Angioembolisation von Nierenblutungen

Zusammenfassung

Das Therapiekonzept von Nierenblutungen hat sich in den letzten Jahrzehnten gewandelt. Während höhergradige Nierentraumata in der Vergangenheit der operativen Versorgung vorbehalten waren, wird heutzutage zunehmend ein nicht-operatives Behandlungsmanagement angestrebt. Dies ist insbesondere auf die verbesserten Diagnosemöglichkeiten mittels mehrphasiger Computertomografie und die zunehmende Verbreitung der Angioembolisation in der Therapie von Nierenblutungen zurückzuführen. Unabhängig von der Ätiologie der Nierenblutung sind bei bestehender Kreislaufstabilität des zu behandelnden Patienten das CT-grafische Vorliegen eines Kontrastmittelextravasates, eines Pseudoaneurysmas oder einer arteriovenösen Fistel als prädiktive Faktoren für einen erfolgsversprechenden Einsatz der selektiven Angioembolisation beschrieben. Die Verfügbarkeit einer Vielzahl unterschiedlicher Katheter- und Embolisationsmaterialien ermöglicht es dem interventionell tätigen Radiologen, die entsprechende Nierenpathologie minimalinvasiv und superselektiv über das arterielle Gefäßsystem zu behandeln und dadurch das gesunde Nierenparenchym und damit auch die Nierenfunktion bestmöglich zu schonen. Als entscheidender Erfolg des zunehmenden Einsatzes der selektiven Angioembolisation bei der Behandlung von Nierenblutungen konnte eine signifikante Senkung der Nephrektomie-Rate erreicht werden. Unter Beachtung der Limitationen des Verfahrens ist die Angioembolisation ein effektives und sicheres Verfahren, das sich als wichtiger Bestandteil des nicht-operativen Managements von Nierenblutungen fest etabliert hat.

Abstract

The therapeutic approach to renal hemorrhage has changed in recent decades. In the past, renal trauma was primarily managed by surgical intervention, whereas non-operative management is increasingly preferred today. This shift is largely attributable to improved diagnostic options, particularly multiphase computed tomography, and to the growing availability and use of angioembolization in the treatment of renal hemorrhage. Regardless of the etiology of renal hemorrhage, the CT-based detection of contrast extravasation, a pseudoaneurysm, or an arteriovenous fistula has been described as a predictive factor for the successful use of selective angioembolization in hemodynamically stable patients. The availability of a wide range of different catheters and embolization materials enables interventional radiologists to treat the underlying renal pathology in a minimally-invasive and superselective manner via the arterial vascular system, thereby preserving healthy renal parenchyma and renal function to the greatest extent possible. A key outcome of the increasing use of selective angioembolization in the management of renal hemorrhage is a significant reduction in nephrectomy rates. In due consideration of the limitations of the technique, angioembolization represents an effective and safe procedure that has firmly established itself as an important approach in the non-operative management of renal hemorrhage.

Schlüsselwörter

Angioembolisation - Nierenblutung - Nicht-operatives Management

Keywords

angioembolization - renal hemorrhage - non-operative management

Publication History

Received: 15 September 2025

Accepted after revision: 16 December 2025

Article published online:
06 February 2026

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