Endovascular management of vascular renal injuries: outcomes and comparison between traumatic and iatrogenic settings

Endovascular Treatment of Renal Artery Pseudoaneurysm Following Laparoscopic Partial Nephrectomy: A Case Report

This report presents the case of a patient diagnosed with stage I renal cell carcinoma (RCC), who was treated with a laparoscopic partial nephrectomy and, subsequently, percutaneous transarterial embolization (PTAE) due to a renal pseudoaneurysm secondary to partial nephrectomy. A laparoscopic partial nephrectomy was performed, sparing the healthy renal tissue. Four days after surgery, the patient's hematocrit count decreased by 8 points, and macroscopic hematuria was noted. PTAE of a renal pseudoaneurysm was indicated due to refractory bleeding. Adequate bleeding control and preservation of the renal parenchyma were achieved. Progress in early diagnosis of malignancy has resulted in the detection of more than 60% of RCCs at stage T1. In this scenario, new surgical techniques, which spare the renal parenchyma, have become the recommended therapeutic option in patients with early renal tumors. Likewise, dealing with complications arising from these new surgical techniques should also focus on maintaining kidney tissue integrity. We highlight the growing trend to implement minimally invasive therapies in patient care while pointing out the scarcity of studies contrasting immediate imaging results and clinically significant outcomes.

Predictive factors of selective transarterial embolization failure in acute renal bleeding: a single-center experience

PURPOSE

Transarterial embolization of renal artery branches (RTE) is a minimally invasive procedure commonly performed in life-threatening renal bleeding of different etiologies. Despite the widespread use of RTE, no consensus guidelines are currently available. Our aim was to investigate clinical and technical efficacy and to identify potential predictors for clinical failure of this procedure.

METHODS

All the RTE procedures performed in our Interventional Radiology unit in last 10 years were retrospectively collected and analyzed. All selected patients underwent both pre-procedural computed tomography angiography (CTA) and post-procedural CTA within 30 days. Clinical success was considered as primary endpoint. Demographic, laboratory, and diagnostic findings predictive of clinical failure of RTE were identified.

RESULTS

Over a total of 51 patients enrolled, 27 (53%) were females and 33 (64.7%) had a renal bleeding of iatrogenic origin. Technical and clinical success was 100% and 80.4%, respectively. Hematoma volumes > 258.5 cm3 measured at CTA, higher pre- and post-procedural serum creatinine (Scr) levels, an increase in Scr value > 0.135 mg/dl after the procedure, a worse post-procedural estimated glomerular filtration rate (eGFR), a post-procedural reduction of eGFR < 3.350 ml/min, and a post-procedural reduction of platelet count (PLT) > 46.50 × 103/mmc showed a significantly higher rate of clinical failure.

CONCLUSION

RTE is a safe and effective procedure in the management of acute renal bleeding of various origins. Hematoma volume, Scr, PLT, and eGFR values were found to be predictive factors of poor clinical outcome and should be closely monitored.