Treatment of renal-vascular injury by transcatheter embolization: immediate and long-term effects on renal function.
OBJECTIVE
To evaluate the impact of superselective embolization for treatment of renal-vascular injuries on renal function.


METHODS
Between 1995 and 2004, four male patients and one female patient with a mean age of 45.4 years underwent embolization to control bleeding from renal-vascular injuries resulting from iatrogenic interventions (N = 4) or blunt abdominal trauma (N = 1). Angiography depicted a pseudoaneurysm in all patients, together with an arteriovenous fistula in one. Superselective embolization was achieved with 0.035- or 0.018-inch coils combined with a mixture of Histoacryl and Lipiodol in one patient.


RESULTS
Bleeding was controlled in all patients and did not recur. No complications occurred after the procedure. Hematuria ceased within 3 days. The serum creatinine concentration returned to pre-injury values within 10 days. Embolization caused an immediate parenchymal ischemic area of 0 to 20% (mean 9%). The contrast-enhanced CT scan 6 months after the procedure revealed a parenchymal perfusion deficit of 0 to 10% (mean 5%).


CONCLUSIONS
Superselective embolization resulted in permanent cessation of bleeding. Renal function was preserved in all the patients, and serum creatinine concentrations returned to the pre-injury values. Transcatheter embolization should be considered the treatment of choice in the management of renal-vascular injuries.
Poulakis
Vassilis
V
Department of Urology, Krankenhaus Nordwest, Stiftung Hospital zum Heiligen Geist, Frankfurt am Main, Germany. vpoulakis@aol.com
Ferakis
Nikolaos
N
Becht
Eduard
E
Deliveliotis
Charalabos
C
Duex
Markus
M
D000007:Abdominal Injuries / Q000150:complications*; D000328:Adult; D017541:Aneurysm, False / Q000150:complications; D000792:Angiography; D001164:Arteriovenous Fistula / Q000150:complications; D003287:Contrast Media; D004621:Embolization, Therapeutic / Q000379:methods*; D004659:Enbucrilate; D005260:Female; D005500:Follow-Up Studies; D006417:Hematuria / Q000209:etiology / Q000628:therapy; D006470:Hemorrhage / Q000209:etiology / Q000628:therapy*; D006801:Humans; D007459:Iodized Oil; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000009:adverse effects*; D011183:Postoperative Complications / Q000628:therapy; D012077:Renal Artery / Q000293:injuries*; D012189:Retrospective Studies; D014949:Wounds, Nonpenetrating / Q000150:complications
D003287:Contrast Media; D007459:Iodized Oil; D004659:Enbucrilate