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Multiple Renal Artery Pseudoaneurysms in Patients Undergoing Renal Artery Embolization Following Partial Nephrectomy: Correlation with RENAL Nephrometry Scores

  • Clinical Investigation
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Abstract

Purpose

To describe the incidence of multiple renal artery pseudoaneurysms (PSA) in patients referred for renal artery embolization following partial nephrectomy and to study its relationship to RENAL nephrometry scores.

Materials and Methods

The medical records of 25 patients referred for renal artery embolization after partial nephrectomy were retrospectively reviewed for the following parameters: size and number of tumors, RENAL nephrometry scores, angiographic abnormalities, technical and clinical outcomes, and estimated glomerular filtration rates (eGFRs) after embolization.

Results

Twenty-four patients had primary renal tumors, while 1 patient had a pancreatic tumor invading the kidney. Multiple tumors were resected in 4 patients. Most patients (92 %) were symptomatic, presenting with gross hematuria, flank pain, or both. Angiography revealed PSA with (n = 5) or without (n = 20) AV fistulae. Sixteen patients (64 %) had multiple PSA involving multiple renal vessels. Higher RENAL nephrometry scores were associated with an increasing likelihood of multiple PSA. Multiple vessels were embolized in 14 patients (56 %). Clinical success was achieved after one (n = 22) or two (n = 3) embolization sessions in all patients. Post-embolization eGFR values at different time points after embolization were not significantly different from the post-operative eGFR.

Conclusion

A majority of patients requiring renal artery embolization following partial nephrectomy have multiple pseudoaneurysms, often requiring selective embolization of multiple vessels. Higher RENAL nephrometry score is associated with an increasing likelihood of multiple pseudoaneurysms. We found transarterial embolization to be a safe and effective treatment option with no long-term adverse effect on renal function in all but one patient with a solitary kidney.

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Authors and Affiliations

  1. Houston Methodist Hospital, Houston, TX, USA

    Nakul Gupta

  2. The University of Texas Southwestern Medical Center, Dallas, TX, USA

    Anish Patel

  3. The Houston Methodist Cancer Center, Houston Methodist Research Institute, Houston, TX, USA

    Joe Ensor

  4. Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Unit 1471, PO Box 301402, Houston, TX, 77230-1402, USA

    Kamran Ahrar, Judy Ahrar, Alda Tam, Bruno Odisio, Stephen Huang, Ravi Murthy, Armeen Mahvash, Rony Avritscher, Stephen McRae, Sharjeel Sabir, Michael Wallace & Sanjay Gupta

  5. Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Surena Matin

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  1. Nakul Gupta
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Corresponding author

Correspondence to Sanjay Gupta.

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Conflict of interest

On behalf of all authors, the corresponding author states that there is no conflict of interest.

Ethical Approval

This retrospective study was approved by the Institutional Review Board and a waiver of consent was obtained. From August 2007 to February 2013, 25 patients underwent embolization of renal artery pseudoaneurysms and/or arteriovenous fistulae at our center following partial nephrectomy. These patients were identified from an IRB approved database of partial nephrectomy patients. The electronic medical record of these patients was retrospectively reviewed for patient age, tumor characteristics, presenting symptoms of PSA/AVF, transfusion requirement, imaging findings, time to presentation, embolization procedure details, and outcomes.

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Gupta, N., Patel, A., Ensor, J. et al. Multiple Renal Artery Pseudoaneurysms in Patients Undergoing Renal Artery Embolization Following Partial Nephrectomy: Correlation with RENAL Nephrometry Scores. Cardiovasc Intervent Radiol 40, 202–209 (2017). https://doi.org/10.1007/s00270-016-1473-4

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  • DOI: https://doi.org/10.1007/s00270-016-1473-4

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