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Jiang L, Wang X, Zhang Y, Wang Q, Zhang H, Ren L. Comparative Study of Safety and Efficacy of α-n-Butyl-2-cyanoacrylate Glue versus Traditional Embolization Materials in the Treatment of Acute Renal Hemorrhage. Br J Hosp Med (Lond) 2024; 85:1-16. [PMID: 39831481 DOI: 10.12968/hmed.2024.0514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2025]
Abstract
Aims/Background This study aims to evaluate the safety and efficacy of α-n-butyl-2-cyanoacrylate (NBCA) glue in comparison with traditional embolization materials for the treatment of acute renal hemorrhage. Methods A total of 105 patients with the acute renal hemorrhage who underwent superselective renal artery embolization were enrolled. The patients were divided into two groups based on the embolization materials used: the traditional group (43 cases, control group) and the medical glue group (62 cases, observation group). Demographic characteristics, medical history, preoperative and postoperative 24-hour blood counts, renal function, and other clinical data were collected. The safety and efficacy of the two treatment methods were then compared between the groups. Results No significant difference in efficacy was observed between the traditional group and the medical glue group (p > 0.05). However, significant differences were found between the two groups in terms of embolization vessel grade, systemic immune-inflammation index (SII) difference, estimated glomerular filtration rate (eGFR) difference, and combined eGFR difference (p < 0.05). The traditional group exhibited a higher postoperative inflammatory response and greater renal function damage compared to the medical glue group. The degree of vascular embolization also influenced the extent of postoperative inflammatory response and renal function damage in patients with acute renal hemorrhage. Conclusion Compared to traditional embolization materials, NBCA glue demonstrates a clear hemostatic effect in the treatment of patients with acute renal hemorrhage, while also leading to reduced postoperative inflammatory response and renal function damage. NBCA adhesive is both safe and effective for treating acute renal hemorrhage.
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Affiliation(s)
- Liping Jiang
- Department of Interventional Diagnosis and Treatment, The First Affiliated Hospital of Shihezi University, Shihezi, Xinjiang, China
| | - Xu Wang
- Department of Interventional Diagnosis and Treatment, The First Affiliated Hospital of Shihezi University, Shihezi, Xinjiang, China
| | - Youting Zhang
- Imaging Center, The First Affiliated Hospital of Shihezi University, Shihezi, Xinjiang, China
| | - Qibin Wang
- Department of Interventional Diagnosis and Treatment, The First Affiliated Hospital of Shihezi University, Shihezi, Xinjiang, China
| | - Hongmei Zhang
- Department of Interventional Diagnosis and Treatment, The First Affiliated Hospital of Shihezi University, Shihezi, Xinjiang, China
| | - Luoyi Ren
- Department of Interventional Diagnosis and Treatment, The First Affiliated Hospital of Shihezi University, Shihezi, Xinjiang, China
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Kazemi R, Jandaghi F, Montazeri F, Salehi H. Acute liver injury and contralateral pleural effusion as two rare complications following percutaneous nephrolithotomy: a case report. AMERICAN JOURNAL OF CLINICAL AND EXPERIMENTAL UROLOGY 2024; 12:46-51. [PMID: 38500867 PMCID: PMC10944364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 01/25/2024] [Indexed: 03/20/2024]
Abstract
INTRODUCTION Percutaneous Nephrolithotomy (PCNL) is a widely used surgical intervention for removing large and complex renal calculi. While considered a safe and effective procedure, it can still lead to severe and rare complications, including bleeding, pulmonary complications, and liver dysfunction. CASE PRESENTATION This case report presents a case who underwent PCNL for a kidney stone and subsequently developed a series of rare and severe complications. Following the PCNL procedure, the patient experienced significant bleeding, a known but uncommon complication of PCNL, pulmonary complications, a common complication that may carry a risk of death, and acute liver failure, an exceedingly rare consequence of PCNL. CONCLUSION In summary, while PCNL is a valuable technique for treating kidney stones, it is not without risk. This case underscores the importance of recognizing and managing rare complications following PCNL surgery, highlighting the need for vigilance, multidisciplinary care, and timely interventions to ensure favorable patient outcomes.
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Affiliation(s)
- Reza Kazemi
- Department of Urology, Isfahan University of Medical SciencesIsfahan, Iran
| | - Faezeh Jandaghi
- Department of Urology, School of Medicine, Al-Zahra Hospital, Isfahan University of Medical SciencesIsfahan, Iran
| | | | - Hanieh Salehi
- School of Medicine, Isfahan University of Medical SciencesIsfahan, Iran
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Floridi C, Cacioppa LM, Rossini N, Ventura C, Macchini M, Rosati M, Boscarato P, Torresi M, Candelari R, Giovagnoni A. Predictive factors of selective transarterial embolization failure in acute renal bleeding: a single-center experience. Emerg Radiol 2023; 30:597-606. [PMID: 37481680 DOI: 10.1007/s10140-023-02159-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Accepted: 07/11/2023] [Indexed: 07/24/2023]
Abstract
PURPOSE Transarterial embolization of renal artery branches (RTE) is a minimally invasive procedure commonly performed in life-threatening renal bleeding of different etiologies. Despite the widespread use of RTE, no consensus guidelines are currently available. Our aim was to investigate clinical and technical efficacy and to identify potential predictors for clinical failure of this procedure. METHODS All the RTE procedures performed in our Interventional Radiology unit in last 10 years were retrospectively collected and analyzed. All selected patients underwent both pre-procedural computed tomography angiography (CTA) and post-procedural CTA within 30 days. Clinical success was considered as primary endpoint. Demographic, laboratory, and diagnostic findings predictive of clinical failure of RTE were identified. RESULTS Over a total of 51 patients enrolled, 27 (53%) were females and 33 (64.7%) had a renal bleeding of iatrogenic origin. Technical and clinical success was 100% and 80.4%, respectively. Hematoma volumes > 258.5 cm3 measured at CTA, higher pre- and post-procedural serum creatinine (Scr) levels, an increase in Scr value > 0.135 mg/dl after the procedure, a worse post-procedural estimated glomerular filtration rate (eGFR), a post-procedural reduction of eGFR < 3.350 ml/min, and a post-procedural reduction of platelet count (PLT) > 46.50 × 103/mmc showed a significantly higher rate of clinical failure. CONCLUSION RTE is a safe and effective procedure in the management of acute renal bleeding of various origins. Hematoma volume, Scr, PLT, and eGFR values were found to be predictive factors of poor clinical outcome and should be closely monitored.
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Affiliation(s)
- C Floridi
- Department of Clinical, Special and Dental Sciences, University Politecnica Delle Marche, 60126, Ancona, Italy
- Division of Radiology, Department of Radiological Sciences, University Hospital "Azienda Ospedaliero Universitaria Delle Marche", 60126, Ancona, Italy
- Division of Interventional Radiology, Department of Radiological Sciences, University Hospital "Azienda Ospedaliero Universitaria Delle Marche", 60126, Ancona, Italy
| | - L M Cacioppa
- Division of Interventional Radiology, Department of Radiological Sciences, University Hospital "Azienda Ospedaliero Universitaria Delle Marche", 60126, Ancona, Italy
| | - N Rossini
- Department of Clinical, Special and Dental Sciences, University Politecnica Delle Marche, 60126, Ancona, Italy.
| | - C Ventura
- UOC Radiology, AST Fermo, Marche Region, 63900, Fermo, Italy
| | - M Macchini
- Division of Interventional Radiology, Department of Radiological Sciences, University Hospital "Azienda Ospedaliero Universitaria Delle Marche", 60126, Ancona, Italy
| | - M Rosati
- Division of Interventional Radiology, Department of Radiological Sciences, University Hospital "Azienda Ospedaliero Universitaria Delle Marche", 60126, Ancona, Italy
| | - P Boscarato
- Division of Interventional Radiology, Department of Radiological Sciences, University Hospital "Azienda Ospedaliero Universitaria Delle Marche", 60126, Ancona, Italy
| | - M Torresi
- Division of Interventional Radiology, Department of Radiological Sciences, University Hospital "Azienda Ospedaliero Universitaria Delle Marche", 60126, Ancona, Italy
| | - R Candelari
- Division of Interventional Radiology, Department of Radiological Sciences, University Hospital "Azienda Ospedaliero Universitaria Delle Marche", 60126, Ancona, Italy
| | - A Giovagnoni
- Department of Clinical, Special and Dental Sciences, University Politecnica Delle Marche, 60126, Ancona, Italy
- Division of Radiology, Department of Radiological Sciences, University Hospital "Azienda Ospedaliero Universitaria Delle Marche", 60126, Ancona, Italy
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Loffroy R, Mazit A, Comby PO, Falvo N, Tinel C, Chevallier O. Selective Arterial Embolization of Pseudoaneurysms and Arteriovenous Fistulas after Partial Nephrectomy: Safety, Efficacy, and Mid-Term Outcomes. Biomedicines 2023; 11:1935. [PMID: 37509574 PMCID: PMC10377731 DOI: 10.3390/biomedicines11071935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 07/01/2023] [Accepted: 07/04/2023] [Indexed: 07/30/2023] Open
Abstract
The primary objective was to evaluate the clinical success rate after endovascular embolization of iatrogenic vascular lesions caused during partial nephrectomy. The secondary objective was to evaluate the technical success and to assess potential effects on renal function. We retrospectively included consecutive patients from our center who underwent selective embolization to treat iatrogenic renal arterial lesions induced during partial nephrectomy between June 2010 and June 2020. The technical and clinical success rates and renal outcomes were collected. We identified 25 patients with 47 pseudoaneurysms and nine arteriovenous fistulas. Among them, eight were treated by coils only, eight by liquid embolization agents only, and nine by both. The technical success rate was 96% after the first attempt and 100% after the second attempt. The median follow-up was 27.1 ± 24.3 months. Clinical success, defined as no need for further hemostatic surgery during follow-up, was also obtained in 96% and 100% of patients with one and two attempts, respectively. Renal function estimated by the modification of diet in renal disease equation did not change significantly despite a mean 13.8% ± 15.1% decrease in kidney functional volume estimated by angiography. No complications were attributable to the endovascular treatment. No significant difference was found across embolization agents; however, the subgroup sizes were small. Endovascular embolization is safe and effective for treating iatrogenic arterial lesions after partial nephrectomy: success rates are high, complications are infrequent, and renal function is maintained. Recommendations by interventional radiology societies are needed to standardize this treatment.
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Affiliation(s)
- Romaric Loffroy
- Department of Vascular and Interventional Radiology, Image-Guided Therapy Center, François-Mitterrand University Hospital, 14 Rue Paul Gaffarel, BP 77908, 21079 Dijon, France
- ICMUB Laboratory, UMR CNRS 6302, University of Burgundy, 21078 Dijon, France
| | - Amin Mazit
- Department of Vascular and Interventional Radiology, Image-Guided Therapy Center, François-Mitterrand University Hospital, 14 Rue Paul Gaffarel, BP 77908, 21079 Dijon, France
- ICMUB Laboratory, UMR CNRS 6302, University of Burgundy, 21078 Dijon, France
| | - Pierre-Olivier Comby
- Department of Neuroradiology and Emergency Radiology, François-Mitterrand University Hospital, 14 Rue Paul Gaffarel, BP 77908, 21079 Dijon, France
| | - Nicolas Falvo
- Department of Vascular and Interventional Radiology, Image-Guided Therapy Center, François-Mitterrand University Hospital, 14 Rue Paul Gaffarel, BP 77908, 21079 Dijon, France
- ICMUB Laboratory, UMR CNRS 6302, University of Burgundy, 21078 Dijon, France
| | - Claire Tinel
- Department of Nephrology and Renal Transplantation, François-Mitterrand University Hospital, 14 Rue Paul Gaffarel, BP 77908, 21079 Dijon, France
| | - Olivier Chevallier
- Department of Vascular and Interventional Radiology, Image-Guided Therapy Center, François-Mitterrand University Hospital, 14 Rue Paul Gaffarel, BP 77908, 21079 Dijon, France
- ICMUB Laboratory, UMR CNRS 6302, University of Burgundy, 21078 Dijon, France
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Wang Y, Zheng H, Yao W, Ju S, Bai Y, Wang C, Zhou C, Liu J, Yang C, Huang S, Li T, Chen Y, Xiong B. Management of traumatic peripheral artery pseudoaneurysm: A 10-year experience at a single center. J Interv Med 2023; 6:29-34. [PMID: 37180364 PMCID: PMC10167504 DOI: 10.1016/j.jimed.2022.10.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Revised: 10/12/2022] [Accepted: 10/31/2022] [Indexed: 11/11/2022] Open
Abstract
Purpose This study aimed to report our 10-year experience with the management of iatrogenic (penetrating trauma) and traumatic (blunt or penetrating trauma) peripheral artery pseudoaneurysms, based on data from a tertiary referral center. Methods From January 2012 to December 2021, the medical records of consecutive patients with iatrogenic and traumatic peripheral artery pseudoaneurysms were retrospectively reviewed. Patient demographics, clinical features, imaging data, treatment details, and follow-up results were analyzed. Results Sixty-one consecutive patients were included in this study; 48 (79%) were men and 13 (21%) women, with a mean age of 49.4 ± 13.4 years (range 24-73 years). There were 42 patients (69%) who underwent open surgery, 18 (29%) undergoing endovascular embolization or stent implantation, and one (2%) undergoing ultrasound-guided thrombin injection. All patients successfully underwent open or interventional treatment. The median follow-up was 46.8 months (2.5-117.9 months), and the overall reintervention rate was 10%. Of these, one (5%) patient in the interventional treatment group and five (12%) patients in the open surgery group underwent reintervention. The overall complication rate was 8%, with complications occurring only in the open surgery group. No deaths occurred in the peri-operative period. No late complications, such as thrombosis or pseudoaneurysm recurrence, were observed. Conclusion Peripheral artery pseudoaneurysms arising from iatrogenic or traumatic causes can be effectively treated by both open surgery and interventional procedures in selected patients with acceptable mid- and long-term outcomes.
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Affiliation(s)
- Yingliang Wang
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
- Hubei Key Laboratory of Molecular Imaging, Wuhan, 430022, China
| | - Hai Zheng
- Department of Emergency Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Wei Yao
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
- Hubei Key Laboratory of Molecular Imaging, Wuhan, 430022, China
| | - Shuguang Ju
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
- Hubei Key Laboratory of Molecular Imaging, Wuhan, 430022, China
| | - Yaowei Bai
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
- Hubei Key Laboratory of Molecular Imaging, Wuhan, 430022, China
| | - Chaoyang Wang
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
- Hubei Key Laboratory of Molecular Imaging, Wuhan, 430022, China
| | - Chen Zhou
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
- Hubei Key Laboratory of Molecular Imaging, Wuhan, 430022, China
| | - Jiacheng Liu
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
- Hubei Key Laboratory of Molecular Imaging, Wuhan, 430022, China
| | - Chongtu Yang
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
- Hubei Key Laboratory of Molecular Imaging, Wuhan, 430022, China
| | - Songjiang Huang
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
- Hubei Key Laboratory of Molecular Imaging, Wuhan, 430022, China
| | - Tongqiang Li
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
- Hubei Key Laboratory of Molecular Imaging, Wuhan, 430022, China
| | - Yang Chen
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
- Hubei Key Laboratory of Molecular Imaging, Wuhan, 430022, China
| | - Bin Xiong
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
- Hubei Key Laboratory of Molecular Imaging, Wuhan, 430022, China
- Department of Interventional Radiology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China
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Factors affecting hemostasis in the control of iatrogenic renal hemorrhage. World J Urol 2022; 40:1581-1586. [DOI: 10.1007/s00345-022-03970-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 02/16/2022] [Indexed: 11/25/2022] Open
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McElroy KM, Reisenauer CJ, Welch BT, Takahashi EA, Frimpong RG, Atwell TD, Fleming CJ, Thompson SM. Long-term renal function outcomes after renal cryoablation complicated by major hemorrhage requiring selective transarterial embolization. Abdom Radiol (NY) 2021; 46:4898-4907. [PMID: 34169336 DOI: 10.1007/s00261-021-03182-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Revised: 06/14/2021] [Accepted: 06/14/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE To determine long-term renal function outcomes after renal cryoablation complicated by major hemorrhage requiring transarterial embolization compared to patients who underwent uncomplicated renal cryoablation without major hemorrhage. METHODS Utilizing a matched cohort study design, retrospective review identified 23 patients who underwent percutaneous image-guided renal cryoablation complicated by major hemorrhage requiring ipsilateral transarterial embolization (TAE group) and a control group of 23 patients who underwent uncomplicated renal cryoablation matched 1:1 by age, gender and RENAL Nephrometry score at a single institution from 1/1/2005 to 12/31/2019. Primary outcome parameters included change in creatinine (mg/dl) and estimated glomerular filtration rate (ml/min/1.73 m2; eGFR) from baseline and were compared between TAE and control group using a paired t-test. RESULTS There was a significantly higher proportion of patients on pre-ablation anticoagulation in the TAE v. control group (30% v. 4%; p = 0.047), but all patients were off anticoagulation and with normal coagulation parameters at the time of cryoablation. Otherwise there were no significant differences in clinical, renal tumor, Charlson co-morbidity index, baseline renal function or cryoablation parameters between the TAE and control group. In the post-ablation period, there was trend toward greater increase in creatinine from baseline to worst post-ablation creatinine in the TAE v. the control group (+ 0.5 ± 0.7 mg/dl v. 0.2 ± 0.1 mg/dl; p = 0.056). However, at a mean follow-up of 42.7 ± 35.7 months, there was no significant difference between the TAE and control group in creatinine (p = 0.68), eGFR (p = 0.60) or change from baseline in creatinine (p = 0.28), eGFR (p = 0.80) or CKD stage (p = 0.74). No patient required initiation of hemodialysis. CONCLUSION Selective transarterial embolization for post-renal cryoablation hemorrhage does not significantly affect long-term renal function compared to cryoablation alone. Pre-ablation anticoagulation despite normal coagulation at time of ablation may be a risk factor for post-ablation hemorrhage, and warrants further evaluation when considering pre-ablation embolization.
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Affiliation(s)
- Kevin M McElroy
- Department of Radiology, Mayo Clinic, 200 1st St SW, Rochester, MN, 55905, USA
| | | | - Brian T Welch
- Department of Radiology, Mayo Clinic, 200 1st St SW, Rochester, MN, 55905, USA
| | - Edwin A Takahashi
- Department of Radiology, Mayo Clinic, 200 1st St SW, Rochester, MN, 55905, USA
| | - Richard G Frimpong
- Department of Radiology, Mayo Clinic, 200 1st St SW, Rochester, MN, 55905, USA
| | - Thomas D Atwell
- Department of Radiology, Mayo Clinic, 200 1st St SW, Rochester, MN, 55905, USA
| | - Chad J Fleming
- Department of Radiology, Mayo Clinic, 200 1st St SW, Rochester, MN, 55905, USA
| | - Scott M Thompson
- Department of Radiology, Mayo Clinic, 200 1st St SW, Rochester, MN, 55905, USA.
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Narkhede A, Yadav AK, Gupta A. N-Butyl Cyanoacrylate Embolization in Management of Iatrogenic Renal Hemorrhages—Single-Center Study Evaluating Safety and Efficacy. JOURNAL OF CLINICAL INTERVENTIONAL RADIOLOGY ISVIR 2021. [DOI: 10.1055/s-0041-1732795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
Abstract
Objectives: The aim of the study was to evaluate the efficacy of endovascular N-butyl cyanoacrylate (NBCA)/glue embolization alone in the management of iatrogenic renal injuries and its effect on renal function.
Methods: Thirty-one patients who presented with significant iatrogenic renal injuries over a time period ranging from June 2013 to June 2018 were evaluated. The clinical features, lab parameters, and imaging findings were recorded. The embolizing agent used was exclusively NBCA. The success rate was calculated along with the effect of glue embolization on kidney in the form of postembolization ischemia and change in the serum creatinine levels in immediate pre- and postembolization period. The time between the iatrogenic injury and angioembolization as well as the time from angioembolization to discharge was also calculated. Recurrence was evaluated at 1 and 6 months follow-up.
Results: NBCA embolization showed 100% technical and clinical success in our study and no recurrence was noted at follow-up. Glue was also able to achieve complete embolization in patients with coagulopathy (n = 14, 45.1%). Percentage area deficit of normal renal blush in the postembolization check angiogram varied from 4 to 15.7% with a mean deficit of 7.65%. No significant difference in the serum creatinine was noted in immediate postembolization period.
Conclusions: We conclude that glue is an effective embolizing agent for management of iatrogenic renal injuries even in coagulopathy patients with minimal area of parenchymal loss, no significant effect on renal functions, and no recurrence on 6 months follow-up.
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Affiliation(s)
- Amey Narkhede
- Department of Interventional Radiology, Sir Ganga Ram Hospital, New Delhi, India
| | - Ajit Kumar Yadav
- Department of Interventional Radiology, Sir Ganga Ram Hospital, New Delhi, India
| | - Arun Gupta
- Department of Interventional Radiology, Sir Ganga Ram Hospital, New Delhi, India
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Vorobev V, Beloborodov V, Golub I, Frolov A, Kelchevskaya E, Tsoktoev D, Maksikova T. Urinary System Iatrogenic Injuries: Problem Review. Urol Int 2021; 105:460-469. [PMID: 33535218 DOI: 10.1159/000512882] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 11/04/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION From May to December 2019, a literature review of the urinary system iatrogenic injury problem was performed. The most cited, representative articles in PubMed, Scopus, and WoS databases dedicated to this problem were selected. Urinary system iatrogenic injuries include ureter, bladder, urethra, and kidney traumas. It is widely thought that the main causes of such injuries are urological, obstetric, gynecological, and surgical operations on the retroperitoneal space, pelvis, or perineum. METHODS The purpose of the study is to describe all aspects of the iatrogenic injure problem, under the established scheme and for each of the most damaged organs: the urethra, bladder, kidney, and ureter. The treatment of confirmed iatrogenic injuries largely depends on the period of its detection. Modern medical procedures provide conservative or minimally invasive treatment. An untimely diagnosis worsens the treatment prognosis. "Overlooked" urinary system trauma is a serious threat to society and a particular patient. Thus, incorrect or traumatic catheterization can lead to infection (RR 95%) and urethral stricture (RR ≥11-36%), and percutaneous puncture nephrostomy can cause the risk of functional renal parenchyma loss (median 5%), urinary congestion (7%), or sepsis (0.6-1.5%). RESULTS Lost gain, profits, long-term and expensive, possibly multistage treatment, stress and depression, and the risks of suicide put a heavy financial, moral, and ethical burden on a person and society. Also, iatrogenic injury might have legal consequences. DISCUSSION/CONCLUSION Thus, the significant problem of urinary tract iatrogenic injuries is still difficult to solve. There is a need to implement mandatory examining algorithms for patients at risk, as well as the multidisciplinary principle for all pelvic surgery.
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Affiliation(s)
- Vladimir Vorobev
- Department of General Surgery and Anesthesiology, Irkutsk State Medical University, Irkutsk, Russian Federation,
| | - Vladimir Beloborodov
- Department of General Surgery and Anesthesiology, Irkutsk State Medical University, Irkutsk, Russian Federation
| | - Igor Golub
- Department of General Surgery and Anesthesiology, Irkutsk State Medical University, Irkutsk, Russian Federation
| | - Aleksandr Frolov
- Department of General Surgery and Anesthesiology, Irkutsk State Medical University, Irkutsk, Russian Federation
| | - Elena Kelchevskaya
- Department of General Surgery and Anesthesiology, Irkutsk State Medical University, Irkutsk, Russian Federation
| | - Darizhab Tsoktoev
- Department of General Surgery and Anesthesiology, Irkutsk State Medical University, Irkutsk, Russian Federation
| | - Tatyana Maksikova
- Department of Propedeutics of Internal Diseases, Irkutsk State Medical University, Irkutsk, Russian Federation
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Fornazari VAV, Santos RFT, Nunes TF, Perrella R, Freire TM, Vicentini FC, Claro JFDA, Szejnfeld D. Hemorrhagic complications after percutaneous nephrolithotomy: angiographic diagnosis and management by transcatheter arterial embolization. Radiol Bras 2020; 53:390-396. [PMID: 33304006 PMCID: PMC7720659 DOI: 10.1590/0100-3984.2019.0130] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Objective To identify the main hemorrhagic complications after percutaneous nephrolithotomy, as well as the results obtained with transcatheter arterial embolization (TAE) at an interventional radiology center. Materials and Methods This was a retrospective analysis of patients undergoing TAE for the treatment of hemorrhagic complications after percutaneous nephrolithotomy. All patients underwent computed tomography angiography (CTA). Results We evaluated a total of nine patients. At emergency department readmission, the most common symptom was macroscopic hematuria, which was seen in five patients. Three patients had an isolated pseudoaneurysm, two had a pseudoaneurysm together with active bleeding (perirenal hematoma), and one had a pseudoaneurysm together with arteriocalyceal fistula. Arteriovenous fistula was diagnosed in three patients and was not seen in combination with other vascular lesions. We did not identify arteriocalyceal fistula in isolation. Five patients underwent TAE with 6 × 15 mm and 6 × 20 mm microcoils. Four patients underwent TAE with n-butyl-2-cyanoacrylate and ethiodized oil. Follow-up CTAs revealed no complications. Conclusion Because of its high diagnostic accuracy, CTA provides the interventional radiologist with valuable data for individualized therapeutic planning. The TAE procedure is safe and effective. It can therefore be used as a first-line treatment for hemorrhagic complications resulting from percutaneous renal procedures.
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Affiliation(s)
- Vinicius Adami Vayego Fornazari
- Radiologia Intervencionista e Cirurgia Endovascular, Escola Paulista de Medicina da Universidade Federal de São Paulo (EPM-Unifesp), São Paulo, SP, Brazil
| | | | | | - Rodrigo Perrella
- Centro de Referência da Saúde do Homem, Hospital de Transplantes Euryclides de Jesus Zerbini, São Paulo, SP, Brazil
| | - Tiago Magalhães Freire
- Centro de Referência da Saúde do Homem, Hospital de Transplantes Euryclides de Jesus Zerbini, São Paulo, SP, Brazil
| | - Fabio Carvalho Vicentini
- Centro de Referência da Saúde do Homem, Hospital de Transplantes Euryclides de Jesus Zerbini, São Paulo, SP, Brazil
| | | | - Denis Szejnfeld
- Radiologia Intervencionista e Cirurgia Endovascular, Escola Paulista de Medicina da Universidade Federal de São Paulo (EPM-Unifesp), São Paulo, SP, Brazil
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Liao X, Xu H, Liu F, Min X, Li Y, Yang L, Ren Y. Value of Angioembolization in the Treatment of Iatrogenic Renal Vascular Injury Assisted by 3-Dimensional Digital Subtraction Angiography. Med Sci Monit 2020; 26:e927208. [PMID: 32877388 PMCID: PMC7486794 DOI: 10.12659/msm.927208] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 08/04/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND This study was conducted to investigate the reliability and efficacy of polyvinyl alcohol combined with coils in the embolization of iatrogenic renal vascular injury with the assistance of 3-dimensional digital subtraction angiography (3D-DSA). MATERIAL AND METHODS Twenty-six patients with minimally invasive renal bleeding who underwent transarterial embolization from January 2012 to January 2019 in our hospital were included in the study. We obtained demographic data from these patients, as well as information on clinical presentation, renal procedures used for treatment, and perioperative details. The changes in renal function tests, serum hemoglobin, serum hematocrit, and technetium Tc 99m dimercaptosuccinic acid (99mTc-DMSA) levels pre- and postembolization were compared. In addition, the embolic area and the technical and clinical success rates were analyzed. Finally, an angiographic manifestation of the renal artery, 3D-DSA, and the effect of embolization were analyzed retrospectively. RESULTS All patients achieved technical and clinical success after embolization (100%, 26/26). There were no significant differences between pre- and postoperative estimated glomerular filtration rate, serum parameters, and 99mTc-DMSA. The embolic area was 12%±10%. Patients did not exhibit severe complications during the follow-up period. CONCLUSIONS Proximal embolization technique assisted by 3D-DSA for renal iatrogenic hemorrhage and vascular lesions is both safe and efficacious, offering high rates for both clinical and technical success. It maximizes the protection of the kidney and reduces the rate of renal resection.
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Affiliation(s)
- Xin Liao
- Intervention Center of Fifth People’s Hospital of Nanchong City, Fifth People’s Hospital of Nanchong City, Nanchong, Sichuan, P.R. China
| | - Hao Xu
- Department of Interventional Radiology, Affiliated Hospital of North Sichuan Medical College, Sichuan Key Laboratory of Medical Imaging, North Sichuan Medical College, Nanchong, Sichuan, P.R. China
| | - Fan Liu
- Department of Interventional Radiology, Affiliated Hospital of North Sichuan Medical College, Sichuan Key Laboratory of Medical Imaging, North Sichuan Medical College, Nanchong, Sichuan, P.R. China
| | - Xuli Min
- Department of Interventional Radiology, Affiliated Hospital of North Sichuan Medical College, Sichuan Key Laboratory of Medical Imaging, North Sichuan Medical College, Nanchong, Sichuan, P.R. China
| | - Yugen Li
- Department of Urology, Affiliated Hospital of North Sichuan Medical College, Sichuan Key Laboratory of Medical Imaging, North Sichuan Medical College, Nanchong, Sichuan, P.R. China
| | - Lin Yang
- Department of Interventional Radiology, Affiliated Hospital of North Sichuan Medical College, Sichuan Key Laboratory of Medical Imaging, North Sichuan Medical College, Nanchong, Sichuan, P.R. China
| | - Yongjun Ren
- Department of Interventional Radiology, Affiliated Hospital of North Sichuan Medical College, Sichuan Key Laboratory of Medical Imaging, North Sichuan Medical College, Nanchong, Sichuan, P.R. China
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Ethylene Vinyl Alcohol Copolymer Embolization for Acute Renal Hemorrhage: Initial Experience in 24 Cases. AJR Am J Roentgenol 2019; 214:465-471. [PMID: 31714850 DOI: 10.2214/ajr.19.21508] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE. The purpose of this study was to assess the efficacy and safety of ethylene vinyl alcohol (EVOH) copolymer (Onyx, Medtronic) for embolization for acute renal hemorrhage. MATERIALS AND METHODS. Between October 2006 and June 2018, 24 consecutive patients were treated by embolization with EVOH copolymer for acute renal hemorrhage at Hôpital Bichat-Claude-Bernard. CT angiography was performed in all patients before treatment. Technical success was defined as the complete occlusion of the bleeding artery on final renal angiogram. Clinical success was defined as the absence of rebleeding after embolization. Complications mid procedure, infarcted renal area on final angiogram, and renal function 1 week after embolization were retrospectively analyzed. RESULTS. Active bleeding was observed in all cases. The causes of acute renal hemorrhage were iatrogenic in 12 patients, vascular malformation in four patients, renal tumor in four patients, and unknown in four patients. EVOH copolymer was the sole embolic agent used in 16 patients. In eight patients, EVOH copolymer was used after persistent bleeding after embolization with coils. Technical and clinical success rates were 100%. No patient required surgery or new embolization during a mean follow-up period of 35 months (range, 6-86 months). No serious complications were attributable to EVOH copolymer. The mean infarcted renal area was 10% (range, 5-30%). Renal function, available for 16 (67%) patients, was not altered 1 week after embolization. CONCLUSION. EVOH copolymer is safe and effective for embolization of acute renal hemorrhage, either as a first-line embolic agent or after failure of coil embolization.
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Idil Soylu A, Uzunkaya F, Belet Ü, Akan H. Selective transarterial embolization of acute renal hemorrhage: a retrospective study. MINIM INVASIV THER 2019; 29:326-333. [PMID: 31432743 DOI: 10.1080/13645706.2019.1655063] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Introduction: Selective transarterial embolization (STAE) is a minimally invasive treatment method developed as am alternative to surgery for acute renal haemorrhage (ARH). The aim of this study was to evaluate the efficacy and outcome of STAE in ARH patients.Material and methods: The data of patients who underwent STAE with signs of ARH were collected retrospectively. The etiology of renal haemorrhage, localization and type of lesion, embolizing agent used, the amount of contrast material given, duration of fluoroscopy and perioperative and postoperative complications were recorded. Lesions were classified as pseudoaneurysm (PA), arteriovenous fistula (AVF), arterio pelvic fistula (ACF), pathological tumoral vasculature and extravasation.Results: A total of 51 patients were included in the study. The most common symptom was gross hematuria (76.4%) and the most common underlying cause was iatrogenic renal injury (64.7%). Embolizing agents used were n-BCA-iodized oil in 29 patients, coils alone in six patients, coils + n-BCA in four patients, ethanol-iodized oil in three patients, combination of n-BCA-iodized oil and ethanol-iodized oil in two patients, polyvinyl alcohol particles in three patients and covered stent in one patient. Technical success was 100% in all patients and there was no need for reintervention.Conclusions: STAE is a safe, effective and minimally invasive method in emergency treatment of ARH.
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Affiliation(s)
- Ayşegül Idil Soylu
- Department of Radiology, Ondokuz Mayis University, Faculty of Medicine, Samsun, Turkey
| | - Fatih Uzunkaya
- Department of Radiology, Ondokuz Mayis University, Faculty of Medicine, Samsun, Turkey
| | - Ümit Belet
- Department of Radiology, Tepecik Training and Research Hospital, İzmir, Turkey
| | - Hüseyin Akan
- Department of Radiology, Ondokuz Mayis University, Faculty of Medicine, Samsun, Turkey
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Belczak SQ, Pedroso GD, Atihe LF, Vilela ABF, Melice RS, Benedito C, Marques GG. Renal arteriovenous fistula after renal biopsy: a case report and literature review. J Vasc Bras 2019; 18:e20180112. [PMID: 31258554 PMCID: PMC6582767 DOI: 10.1590/1677-5449.011218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Accepted: 02/01/2019] [Indexed: 11/21/2022] Open
Abstract
Acquired renal arteriovenous fistulas (AVF) are rare conditions in which an anomalous connection arises between the arterial and venous systems. Renal AVFs can be classified into three main groups: idiopathic, congenital, and acquired, the last of which are the most common. Incidence has been increasing, due to the growing number of renal biopsies. Although the renal biopsy procedure is relatively safe nowadays, one possible complication is formation of an AVF in the renal vascular territory. Treatment of renal AVF is widely discussed in the literature and a variety of treatment methods can be employed. We report a case of arteriovenous fistula after renal biopsy that was successfully treated with endovascular coil embolization.
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The Efficacy and Safety of Transcatheter Arterial Embolization to Treat Renal Hemorrhage after Percutaneous Nephrolithotomy. BIOMED RESEARCH INTERNATIONAL 2019; 2019:6265183. [PMID: 31143774 PMCID: PMC6501270 DOI: 10.1155/2019/6265183] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 03/30/2019] [Accepted: 04/03/2019] [Indexed: 01/13/2023]
Abstract
Purpose The aim of this study was to evaluate the safety and efficacy of transcatheter arterial embolization (TAE) in patients with renal hemorrhage after percutaneous nephrolithotomy (PCNL) and evaluate the risk factors that may result in severe bleeding requiring TAE. Methods We retrospectively reviewed 121 patients with post-PCNL renal hemorrhage. Thirty-two patients receiving endovascular embolization were compared with 89 patients only receiving conservative treatment. The demographic and clinical data were recorded and compared between the two groups. The values of estimated glomerular filtration rate (eGFR) and serum creatinine (SCr) were recorded preoperatively, postoperatively, and at last follow-up and analyzed to evaluate the safety and efficiency of TAE. Results The successful hemostasis rate of conservative therapy was 73.6% (89/121) and that of TAE was 100% (32/32). SCr and eGFR were not significantly different before PCNL and after the last follow-up of TAE (SCr: 0.95 vs. 0.95 mg/dl, P=0.857; eGFR: 86.77 vs. 86.18 ml/min/1.73m2, P=0.715). The univariate analysis demonstrated that advanced age, urinary tract infection, and diabetes mellitus were significantly associated with severe bleeding during PCNL. Multivariate analysis further identified that diabetes mellitus was an independent risk factor for severe bleeding needing TAE [odds ratio (OR): 3.778, 95% confidence interval (CI):1.276-11.190, and P=0.016]. Conclusion TAE is a safe and effective procedure to treat renal hemorrhage that cannot be resisted by conservative treatment after PCNL. Diabetes mellitus was associated with high risks of severe bleeding needing TAE after PCNL.
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Are iatrogenic renal artery pseudoaneurysms more challenging to embolize when associated with an arteriovenous fistula? Radiol Med 2018; 123:742-752. [PMID: 29846881 DOI: 10.1007/s11547-018-0906-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Accepted: 05/20/2018] [Indexed: 12/25/2022]
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Oates A, Ahuja S, Lee MM, Phelps AS, Mackenzie JD, Courtier JL. Pediatric renal transplant biopsy with ultrasound guidance: the 'core' essentials. Pediatr Radiol 2017; 47:1572-1579. [PMID: 28573315 DOI: 10.1007/s00247-017-3905-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Revised: 04/03/2017] [Accepted: 05/11/2017] [Indexed: 12/16/2022]
Abstract
This review provides a comprehensive and practical approach to pediatric percutaneous renal transplant biopsies, highlighting techniques and strategies to optimize adequate sample yield and ensure patient safety. In children with end-stage renal disease, transplantation is the preferred choice of therapy, providing for overall lower long-term morbidity and mortality compared with dialysis. In the ongoing management of renal transplant patients, core tissue sampling via a percutaneous renal biopsy remains the gold standard when transplant dysfunction is suspected. Indications for renal transplant biopsy and techniques/tools for adequate sample yield are discussed. Strategies for common challenges such as poor visualization and renal transplant mobility are addressed. We discuss the clinical signs, techniques and imaging findings for common complications including hematomas, arteriovenous fistulas and pseudoaneurysms. Although the percutaneous renal transplant biopsy procedure is generally safe with rare complications, care must be taken to ensure major complications are promptly recognized and treated. Adequate tissue samples obtained via renal biopsy are imperative to promptly identify transplant rejection to provide valuable information for patient diagnosis, treatment and outcomes. Radiologist and nephrologist attention to proper ultrasound techniques and optimal biopsy tools are critical to ensure tissue adequacy and minimize complications.
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Affiliation(s)
- Aris Oates
- Division of Nephrology, Department of Pediatrics, University of California, 550 16th St., 5th floor, Mailstop 3214, San Francisco, CA, 94143- 3214, USA.
| | - Saveen Ahuja
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA
| | - Marsha M Lee
- Division of Nephrology, Department of Pediatrics, University of California, 550 16th St., 5th floor, Mailstop 3214, San Francisco, CA, 94143- 3214, USA
| | - Andrew S Phelps
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA
| | - John D Mackenzie
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA
| | - Jesse L Courtier
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA
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Clinical efficacy and safety of transcatheter embolization for vascular complications after percutaneous nephrolithotomy. Wideochir Inne Tech Maloinwazyjne 2017; 12:403-408. [PMID: 29362656 PMCID: PMC5776481 DOI: 10.5114/wiitm.2017.69108] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Accepted: 07/03/2017] [Indexed: 11/17/2022] Open
Abstract
Introduction Percutaneous nephrolithotomy (PNL) is the preferred procedure for safe and effective surgical treatment of kidney stones. Hemorrhage is the most serious complication of PNL, resulting from pseudoaneurysm (PA) or arteriovenous fistula (AVF), and can usually be controlled with conservative treatment. Aim To evaluate endovascular treatments and outcomes of vascular complications observed after PNL. Material and methods We retrospectively reviewed data on 19 patients who underwent renal embolization due to post-PNL renal artery bleeding between March 2005 and September 2016. Embolization materials included embolization coils and glue. The incidence of post-PNL vascular complications and their endovascular treatments, outcomes, and the follow-up data were analyzed. Results Nineteen (1.1%) of 1,609 patients (mean age: 44.9 years, range: 19-75 years) underwent angiography and subsequent transcatheter embolization to control bleeding. The mean time to onset of hemorrhage was 7.2 days after PNL (range: 3-18 days). The PNL entry site was the lower calyx in 15 patients, the middle calyx in 3, and the upper calyx in 1. PA, AVF, and PA plus AVF occurred in 14, 5, and 3 of the 19 renal angiography patients, respectively. Embolization of the affected vessels was successful in all 19 patients. The embolization materials of coil, glue, and coil plus glue were used in 16, 3, and 2 patients, respectively. Conclusions Severe hematuria is a rare complication of PNL and can be successfully treated with transcatheter embolization.
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Visconti L, Cernaro V, Ricciardi CA, Lacava V, Pellicanò V, Lacquaniti A, Buemi M, Santoro D. Renal biopsy: Still a landmark for the nephrologist. World J Nephrol 2016; 5:321-327. [PMID: 27458561 PMCID: PMC4936339 DOI: 10.5527/wjn.v5.i4.321] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2016] [Revised: 03/14/2016] [Accepted: 04/06/2016] [Indexed: 02/06/2023] Open
Abstract
Renal biopsy was performed for the first time more than one century ago, but its clinical use was routinely introduced in the 1950s. It is still an essential tool for diagnosis and choice of treatment of several primary or secondary kidney diseases. Moreover, it may help to know the expected time of end stage renal disease. The indications are represented by nephritic and/or nephrotic syndrome and rapidly progressive acute renal failure of unknown origin. Nowadays, it is performed mainly by nephrologists and radiologists using a 14-18 gauges needle with automated spring-loaded biopsy device, under real-time ultrasound guidance. Bleeding is the major primary complication that in rare cases may lead to retroperitoneal haemorrhage and need for surgical intervention and/or death. For this reason, careful evaluation of risks and benefits must be taken into account, and all procedures to minimize the risk of complications must be observed. After biopsy, an observation time of 12-24 h is necessary, whilst a prolonged observation may be needed rarely. In some cases it could be safer to use different techniques to reduce the risk of complications, such as laparoscopic or transjugular renal biopsy in patients with coagulopathy or alternative approaches in obese patients. Despite progress in medicine over the years with the introduction of more advanced molecular biology techniques, renal biopsy is still an irreplaceable tool for nephrologists.
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