Interventional Radiology in Renal Trauma

Abstract

Renal trauma is a significant concern in cases of abdominal injury, with its incidence varying from 1 to 10%, depending on the severity of the trauma. Most injuries stem from blunt trauma, such as vehicle accidents, and are observed predominantly in young males. Diagnostic imaging, particularly multiphasic CT, is crucial for accurate assessment and guiding treatment decisions. In cases where intervention is required, interventional radiology (IR) techniques play a pivotal role. This review outlines the various aspects of renal trauma management, focusing on the role of IR interventions. From diagnostic imaging modalities to endovascular techniques like angioembolization, the review offers insights into the comprehensive approach to renal trauma care. Understanding the anatomical considerations, imaging protocols, and treatment options in IR is essential for improving patient outcomes and reducing morbidity and mortality associated with renal trauma.

Keywords

interventional radiology - renal trauma - embolization

Publikationsverlauf

Eingereicht: 23. Mai 2024

Angenommen: 18. November 2024

Artikel online veröffentlicht:
21. März 2025

• References

• 1 Singh S, Sookraj K. Kidney Trauma. In: StatPearls. StatPearls Publishing; 2024. Accessed May 23, 2024 at: http://www.ncbi.nlm.nih.gov/books/NBK532896/
• 2 Willis A. Interventional radiology in renal trauma. Trauma 2011; 13: 282-293
• 3 Erlich T, Kitrey ND. Renal trauma: the current best practice. Ther Adv Urol 2018; 10 (10) 295-303
• 4 Santucci RA, Wessells H, Bartsch G. et al. Evaluation and management of renal injuries: consensus statement of the renal trauma subcommittee. BJU Int 2004; 93 (07) 937-954
• 5 Voelzke BB, Leddy L. The epidemiology of renal trauma. Transl Androl Urol 2014; 3 (02) 143-149
• 6 Guo H, Wang C, Yang M. et al. Management of iatrogenic renal arteriovenous fistula and renal arterial pseudoaneurysm by transarterial embolization: a single center analysis and outcomes. Medicine (Baltimore) 2017; 96 (40) e8187
• 7 Matsumoto MM, Reddy SN, Nadolski GJ, Shamimi-Noori S, Trerotola SO, Stavropoulos SW. Iatrogenic renal artery injury in 90 cases: arteriographic findings and outcomes after embolization for bleeding. J Vasc Interv Radiol 2023; 34 (03) 436-444
• 8 Coccolini F, Moore EE, Kluger Y. et al; WSES-AAST Expert Panel. Kidney and uro-trauma: WSES-AAST guidelines. World J Emerg Surg 2019; 14 (01) 54
• 9 Hirsch K, Heinz M, Wullich B. [Diagnosis and therapeutic management in kidney, ureter and bladder trauma]. Aktuelle Urol 2017; 48 (01) 64-71
• 10 Wessells H, Suh D, Porter JR. et al. Renal injury and operative management in the United States: results of a population-based study. J Trauma 2003; 54 (03) 423-430
• 11 Urine leaks and urinomas: diagnosis and imaging-guided intervention - PubMed. Accessed November 3, 2024 at: https://pubmed.ncbi.nlm.nih.gov/12975505/
• 12 Nah CY, Fueng-Hin Liang R. An unusual case of ascites. ACG Case Rep J 2023; 10 (03) e01020
• 13 Dayal M, Gamanagatti S, Kumar A. Imaging in renal trauma. World J Radiol 2013; 5 (08) 275-284
• 14 Brandes SB, McAninch JW. Renal trauma: a practical guide to evaluation and management. ScientificWorldJournal 2004; 4 (Suppl. 01) 31-40
• 15 Bonatti M, Lombardo F, Vezzali N. et al. MDCT of blunt renal trauma: imaging findings and therapeutic implications. Insights Imaging 2015; 6 (02) 261-272
• 16 Heller MT, Schnor N. MDCT of renal trauma: correlation to AAST organ injury scale. Clin Imaging 2014; 38 (04) 410-417
• 17 Keihani S, Putbrese BE, Rogers DM. et al; in conjunction with the Trauma and Urologic Reconstruction Network of Surgeons. Optimal timing of delayed excretory phase computed tomography scan for diagnosis of urinary extravasation after high-grade renal trauma. J Trauma Acute Care Surg 2019; 86 (02) 274-281
• 18 Value of Delayed Imaging in MDCT of the Abdomen and Pelvis | AJR. Accessed May 23, 2024 at: https://ajronline.org/doi/10.2214/AJR.05.0148
• 19 Hassan R, Abd Aziz A. Computed tomography (CT) imaging of injuries from blunt abdominal trauma: a pictorial essay. Malays J Med Sci 2010; 17 (02) 29-39
• 20 Kim SJ, Ahn SJ, Choi SJ, Park DH, Kim HS, Kim JH. Optimal CT protocol for the diagnosis of active bleeding in abdominal trauma patients. Am J Emerg Med 2019; 37 (07) 1331-1335
• 21 White RD, Moore KS, Salahia MG. et al. Renal arteries revisited: anatomy, pathologic entities, and implications for endovascular management. Radiographics 2021; 41 (03) 909-928
• 22 Hosein M, Paskar D, Kodama R, Ditkofsky N. Coming together: a review of the American Association for the Surgery of Trauma's updated kidney injury scale to facilitate multidisciplinary management. AJR Am J Roentgenol 2019; 213 (05) 1091-1099
• 23 Dixe de Oliveira Santo I, Sailer A, Solomon N. et al. Grading abdominal trauma: changes in and implications of the revised 2018 AAST-OIS for the spleen, liver, and kidney. Radiographics 2023; 43 (09) e230040
• 24 Vaidya PN, Rathi BM, Finnigan NA. Page Kidney. In: StatPearls. StatPearls Publishing; 2024. Accessed May 23, 2024 at: http://www.ncbi.nlm.nih.gov/books/NBK482486/
• 25 Engelsgjerd JS, LaGrange CA. Ureteral Injury. In: StatPearls. StatPearls Publishing; 2024. Accessed May 23, 2024 at: http://www.ncbi.nlm.nih.gov/books/NBK507817/
• 26 Yagci C, Ustuner E, Atman ED, Baltaci S, Uzun C, Akyar S. Diuretic agent and normal saline infusion technique for ultrasound-guided percutaneous nephrostomies in nondilated pelvicaliceal systems. Cardiovasc Intervent Radiol 2013; 36 (02) 492-497
• 27 Macchi V, Picardi E, Inferrera A. et al. Anatomic and radiologic study of renal avascular plane (Brödel's line) and its potential relevance on percutaneous and surgical approaches to the kidney. J Endourol 2018; 32 (02) 154-159
• 28 Padia SA, Ingraham CR, Moriarty JM. et al. Society of Interventional Radiology position statement on endovascular intervention for trauma. J Vasc Interv Radiol 2020; 31 (03) 363-369.e2
• 29 Schmidlin F. [Renal trauma. Treatment strategies and indications for surgical exploration]. Urologe A 2005; 44 (08) 863-869
• 30 Glass AS, Appa AA, Kenfield SA. et al. Selective angioembolization for traumatic renal injuries: a survey on clinician practice. World J Urol 2014; 32 (03) 821-827
• 31 Saoud R, Abou Heidar N, Aizen J. et al. Long term renal function following selective angioembolization for iatrogenic vascular lesions after partial nephrectomy: a matched case-control study. Investig Clin Urol 2021; 62 (03) 267-273
• 32 Minocha J, Parvinian A, Bui JT, Knuttinen MG, Ray Jr CE, Gaba RC. Transcatheter renal interventions: a review of established and emerging procedures. J Clin Imaging Sci 2015; 5: 5
• 33 Leslie SW, Sajjad H. Anatomy, Abdomen and Pelvis, Renal Artery. In: StatPearls. StatPearls Publishing; 2024. Accessed May 23, 2024 at: http://www.ncbi.nlm.nih.gov/books/NBK459158/
• 34 Gulas E, Wysiadecki G, Szymański J. et al. Morphological and clinical aspects of the occurrence of accessory (multiple) renal arteries. Arch Med Sci 2018; 14 (02) 442-453
• 35 Fataftah J, Amarin JZ, Suradi HH. et al. Variation in the vertebral levels of the origins of the abdominal aorta branches: a retrospective imaging study. Anat Cell Biol 2020; 53 (03) 279-283
• 36 Houat AP, Guimarães CTS, Takahashi MS. et al. Congenital anomalies of the upper urinary tract: a comprehensive review. Radiographics 2021; 41 (02) 462-486
• 37 Majos M, Polguj M, Szemraj-Rogucka Z, Arazińska A, Stefańczyk L. The level of origin of renal arteries in horseshoe kidney vs. in separated kidneys: CT-based study. Surg Radiol Anat 2018; 40 (10) 1185-1191
• 38 Kozak RI, Bennett JD, Brown TC, Lee TY. Reduction of bowel motion artifact during digital subtraction angiography: a comparison of hyoscine butyl bromide and glucagon. Can Assoc Radiol J 1994; 45 (03) 209-211
• 39 Smith TA, Eastaway A, Hartt D, Quencer KB. Endovascular embolization in renal trauma: a narrative review. Ann Transl Med 2021; 9 (14) 1198
• 40 Hill H, Chick JFB, Hage A, Srinivasa RN. N-butyl cyanoacrylate embolotherapy: techniques, complications, and management. Diagn Interv Radiol 2018; 24 (02) 98-103
• 41 Li X, Chen G, Zhu D. Percutaneous transcatheter super-selective renal arterial embolization with N-butyl cyanoacrylate for iatrogenic renal hemorrhage. J Interv Med 2022; 5 (04) 200-206
• 42 Dinh L, Hamandi M, Shutze W. Repair of renal artery aneurysm with stent angiography and coil embolization. Proc Bayl Univ Med Cent 2021; 34 (03) 391-393
• 43 Das CJ, Rahul K, Sharma S, Seth A. Endovascular management of post traumatic giant renal arteriovenous fistula using occluder device. Indian J Radiol Imaging 2016; 26 (03) 416-417
• 44 Sundarakumar DK, Kroma GM, Smith CM, Lopera JE, Suri R. Embolization of a large high-flow renal arteriovenous fistula using 035″ and 018″ detachable coils. Indian J Radiol Imaging 2013; 23 (02) 151-154
• 45 Lopera JE, Suri R, Kroma G, Gadani S, Dolmatch B. Traumatic occlusion and dissection of the main renal artery: endovascular treatment. J Vasc Interv Radiol 2011; 22 (11) 1570-1574
• 46 Young M, Leslie SW. Percutaneous Nephrostomy. In: StatPearls. StatPearls Publishing; 2024. Accessed May 23, 2024 at: http://www.ncbi.nlm.nih.gov/books/NBK493205/
• 47 Kaufman JA, Lee MJ. Vascular and Interventional Radiology: The Requisites. Elsevier Health Sciences; 2013
• 48 Onishi Y, Ohno T, Shimizu H. et al. Pediatric abdominal arterial intervention using a steerable microcatheter through an introducer with 4-F outer diameter: report of two cases. Radiol Case Rep 2021; 16 (11) 3326-3329
• 49 Shamseldin M, Stier A, Hosten N, Puls R. Endovascular retrieval of a dislocated pushable coil in the common hepatic artery using a cerebral stent retriever. CVIR Endovasc 2021; 4 (01) 34