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Transcatheter embolisation of iatrogenic renal vascular injuries

  • Vascular and Interventional Radiology
  • Published:
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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.

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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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Authors and Affiliations

  1. Interventional Radiology, Department of Radiology, Insubria University, Viale Borri 57, 21100, Varese, Italy

    Anna Maria Ierardi, Chiara Floridi, Federico Fontana, Ejona Duka & Gianpaolo Carrafiello

  2. Department of Radiology, Cardarelli Hospital, Naples, Italy

    Antonio Pinto

  3. Department of Radiology, Second University of Naples, Piazza Miraglia 9, 80134, Naples, Italy

    Mario Petrillo

  4. Interventional Radiology, Heraklion University Hospital, Heraklion, Crete, Greece

    Elias Kehagias & Dimitrios Tsetis

  5. Department of Radiology, Università degli Studi del Molise, Campobasso, Italy

    Luca Brunese

Authors
  1. Anna Maria Ierardi
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  2. Chiara Floridi
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  3. Federico Fontana
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  4. Ejona Duka
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  5. Antonio Pinto
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  6. Mario Petrillo
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  7. Elias Kehagias
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  8. Dimitrios Tsetis
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  9. Luca Brunese
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  10. Gianpaolo Carrafiello
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Corresponding author

Correspondence to Gianpaolo Carrafiello.

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Ierardi, A.M., Floridi, C., Fontana, F. et al. Transcatheter embolisation of iatrogenic renal vascular injuries. Radiol med 119, 261–268 (2014). https://doi.org/10.1007/s11547-013-0343-2

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  • DOI: https://doi.org/10.1007/s11547-013-0343-2

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