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Are iatrogenic renal artery pseudoaneurysms more challenging to embolize when associated with an arteriovenous fistula?

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Abstract

Background

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.

Objective

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.

Methods

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.

Results

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.

Conclusions

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.

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Acknowledgements

The authors wish to acknowledge Elisabetta Balestro for English assistance.

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Correspondence to Giulio Barbiero.

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The authors declare that they have no conflict of interest.

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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. This article does not contain any studies with animals performed by any of the authors.

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Informed consent was obtained from all individual participants included in the study.

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Barbiero, G., Groff, S., Battistel, M. et al. Are iatrogenic renal artery pseudoaneurysms more challenging to embolize when associated with an arteriovenous fistula?. Radiol med 123, 742–752 (2018). https://doi.org/10.1007/s11547-018-0906-3

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  • DOI: https://doi.org/10.1007/s11547-018-0906-3

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