Transarterial Embolization of the Renal Arteries for the Management of Iatrogenic Renal Vascular Injuries: Two Centers Experience in 150+ Patients

Objectives: Nephrourologic percutaneous interventions namely percutaneous nephrolithotomy (PCNL), percutaneous nephrostomy (PCN), and renal biopsy are common minimally invasive procedures; however, they can be associated with massive life-threatening hemorrhage. Conventional surgical management in the form of partial and total nephrectomy is usually associated with marked comorbidity and massive renal parenchymal loss. This study aims to retrospectively assess the technique and short-term hemostasis of transarterial renal artery embolization in iatrogenic vascular injuries in two centers. Methods: A total of 154 patients (90 males and 64 females) with suspected renal vascular trauma (107 post-PCNL, 46 postrenal biopsy, and 1 post-PCN) either presenting with hematuria (120 patients) or increasing perinephric hematoma by ultrasonography (34 patients) were referred to both institutes for the possibility of embolization. Embolization was done with variable-sized vascular coils in 133 patients, hand-cut gel foam pledgets in 13 cases, and NBCA in three patients with marked hemodynamic instability. Five patients had negative angiographic findings, so embolization was not done. Results: The bleeding artery could be identified and embolized in 149 patients; in patients with negative angiography, no further intervention was done. A total of 146 patients showed clinical improvement in the form of stoppage of hematuria and stabilized vital data. Rebleeding occurred in three patients (all embolized by gel foam) who were treated by another session of embolization with combined gel foam and NBCA. None of the treated patients needed any further surgical treatment. No major complications occurred. Conclusion: In this large-volume series, transarterial renal artery embolization has shown to be an effective option in the management of iatrogenic renal vascular injuries with high hemostasis as well as low complication rates.

Publication History

Article published online:
26 April 2021