Skip to main content

Advertisement

SpringerLink
Log in

Selective angioembolization for traumatic renal injuries: a survey on clinician practice

  • Original Article
  • Published:
World Journal of Urology Aims and scope Submit manuscript

Abstract

Purpose

A variety of clinical and imaging findings are used by clinicians to determine utility of renal angioembolization (AE) in managing renal trauma. Our purpose was to investigate specific criteria that clinicians who manage high-grade renal trauma (HGRT) utilize in decision-making for primary or delayed AE.

Methods

A total of 413 urologists and interventional radiologists (IRs) who practice at level 1 or 2 trauma centers within the United States were provided an original survey via email on experience and opinions regarding the utility of AE for HGRT. We described overall practice patterns and assessed differences by clinician type, using the Fisher’s exact test.

Results

A total of 79 (20 %) clinicians completed the survey. All clinicians had AE capability for HGRT management. A higher proportion of IRs reported using AE for grade I–II (33 vs. 3 %, p = 0.002), grade III (65 vs. 26 %, p = 0.001), and penetrating injuries (83 vs. 58 %, p = 0.02). A greater proportion of urologists reported using AE for grade V injuries (81 vs. 56 %, p = 0.03). Clinicians most commonly cited computed tomography evidence of active arterial bleeding (97 %), or arteriovenous fistula/pseudoaneurysm (94 %) as indications for primary AE, and 62 % identified concurrent visceral injury as factor that would necessitate surgical intervention.

Conclusion

In a survey of clinicians, we report that IRs and urologists utilize AE differently when managing HGRT, as a higher proportion of IRs use AE to manage lower grade as well as penetrating injuries. Validation studies are needed to establish algorithms to identify patients with HGRT who would benefit from selective renal AE.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

Abbreviations

IR:

Interventional radiology

IRs:

Terventional radiologists

AE:

Angioembolization

HGRT:

High-grade renal trauma

AAST OIS:

American Association for the Surgery of Trauma Organ Injury Scale

CT:

Computed tomography

HCT:

Hematocrit

PRBCs:

Packed red blood cells

ICE:

Intravascular contrast extension

References

  1. Santucci RA, Doumanian LR (2012) Chapter 42—Upper urinary tract trauma. In: Wein A (ed) Campbell-walsh urology, 10th edn. Elsevier, Philadelphia, pp 1169–1178

    Chapter  Google Scholar 

  2. Buckley JC, McAninch JW (2011) Revision of current American Association for the Surgery of Trauma Renal Injury grading system. J Trauma 70:35–37. doi:10.1097/TA.0b013e318207ad5a

    Article  PubMed  Google Scholar 

  3. Santucci RA, Wessells H, Bartsch G, Descotes J, Heyns CF, McAninch JW, Nash P, Schmidlin F (2004) Evaluation and management of renal injuries: consensus statement of the renal trauma subcommittee. BJU Int 93:937–954. doi:10.1111/j.1464-4096.2004.04820.x

    Article  CAS  PubMed  Google Scholar 

  4. Moore EE, Shackford SR, Pachter HL, McAninch JW, Browner BD, Champion HR, Flint LM, Gennarelli TA, Malangoni MA, Ramenofsky ML et al (1989) Organ injury scaling: spleen, liver, and kidney. J Trauma 29:1664–1666

    Article  CAS  PubMed  Google Scholar 

  5. Santucci RA, McAninch JW (2000) Diagnosis and management of renal trauma: past, present, and future. J Am Coll Surg 191:443–451

    Article  CAS  PubMed  Google Scholar 

  6. Bookstein JJ, Ernst CB (1973) Vasodilatory and vasoconstrictive pharmacoangiographic manipulation of renal collateral flow. Radiology 108:55–59

    CAS  PubMed  Google Scholar 

  7. Shariat SF, Roehrborn CG, Karakiewicz PI, Dhami G, Stage KH (2007) Evidence-based validation of the predictive value of the American Association for the Surgery of Trauma kidney injury scale. J Trauma 62:933–939. doi:10.1097/TA.0b013e318031ccf9

    Article  PubMed  Google Scholar 

  8. Santucci RA, McAninch JW, Safir M, Mario LA, Service S, Segal MR (2001) Validation of the American Association for the Surgery of Trauma organ injury severity scale for the kidney. J Trauma 50:195–200

    Article  Google Scholar 

  9. Breyer BN, McAninch JW, Elliott SP, Master VA (2008) Minimally invasive endovascular techniques to treat acute renal hemorrhage. J Urol 179:2248–2252. doi:10.1016/j.juro.2008.01.104 discussion 2253

    Article  PubMed  Google Scholar 

  10. Brewer ME Jr, Strnad BT, Daley BJ, Currier RP, Klein FA, Mobley JD, Kim ED (2009) Percutaneous embolization for the management of grade 5 renal trauma in hemodynamically unstable patients: initial experience. J Urol 181:1737–1741. doi:10.1016/j.juro.2008.11.100

    Article  PubMed  Google Scholar 

  11. Stewart AF, Brewer ME Jr, Daley BJ, Klein FA, Kim ED (2010) Intermediate-term follow-up of patients treated with percutaneous embolization for grade 5 blunt renal trauma. J Trauma 69:468–470. doi:10.1097/TA.0b013e3181e5407a

    Article  PubMed  Google Scholar 

  12. Eassa W, El-Ghar MA, Jednak R, El-Sherbiny M (2010) Nonoperative management of grade 5 renal injury in children: does it have a place? Eur Urol 57:154–161. doi:10.1016/j.eururo.2009.02.001

    Article  PubMed  Google Scholar 

  13. Kiankhooy A, Sartorelli KH, Vane DW, Bhave AD (2010) Angiographic embolization is safe and effective therapy for blunt abdominal solid organ injury in children. J Trauma 68:526–531. doi:10.1097/TA.0b013e3181d3e5b7

    Article  PubMed  Google Scholar 

  14. Mohamed AZ, Morsi HA, Ziada AM, Habib EM, Aref AM, Kotb EA, Eissa MA, Daw M (2010) Management of major blunt pediatric renal trauma: single-center experience. J Pediatr Urol 6:301–305. doi:10.1016/j.jpurol.2009.09.009

    Article  CAS  PubMed  Google Scholar 

  15. Hotaling JM, Sorensen MD, Smith TG 3rd, Rivara FP, Wessells H, Voelzke BB (2011) Analysis of diagnostic angiography and angioembolization in the acute management of renal trauma using a national data set. J Urol 185:1316–1320. doi:10.1016/j.juro.2010.12.003

    Article  PubMed Central  PubMed  Google Scholar 

  16. Nuss GR, Morey AF, Jenkins AC, Pruitt JH, Dugi DD 3rd, Morse B, Shariat SF (2009) Radiographic predictors of need for angiographic embolization after traumatic renal injury. J Trauma 67:578–582. doi:10.1097/TA.0b013e3181af6ef4 (discussion 582)

    Article  PubMed  Google Scholar 

  17. Charbit J, Manzanera J, Millet I, Roustan JP, Chardon P, Taourel P, Capdevila X (2011) What are the specific computed tomography scan criteria that can predict or exclude the need for renal angioembolization after high-grade renal trauma in a conservative management strategy? J Trauma 70:1219–1227. doi:10.1097/TA.0b013e31821180b1 (discussion 1227–1218)

    Article  PubMed  Google Scholar 

  18. Fu CY, Wu SC, Chen RJ, Chen YF, Wang YC, Chung PK, Huang HC, Huang JC, Lu CW (2010) Evaluation of need for angioembolization in blunt renal injury: discontinuity of Gerota’s fascia has an increased probability of requiring angioembolization. Am J Surg 199:154–159. doi:10.1016/j.amjsurg.2008.12.023

    Article  PubMed  Google Scholar 

  19. Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG (2009) Research electronic data capture (REDCap)–a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform 42:377–381. doi:10.1016/j.jbi.2008.08.010

    Article  PubMed Central  PubMed  Google Scholar 

  20. Breyer BN, McAninch JW (2012) What’s new in urological trauma? 2012 update. Transl Androl Urol 1:2–3. doi:10.3978/j.issn.2223-4683.2011.12.05

    Google Scholar 

  21. Armenakas NA, Duckett CP, McAninch JW (1999) Indications for nonoperative management of renal stab wounds. J Urol 161:768–771

    Article  CAS  PubMed  Google Scholar 

  22. Morey AF, Metro MJ, Carney KJ, Miller KS, McAninch JW (2004) Consensus on genitourinary trauma: external genitalia. BJU Int 94:507–515. doi:10.1111/j.1464-410X.2004.04993.x

    Article  PubMed  Google Scholar 

  23. Haas CA, Spirnak JP (1998) Traumatic renal artery occlusion: a review of the literature. Tech Urol 4:1–11

    CAS  PubMed  Google Scholar 

  24. Heyns CF, Van Vollenhoven P (1992) Selective surgical management of renal stab wounds. Br J Urol 69:351–357

    Article  CAS  PubMed  Google Scholar 

  25. Hagiwara A, Sakaki S, Goto H, Takenega K, Fukushima H, Matuda H, Shimazaki S (2001) The role of interventional radiology in the management of blunt renal injury: a practical protocol. J Trauma 51:526–531

    Article  CAS  PubMed  Google Scholar 

  26. Dugi DD 3rd, Morey AF, Gupta A, Nuss GR, Sheu GL, Pruitt JH (2010) American Association for the Surgery of Trauma grade 4 renal injury substratification into grades 4a (low risk) and 4b (high risk). J Urol 183:592–597. doi:10.1016/j.juro.2009.10.015

    Article  PubMed  Google Scholar 

  27. Sinclair M, O’Toole J, Malawaraarachchi M, Leder K (2012) Comparison of response rates and cost-effectiveness for a community-based survey: postal, internet and telephone modes with generic or personalised recruitment approaches. BMC Med Res Methodol 12:132. doi:10.1186/1471-2288-12-132

    Article  PubMed Central  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Urology, University of California San Francisco, 400 Parnassus Ave, Suite A-610, San Francisco, CA, 94143, USA

    Allison S. Glass, Ayesha A. Appa, Stacey A. Kenfield, Herman S. Bagga, Sarah D. Blaschko, James B. McGeady, Jack W. McAninch & Benjamin N. Breyer

Authors
  1. Allison S. Glass
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ayesha A. Appa
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Stacey A. Kenfield
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Herman S. Bagga
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Sarah D. Blaschko
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. James B. McGeady
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Jack W. McAninch
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Benjamin N. Breyer
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Allison S. Glass.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (DOCX 1,775 kb)

Rights and permissions

Reprints and permissions

About this article

Cite this article

Glass, A.S., Appa, A.A., Kenfield, S.A. et al. Selective angioembolization for traumatic renal injuries: a survey on clinician practice. World J Urol 32, 821–827 (2014). https://doi.org/10.1007/s00345-013-1169-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00345-013-1169-1

Keywords

Search

Navigation