Therapeutic intervention in renal arterial injuries

Abstract

The efficacy of transcatheter vascular occlusion has been proven in many disease states. No doubt, its most productive application is its role in posttraumatic vascular injury. Posttraumatic hematuria refractory to conservative management demands intervention. Irrespective of the interventional technique, maximum conservation of renal parenchyma and preservation of normal renal function are mandatory in the management of renal trauma. This paper describes a 10-year experience with transcatheter embolization of posttraumatic refractory hematuria in 45 patients. The angiographic abnormalities requiring embolization are classified, indications for embolizations discussed, and consideration given to the choice of embolic material. As determined by immediate postembolization angiographic criteria and clinical outcome, the procedure was successful in 43 patients. In addition to two minor complications of unintentional nontarget vessel occlusion, there were two failures. It is concluded that transcatheter vascular occlusion in posttraumatic, intractable, renal hematuria, refractory to conservative management, should be considered. It is a safe, simple, and satisfactory alternative to surgical intervention. Should transcatheter embolization fail, conventional nephrectomy, partial nephrectomy, or segmental dearterialization may be necessary.