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1
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Lee P, Roh S. Renal embolization for trauma: a narrative review. JOURNAL OF TRAUMA AND INJURY 2024; 37:171-181. [PMID: 39428726 PMCID: PMC11495897 DOI: 10.20408/jti.2024.0021] [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: 04/04/2024] [Revised: 06/22/2024] [Accepted: 07/13/2024] [Indexed: 10/22/2024] Open
Abstract
Renal injuries commonly occur in association with blunt trauma, especially in the setting of motor vehicle accidents. Contrast-enhanced computed tomography is considered the gold-standard imaging modality to assess patients for renal injuries in the setting of blunt and penetrating trauma, and to help classify injuries based on the American Association for the Surgery of Trauma injury scoring scale. The management of renal trauma has evolved in the past several decades, with a notable shift towards a more conservative, nonoperative approach. Advancements in imaging and interventional radiological techniques have enabled diagnostic angiography with angiographic catheter-directed embolization to become a viable option, making it possible to avoid surgical interventions that pose an increased risk of nephrectomy. This review describes the current management of renal trauma, with an emphasis on renal artery embolization techniques.
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Affiliation(s)
- Peter Lee
- Department of Interventional Radiology, St. Luke’s University Hospital, Bethlehem, PA, USA
| | - Simon Roh
- Department of Interventional Radiology, St. Luke’s University Hospital, Bethlehem, PA, USA
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2
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Youm J, Choi MJ, Kim BM, Seo Y. Transcatheter embolization for hemorrhage from aberrant testicular artery after partial nephrectomy: A case report. World J Clin Cases 2023; 11:7852-7857. [DOI: 10.12998/wjcc.v11.i32.7852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Revised: 09/06/2023] [Accepted: 11/02/2023] [Indexed: 11/16/2023] Open
Abstract
BACKGROUND Arterial bleeding typically involves the renal artery following partial nephrectomy; in this study, we present a case of bleeding originating from the testicular artery that has not been reported in previous studies.
CASE SUMMARY A 52-year-old man suffered hemorrhage from a perinephric branch of the aberrant left testicular artery after an open nephron-sparing surgery for renal cell carcinoma. Clinical signs of bleeding were manifested by the patient, such as fresh blood drainage from the catheter, decreased hemoglobin levels, and significant vital sign changes. Since computed tomography did not show evidence of active bleeding, transcatheter angiography was conducted to identify the bleeding site. Fluoroscopic spot images confirmed bleeding derived from a perinephric branch of the testicular artery originating from the segmental artery of the left renal artery. Using n-butyl-2-cyanoacrylate, successful transcatheter arterial embolization of the affected branch was performed. Immediately after the embolization procedure, the bleeding ceased, and the patient experienced complete recovery devoid of complications.
CONCLUSION In patients with postoperative arterial hemorrhage after partial nephrectomy, the testicular artery can be a rare but notable source of bleeding. Accurate bleeding site localization via angiographic evaluation, followed by transcatheter arterial embolization, can be instrumental for safe, prompt, and effective hemostasis.
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Affiliation(s)
- Juyoun Youm
- Department of Radiology, Dankook University Hospital, Cheonan 31116, South Korea
| | - Min-Jeong Choi
- Department of Radiology, Dankook University Hospital, Cheonan 31116, South Korea
| | - Bong Man Kim
- Department of Radiology, Dankook University Hospital, Cheonan 31116, South Korea
| | - Yumi Seo
- Department of Urology, Dankook University Hospital, Cheonan 31116, South Korea
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3
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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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4
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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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5
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Saoud R, Abou Heidar N, Aizen J, Andolfi C, Galansky L, Ahmed O, Shalhav AL. Long term renal function following selective angioembolization for iatrogenic vascular lesions after partial nephrectomy: A matched case-control study. Investig Clin Urol 2021; 62:267-273. [PMID: 33834638 PMCID: PMC8100014 DOI: 10.4111/icu.20200510] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Revised: 12/21/2020] [Accepted: 12/30/2020] [Indexed: 01/09/2023] Open
Abstract
Purpose Partial nephrectomy is associated with a 1%–2% risk of renal iatrogenic vascular lesion (IVL) that are commonly treated with selective angioembolization (SAE). The theoretical advantage of SAE is preservation of renal parenchyma by targeting only the bleeding portion of the kidney. Our study aims to assess the long-term effect of SAE on renal function, especially that this intervention requires potentially nephrotoxic contrast load injection. Materials and Methods A retrospective review of patients undergoing partial nephrectomy between 2002 and 2018 was performed, and patients who developed IVL were identified. A 1:4 matched case-control analysis was performed. Paired t-test and χ2 test were used for continuous and categorical variables, respectively. Multivariable logistic and Cox proportional hazards regression analyses were used to identify risk factors and confounders for SAE and postoperative renal function. Results Eighteen patients found to have an IVL after partial nephrectomy were matched with 72 control patients. IVL's were more common in patients after minimally invasive partial nephrectomy (89% vs. 70%, p=0.008) and in those with higher RENAL nephrometry scores (8.8±2.0 vs. 6.5±1.8, p<0.001). On multivariable analysis, lower RENAL scores proved to decrease the odds of requiring postoperative SAE. No significant difference in renal function outcomes was seen at 24 months of follow-up after surgery. Conclusions SAE for the management of IVL following partial nephrectomy is a safe and efficient procedure with no significant impact on short or long-term renal function. Less complex renal tumors with lower RENAL scores are less likely to require postoperative SAE.
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Affiliation(s)
- Ragheed Saoud
- Section of Urology, Department of Surgery, The University of Chicago Medicine, Chicago, IL, USA.
| | - Nassib Abou Heidar
- Division of Urology, Department of Surgery, The American University of Beirut Medical Center, Beirut, Lebanon
| | - Joshua Aizen
- Section of Urology, Department of Surgery, The University of Chicago Medicine, Chicago, IL, USA
| | - Ciro Andolfi
- Section of Urology, Department of Surgery, The University of Chicago Medicine, Chicago, IL, USA
| | - Logan Galansky
- Pritzker School of Medicine, The University of Chicago, Chicago, IL, USA
| | - Osmanuddin Ahmed
- Department of Radiology, The University of Chicago Medicine, Chicago, IL, USA
| | - Arieh L Shalhav
- Section of Urology, Department of Surgery, The University of Chicago Medicine, Chicago, IL, USA
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6
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Gieraerts C, Vanhoutte E, Laenen A, Bonne L, De Wever L, Joniau S, Oyen R, Maleux G. Safety and efficacy of embolotherapy for severe hemorrhage after partial nephrectomy. Acta Radiol 2020; 61:1701-1707. [PMID: 32102548 DOI: 10.1177/0284185120907253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Partial nephrectomy may be complicated by postoperative hemorrhage, which may be treated by transcatheter embolization. PURPOSE To assess the safety and efficacy of embolotherapy for hemorrhagic complications of partial nephrectomy and to analyze the potential correlation between multiple bleeding sites on angiography and surgical complexity. MATERIAL AND METHODS A cohort of 25 patients presenting with severe, postoperative bleeding after partial nephrectomy and treated with catheter-directed superselective embolization was included. Patients' demographics, radiological investigations before the embolization, and clinical outcome after embolization were analyzed. Mann-Whitney U test was used to analyze the potential difference in the RENAL score between patients with one or more bleeding sites in the resection area. RESULTS Selective renal angiography revealed multiple bleeding sites at the resection bed in 8 (32%) patients with amorphous contrast extravasation in 10 (40%) patients. Embolization with use of a microcatheter and microcoils was effective to stop the bleeding in all but one patient, the latter requiring a second embolization two days later. Transient decrease in renal function was noted in 3/25 (12%) patients with full recovery in two of the three. Patients with multiple bleeding sites did not show significantly different RENAL scores compared to patients with a single bleeding site (P = 0.148). CONCLUSION Embolotherapy for postoperative partial nephrectomy-related bleeding is safe and effective with a low rate of recurrent bleeding. The number of bleeding sites at the resection area did not correlate to the RENAL score.
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Affiliation(s)
| | - Els Vanhoutte
- Department of Radiology, University Hospitals Leuven, Leuven, Belgium
| | - Annouschka Laenen
- Department of Biostatistics and Statistical Bioinformatics, KU Leuven Universiteit Hasselt, Leuven, Belgium
| | - Lawrence Bonne
- Department of Radiology, University Hospitals Leuven, Leuven, Belgium
| | - Liesbeth De Wever
- Department of Radiology, University Hospitals Leuven, Leuven, Belgium
| | - Steven Joniau
- Department of Urology, University Hospitals Leuven, Leuven, Belgium
| | - Raymond Oyen
- Department of Radiology, University Hospitals Leuven, Leuven, Belgium
| | - Geert Maleux
- Department of Radiology, University Hospitals Leuven, Leuven, Belgium
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7
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Baboudjian M, Gondran-Tellier B, Abdallah R, Lannes F, Sichez PC, Akiki A, Gaillet S, Toledano H, Delaporte V, Andre M, Karsenty G, Lechevallier E, Rossi D, Vidal V, Boissier R, Bastide C. Selective Trans-arterial Embolization of Iatrogenic Vascular Lesions Did Not Influence the Global Renal Function After Partial Nephrectomy. Urology 2020; 141:108-113. [PMID: 32283170 DOI: 10.1016/j.urology.2020.03.036] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 03/19/2020] [Accepted: 03/26/2020] [Indexed: 01/20/2023]
Abstract
OBJECTIVE To evaluate the renal function outcomes after selective trans-arterial embolization (SAE) of iatrogenic vascular lesions (IVL), including pseudoaneurysm and arteriovenous fistula, following partial nephrectomy (PN). MATERIALS AND METHODS A multi-institutional study was conducted including consecutive patients who underwent PN between January 2009 and March 2019. Two surgical approaches were used: open and robot-assisted PN. Patients with SAE were identified and matched (1:2) with patients without IVL. The matching criteria were age, gender, Charlson score, creatinine clearance, RENAL score, and tumor size. The primary outcome was the evolution of global renal function at 6-months postoperatively. RESULTS A total of 493 consecutive PN (360 open PN and 133 robot-assisted PN) were included. IVL occurred in 17 cases (3.4%) without statistical difference according to the surgical approach (P = .78). Patients from embolization group were matched to 34 cases without postoperative IVL. Groups were comparable concerning clinical, tumor and surgical characteristics. The clinical success of SAE, defined as the absence of recourse to a second embolization or a total nephrectomy, was obtained in 16 (94.1%) cases. No minor or major complications were reported after SAE. The preoperative estimated glomerular filtration rate (eGFR) was similar between control group (93 [85-102] ml/min) and embolization group (95 [83-102] ml/min) (P = .99). Median (IQR) eGFR between control group (87 [72-95] ml/min) and embolization group (83 [76-93] ml/min) at a follow-up of 6 months showed no significant difference (P = .73). CONCLUSION IVL are rare complications of PN. SAE is an effective and minimally invasive management tool, with no deleterious effect on global renal function.
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Affiliation(s)
- Michael Baboudjian
- Aix-Marseille University, APHM, Conception Academic Hospital, Dept. of Urology and Kidney Transplantation, Marseille, France.
| | - Bastien Gondran-Tellier
- Aix-Marseille University, APHM, Conception Academic Hospital, Dept. of Urology and Kidney Transplantation, Marseille, France
| | - Rony Abdallah
- Aix-Marseille University, APHM, Conception Academic Hospital, Dept. of Urology and Kidney Transplantation, Marseille, France
| | - Francois Lannes
- Aix-Marseille University, APHM, Nord Academic Hospital, Dept. of Urology, Marseille, France
| | - Pierre Clement Sichez
- Aix-Marseille University, APHM, Conception Academic Hospital, Dept. of Urology and Kidney Transplantation, Marseille, France
| | - Akram Akiki
- Aix-Marseille University, APHM, Conception Academic Hospital, Dept. of Urology and Kidney Transplantation, Marseille, France
| | - Sarah Gaillet
- Aix-Marseille University, APHM, Conception Academic Hospital, Dept. of Urology and Kidney Transplantation, Marseille, France
| | - Harry Toledano
- Aix-Marseille University, APHM, Nord Academic Hospital, Dept. of Urology, Marseille, France
| | - Veronique Delaporte
- Aix-Marseille University, APHM, Conception Academic Hospital, Dept. of Urology and Kidney Transplantation, Marseille, France
| | - Marc Andre
- Aix-Marseille University, APHM, Conception Academic Hospital, Dept. of Radiology and Medical imaging, Marseille, France
| | - Gilles Karsenty
- Aix-Marseille University, APHM, Conception Academic Hospital, Dept. of Urology and Kidney Transplantation, Marseille, France
| | - Eric Lechevallier
- Aix-Marseille University, APHM, Conception Academic Hospital, Dept. of Urology and Kidney Transplantation, Marseille, France
| | - Dominique Rossi
- Aix-Marseille University, APHM, Nord Academic Hospital, Dept. of Urology, Marseille, France
| | - Vincent Vidal
- Aix-Marseille University, APHM, La Timone Academic Hospital, Dept. of Radiology and Medical imaging, Marseille, France; European Center for Medical Imaging Research CERIMED/LIIE, Marseille, France
| | - Romain Boissier
- Aix-Marseille University, APHM, Conception Academic Hospital, Dept. of Urology and Kidney Transplantation, Marseille, France
| | - Cyrille Bastide
- Aix-Marseille University, APHM, Nord Academic Hospital, Dept. of Urology, Marseille, France
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8
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Tran MGB, Aben KKH, Werkhoven E, Neves JB, Fowler S, Sullivan M, Stewart GD, Challacombe B, Mahrous A, Patki P, Mumtaz F, Barod R, Bex A. Guideline adherence for the surgical treatment of T1 renal tumours correlates with hospital volume: an analysis from the British Association of Urological Surgeons Nephrectomy Audit. BJU Int 2019; 125:73-81. [PMID: 31293036 DOI: 10.1111/bju.14862] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To assess European Association of Urology guideline adherence on the surgical management of patients with T1 renal tumours and the effects of centralisation of care. PATIENTS AND METHODS Retrospective data from all kidney tumours that underwent radical nephrectomy (RN) or partial nephrectomy (PN) in the period 2012-2016 from the British Association of Urological Surgeons Nephrectomy Audit were retrieved and analysed. We assessed total surgical hospital volume (HV; RN and PN performed) per centre, PN rates, complication rates, and completeness of data. Descriptive analyses were performed, and confidence intervals were used to illustrate the association between hospital volume and proportion of PN. Chi- squared and Cochran-Armitage trend tests were used to evaluate differences and trends. RESULTS In total, 13 045 surgically treated T1 tumours were included in the analyses. Over time, there was an increase in PN use (39.7% in 2012 to 44.9% in 2016). Registration of the Preoperative Aspects and Dimensions Used for an Anatomical (PADUA) complexity score was included in March 2016 and documented in 39% of cases. Missing information on postoperative complications appeared constant over the years (8.5-9%). A clear association was found between annual HV and the proportion of T1 tumours treated with PN rather than RN (from 18.1% in centres performing <25 cases/year [lowest volume] to 61.8% in centres performing ≥100 cases/year [high volume]), which persisted after adjustment for PADUA complexity. Overall and major (Clavien-Dindo grade ≥III) complication rate decreased with increasing HV (from 12.2% and 2.9% in low-volume centres to 10.7% and 2.2% in high-volume centres, respectively), for all patients including those treated with PN. CONCLUSION Closer guideline adherence was exhibited by higher surgical volume centres. Treatment of T1 tumours using PN increased with increasing HV, and was accompanied by an inverse association of HV with complication rate. These results support the centralisation of kidney cancer specialist cancer surgical services to improve patient outcomes.
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Affiliation(s)
- Maxine G B Tran
- Division of Surgery and Interventional Science, University College London, London, UK.,Specialist Centre for Kidney Cancer, Royal Free London NHS Foundation Trust, London, UK
| | - Katja K H Aben
- Netherlands Comprehensive Cancer Centre, Utrecht, The Netherlands.,Research Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Erik Werkhoven
- Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Joana B Neves
- Division of Surgery and Interventional Science, University College London, London, UK.,Specialist Centre for Kidney Cancer, Royal Free London NHS Foundation Trust, London, UK
| | - Sarah Fowler
- British Association of Urological Surgeons, London, UK
| | - Mark Sullivan
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Grant D Stewart
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.,Department of Surgery, University of Cambridge, Cambridge Biomedical Campus, Cambridge, UK
| | | | - Ahmed Mahrous
- Specialist Centre for Kidney Cancer, Royal Free London NHS Foundation Trust, London, UK
| | - Prasad Patki
- Specialist Centre for Kidney Cancer, Royal Free London NHS Foundation Trust, London, UK
| | - Faiz Mumtaz
- Specialist Centre for Kidney Cancer, Royal Free London NHS Foundation Trust, London, UK
| | - Ravi Barod
- Specialist Centre for Kidney Cancer, Royal Free London NHS Foundation Trust, London, UK
| | - Axel Bex
- Division of Surgery and Interventional Science, University College London, London, UK.,Specialist Centre for Kidney Cancer, Royal Free London NHS Foundation Trust, London, UK.,Netherlands Comprehensive Cancer Centre, Utrecht, The Netherlands.,Netherlands Cancer Institute, Amsterdam, The Netherlands
| | -
- Netherlands Cancer Institute, Amsterdam, The Netherlands
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9
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Zuo M, Yuan H, Ou S, Huang J. Superselective transcatheter arterial embolization to control renal hemorrhage after partial nephrectomy for renal tumors: A report of 9 cases and a literature review. J Interv Med 2019; 2:134-138. [PMID: 34805888 PMCID: PMC8562230 DOI: 10.1016/j.jimed.2019.09.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
Objective Materials and methods Results Conclusions
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10
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Gupta N, Patel A, Ensor J, Ahrar K, Ahrar J, Tam A, Odisio B, Huang S, Murthy R, Mahvash A, Avritscher R, McRae S, Sabir S, Wallace M, Matin S, Gupta S. Multiple Renal Artery Pseudoaneurysms in Patients Undergoing Renal Artery Embolization Following Partial Nephrectomy: Correlation with RENAL Nephrometry Scores. Cardiovasc Intervent Radiol 2016; 40:202-209. [PMID: 27681271 DOI: 10.1007/s00270-016-1473-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Accepted: 09/19/2016] [Indexed: 02/06/2023]
Abstract
PURPOSE To describe the incidence of multiple renal artery pseudoaneurysms (PSA) in patients referred for renal artery embolization following partial nephrectomy and to study its relationship to RENAL nephrometry scores. MATERIALS AND METHODS The medical records of 25 patients referred for renal artery embolization after partial nephrectomy were retrospectively reviewed for the following parameters: size and number of tumors, RENAL nephrometry scores, angiographic abnormalities, technical and clinical outcomes, and estimated glomerular filtration rates (eGFRs) after embolization. RESULTS Twenty-four patients had primary renal tumors, while 1 patient had a pancreatic tumor invading the kidney. Multiple tumors were resected in 4 patients. Most patients (92 %) were symptomatic, presenting with gross hematuria, flank pain, or both. Angiography revealed PSA with (n = 5) or without (n = 20) AV fistulae. Sixteen patients (64 %) had multiple PSA involving multiple renal vessels. Higher RENAL nephrometry scores were associated with an increasing likelihood of multiple PSA. Multiple vessels were embolized in 14 patients (56 %). Clinical success was achieved after one (n = 22) or two (n = 3) embolization sessions in all patients. Post-embolization eGFR values at different time points after embolization were not significantly different from the post-operative eGFR. CONCLUSION A majority of patients requiring renal artery embolization following partial nephrectomy have multiple pseudoaneurysms, often requiring selective embolization of multiple vessels. Higher RENAL nephrometry score is associated with an increasing likelihood of multiple pseudoaneurysms. We found transarterial embolization to be a safe and effective treatment option with no long-term adverse effect on renal function in all but one patient with a solitary kidney.
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Affiliation(s)
- Nakul Gupta
- Houston Methodist Hospital, Houston, TX, USA
| | - Anish Patel
- The University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Joe Ensor
- The Houston Methodist Cancer Center, Houston Methodist Research Institute, Houston, TX, USA
| | - Kamran Ahrar
- Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Unit 1471, PO Box 301402, Houston, TX, 77230-1402, USA
| | - Judy Ahrar
- Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Unit 1471, PO Box 301402, Houston, TX, 77230-1402, USA
| | - Alda Tam
- Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Unit 1471, PO Box 301402, Houston, TX, 77230-1402, USA
| | - Bruno Odisio
- Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Unit 1471, PO Box 301402, Houston, TX, 77230-1402, USA
| | - Stephen Huang
- Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Unit 1471, PO Box 301402, Houston, TX, 77230-1402, USA
| | - Ravi Murthy
- Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Unit 1471, PO Box 301402, Houston, TX, 77230-1402, USA
| | - Armeen Mahvash
- Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Unit 1471, PO Box 301402, Houston, TX, 77230-1402, USA
| | - Rony Avritscher
- Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Unit 1471, PO Box 301402, Houston, TX, 77230-1402, USA
| | - Stephen McRae
- Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Unit 1471, PO Box 301402, Houston, TX, 77230-1402, USA
| | - Sharjeel Sabir
- Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Unit 1471, PO Box 301402, Houston, TX, 77230-1402, USA
| | - Michael Wallace
- Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Unit 1471, PO Box 301402, Houston, TX, 77230-1402, USA
| | - Surena Matin
- Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Sanjay Gupta
- Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Unit 1471, PO Box 301402, Houston, TX, 77230-1402, USA.
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Jeon CH, Seong NJ, Yoon CJ, Byun SS, Lee SE. Clinical results of renal artery embolization to control postoperative hemorrhage after partial nephrectomy. Acta Radiol Open 2016; 5:2058460116655833. [PMID: 27570638 PMCID: PMC4984322 DOI: 10.1177/2058460116655833] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2015] [Accepted: 05/30/2016] [Indexed: 01/20/2023] Open
Abstract
Background With the wider application of nephron-sparing surgery, there has been an increase in the occurrence of postoperative hemorrhage. However, despite such an increase, there are only a limited number of reports regarding renal artery embolization (RAE) for the management of postoperative bleeding after nephron-sparing surgery, especially after robot-assisted laparoscopic partial nephrectomy (RALPN). Purpose To evaluate the safety and clinical efficacy of transcatheter RAE for postoperative hemorrhage after open partial nephrectomy (OPN) and RALPN. Material and Methods A total of 29 patients (17 men, 12 women; age range, 31–70 years) who were referred to our hospital for postoperative hemorrhage after partial nephrectomy, between December 2003 and December 2014, were selected. We retrospectively reviewed patients’ clinical data, angiographic findings, embolization details, and clinical outcomes. Results Embolization was performed in patients who underwent OPN (25/29) and RALPN (4/29). The angiographic findings were as follows: renal artery pseudoaneurysm (n = 18), contrast extravasation (n = 8), and arteriovenous fistula (n = 3). Fiber-coated microcoil and n-butyl-2-cyanoacrylate (NBCA) was administered to the targeted bleeding renal arteries in 12 and 11 patients, respectively. In six patients, fiber-coated microcoil and NBCA were used concurrently. Technical and clinical successes were achieved in all patients (100%). Bleeding cessation was achieved in all patients, and no further relevant surgeries or interventions were required for hemorrhage control. There were no episodes of hemorrhagic recurrence during the follow-up period (median, 20 days; range, 7–108 days). Conclusion Angiography and RAE identified the origin of bleeding and could successfully preserve the residual renal function.
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Affiliation(s)
- Chang Ho Jeon
- Department of Radiology, Seoul National University Bundang Hospital, Gyeonggi-do, Republic of Korea
| | - Nak Jong Seong
- Department of Radiology, Seoul National University Bundang Hospital, Gyeonggi-do, Republic of Korea
| | - Chang Jin Yoon
- Department of Radiology, Seoul National University Bundang Hospital, Gyeonggi-do, Republic of Korea
| | - Seok-Soo Byun
- Department of Urology, Seoul National University Bundang Hospital, Gyeonggi-do, Republic of Korea
| | - Sang Eun Lee
- Department of Urology, Seoul National University Bundang Hospital, Gyeonggi-do, Republic of Korea
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Tinto H, Di Primio M, Tselikas L, Rico AP, Pellerin O, Pagny JY, Sapoval M. Selective arterial embolization of life-threatening renal hemorrhage in four patients after partial nephrectomy. Diagn Interv Imaging 2014; 95:601-9. [DOI: 10.1016/j.diii.2014.02.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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13
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Jack GS, Lua M, Chan Y, Bolton DM. Integration of laparoscopic partial nephrectomy into an Australian public hospital: three-year follow-up of our initial 50 cases. BJU Int 2012; 109 Suppl 3:35-9. [PMID: 22458491 DOI: 10.1111/j.1464-410x.2012.11043.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To examine the early outcomes and complications of integrating laparoscopic partial nephrectomy (LPN) into a public teaching hospital in Australia. PATIENTS AND METHODS An outcomes review from prospectively collected data on our initial 50 cases of LPN. The median follow-up was 36 months with a minimum follow-up of 2 years and a maximum of 5 years. RESULTS The mean patient age was 60 years, mean tumour size was 2.9 cm, and mean baseline creatinine concentration was 79 µmol/L. One patient had a solitary kidney, and one patient had bilateral tumours. The mean operative duration was 168 min, with a mean warm ischaemia time of 25 min. The median blood loss was 100 mL and the median (range) hospital stay was 4 (2-12) days. The complication rate was 6%, including two instances of secondary haemorrhage, and one port-site hernia. No patient required conversion to radical nephrectomy or experienced clinically significant deterioration in their renal function. There have been no local or systemic recurrences to date, with a maximum follow-up of 5 years. CONCLUSIONS LPN can be successfully integrated into the Australian public health care sector as standard of care for stage 1 renal masses requiring treatment. Due to the inherent risk of bleeding early in the learning curve, cases should be performed in the setting of adequate surgical and interventional radiographic support.
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Affiliation(s)
- Gregory S Jack
- Division of Urology, Austin Health, Heidelberg, Victoria, Australia.
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Huber J, Pahernik S, Hallscheidt P, Sommer CM, Hatiboglu G, Haferkamp A, Hohenfellner M. Risk factors and clinical management of haemorrhage after open nephron-sparing surgery. BJU Int 2010; 106:1488-93. [DOI: 10.1111/j.1464-410x.2010.09345.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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15
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Sommer CM, Stampfl U, Bellemann N, Ramsauer S, Loenard BM, Haferkamp A, Hallscheidt P, Richter GM, Kauczor HU, Radeleff BA. Patients with Life-Threatening Arterial Renal Hemorrhage: CT Angiography and Catheter Angiography with Subsequent Superselective Embolization. Cardiovasc Intervent Radiol 2010; 33:498-508. [DOI: 10.1007/s00270-009-9787-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2009] [Accepted: 11/02/2009] [Indexed: 10/20/2022]
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