Clinical outcomes of endovascularly managed iatrogenic renal hemorrhages

George Koshy Chiramel; Shyamkumar Nidugala Keshava; Vinu Moses; Nitin Kekre; V Tamilarasi; Anthony Devasia

doi:10.4103/0971-3026.169454

Indian Journal of Radiology and Imaging, Table of Contents

CC BY-NC-ND 4.0 · Indian J Radiol Imaging 2015; 25(04): 380-390
DOI: 10.4103/0971-3026.169454

Vascular and Interventional Radiology

Clinical outcomes of endovascularly managed iatrogenic renal hemorrhages

George Koshy Chiramel

Department of Radiology, Christian Medical College, Vellore, Tamil Nadu, India

,

Shyamkumar Nidugala Keshava

Department of Radiology, Christian Medical College, Vellore, Tamil Nadu, India

,

Vinu Moses

Department of Radiology, Christian Medical College, Vellore, Tamil Nadu, India

,

Nitin Kekre

Department of Urology, Christian Medical College, Vellore, Tamil Nadu, India

,

V Tamilarasi

Department of Nephrology, Christian Medical College, Vellore, Tamil Nadu, India

,

Anthony Devasia

Department of Urology, Christian Medical College, Vellore, Tamil Nadu, India

› Author Affiliations

Abstract

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Abstract

Objective: To evaluate the effectiveness of endovascular management in iatrogenic renal injuries with regard to clinical status on follow-up and requirements for repeat angiography and embolization. Materials and Methods: This retrospective study included patients who were referred for endovascular management of significant hemorrhage following an iatrogenic injury. Data was recorded from the Picture Archiving and Communication system (PACS) and electronic medical records. The site and type of iatrogenic injury, imaging findings, treatment, angiography findings, embolization performed, clinical status on follow-up, and requirement for repeat embolization were recorded. The outcomes were clinical resolution, nephrectomy, or death. Clinical findings were recorded on follow-up visits to the clinic. Statistical analysis was performed using descriptive statistics. Results: Seventy patients were included in this study between January 2000 and June 2012. A bleeding lesion (a pseudoaneurysm or arteriovenous fistula) was detected during the first angiogram in 55 patients (78.6%) and was selectively embolized. Fifteen required a second angiography as there was no clinical improvement and five required a third angiography. Overall, 66 patients (94.3%) showed complete resolution and 4 patients (5.7%) died. Three patients (4.3%) underwent nephrectomy for clinical stabilization even after embolization. There were no major complications. The two minor complications resolved spontaneously. Conclusions: Angiography and embolization is the treatment of choice in iatrogenic renal hemorrhage. Upto 20% of initial angiograms may not reveal the bleed and repeat angiography is required to identify a recurrent or unidentified bleed. The presence of multiple punctate bleeders on angiography suggests an enlarging subcapsular hematoma and requires preoperative embolization and nephrectomy.

Keywords

Bleeding - embolization - endovascular management - iatrogenic renal hemorrhages - iatrogenic renal vascular injuries

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References

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