscopic pyelolithotomy, 1 renal biopsy). Microcoils were used in 21 cases, microcoils and Spongostan in 3 cases, microcoils and controlled-release microcoils in 4 cases and controlled-release microcoils in 1 case. No significant statistical differences were found in the comparison of technical and clinical success rate, total procedural time, creatinine and parenchymal ischemic area after the procedure.
Transarterial embolization can be considered as the first-line treatment for renal artery iatrogenic lesions, considering its effectiveness. No statistical significant differences were found in the comparison of the embolization procedures of iatrogenic renal PSA and PSA + AVF.
KeywordsIatrogenic pseudoaneurysm Arteriovenous fistula Transarterial embolization Endovascular treatment
The authors wish to acknowledge Elisabetta Balestro for English assistance.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
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. This article does not contain any studies with animals performed by any of the authors.
Informed consent was obtained from all individual participants included in the study.
- 2.Spiliopoulos S, Sabharwal T, Karnabatidis D, Brontzos E, Katsanos K, Krokidis M, Gkoutzios P, Siablis D, Adam A (2012) Endovascular treatment of visceral aneurysms and pseudoaneurysms: long-term outcomes from a multicenter European study. Cardiovasc Interv Radiol 35:1315–1325. https://doi.org/10.1007/s00270-011-0312-x CrossRefGoogle Scholar
- 10.Li L, Zhang Y, Chen Y, Zhu KS, Chen DJ, Zeng XQ, Wang XB (2015) A multicentre retrospective study of transcatheter angiographic embolization in the treatment of delayed haemorrhage after percutaneous nephrolithotomy. Eur Radiol 25:1140–1147. https://doi.org/10.1007/s00330-014-3491-4 CrossRefPubMedGoogle Scholar
- 13.Sam K, Gahide G, Soulez G, Giroux MF, Oliva VL, Perrault P, Bouchard L, Gilbert P, Therasse E (2011) Percutaneous embolization of iatrogenic arterial kidney injuries: safety, efficacy, and impact on blood pressure and renal function. J Vasc Interv Radiol 22:1563–1568. https://doi.org/10.1016/j.jvir.2011.06.020 CrossRefPubMedGoogle Scholar
- 19.Tinto HR, Di Primio M, Tselikas L, Rico AP, Pellerin O, Pagny JY, Sapoval M (2014) Selective arterial embolization of life-threatening renal hemorrhage in four patients after partial nephrectomy. Diagn Interv Imaging 95:601–609. https://doi.org/10.1016/j.diii.2014.02.005 CrossRefPubMedGoogle Scholar
- 23.El-Nahas AR, Shokeir AA, Mohsen T, Gad H, El-Assmy AM, El-Diasty T, el-Kappany HA (2008) Functional and morphological effects of postpercutaneous nephrolithotomy superselective renal angiographic embolization. Urology 71:408–412. https://doi.org/10.1016/j.urology.2007.10.033 CrossRefPubMedGoogle Scholar
- 24.Loffroy R, Guiu B, Lambert A, Mousson C, Tanter Y, Martin L, Cercueil JP, Krausé D (2008) Management of post-biopsy renal allograft arteriovenous fistulas with selective arterial embolization: immediate and long-term outcomes. Clin Radiol 63:657–665. https://doi.org/10.1016/J.CRAD.2007.11.014 CrossRefPubMedGoogle Scholar
- 25.Strobl FF, D’Anastasi M, Hinzpeter R, Franke PS, Trumm CG, Waggershauser T, Staehler M, Clevert DA, Reiser M, Graser A, Paprottka PM (2016) Renal pseudoaneurysms and arteriovenous fistulas as a complication of nephron-sparing partial nephrectomy: technical and functional outcomes of patients treated with selective microcoil embolization during a ten-year period. Rofo 188:188–194. https://doi.org/10.1055/s-0041-110136 CrossRefPubMedGoogle Scholar
- 26.Hongjie G, Chengen W, Min Y, Xiaoqiang T, Jian W, Haitao G, Li S, Yinghua Z (2017) Management of iatrogenic renal arteriovenous fistula and renal arterial pseudoaneurysm by transarterial embolization—a single center analysis and outcomes. Medicine 96:40(e8187). https://doi.org/10.1097/md.0000000000008187 CrossRefGoogle Scholar