title: Angiointervention: high rates of failure following blunt renal injuries.
abstract: BACKGROUND
  Nonoperative management (NOM) of solid organ injury after blunt trauma is now standard. Recently, angioembolization (AE) has been used to extend NOM. Few data exist on evaluating NOM of blunt renal injuries (BRIs). We sought to determine the overall efficacy of NOM as well as the outcome of AE in patients with BRI.
  
  
  METHODS
  The trauma registry was used to identify all patients with BRI between January 2002 and December 2008. Medical records were reviewed for demographics, grade of injury, use of angiographic intervention, and outcome.
  
  
  RESULTS
  A total of 434 patients with BRI were identified, 416 of whom had planned NOM; 337 (81%) patients were successfully managed without further intervention for their BRI. In all, 79 (19%) patients underwent angiography; 22 (27.8%) of these patients underwent AE, and 6 (27.2%) failed 1.2 ± 0.8 days after AE. Patients who failed AE had a significantly higher blood transfusion requirement during the first 24 h of admission (p = 0.01). Seven patients not embolized failed 1.9 ± 1.9 days after angiography. Thus, of the 79 patients having angiography, 13 (16.5%) failed and required laparotomy to treat their BRIs. Overall failure rate of NOM was 3.1% (13/416). Patients who failed angiography, with or without AE, required more blood during the first 24 h after admission (p = 0.03).
  
  
  CONCLUSIONS
  NOM of BRI is safe and effective, with an overall failure rate of 3.1%. However, angiography with or without AE has substantial failure rates. Patients with higher-grade injuries and active vascular extravasation on admission computed tomography scan also fail NOM regardless of therapy. The blood transfusion requirement during the first 24 h may indicate who will require operative intervention following angiography. Close observation and/or early laparotomy are wise for these high-risk patients.
authors.affiliation: Department of Surgery, University of Maryland School of Medicine, Division Trauma/Critical Care, R Adams Cowley Shock Trauma Center, 22 South Greene Street, T1R60, Baltimore, MD 21201, USA. jmenaker@umm.edu
authors.forename: Jay
authors.initials: J
authors.lastname: Menaker
authors.forename: Bellal
authors.initials: B
authors.lastname: Joseph
authors.forename: Deborah M
authors.initials: DM
authors.lastname: Stein
authors.forename: Thomas M
authors.initials: TM
authors.lastname: Scalea
mesh_terms: D000007:Abdominal Injuries / Q000000981:diagnostic imaging / Q000628:therapy; D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000792:Angiography / Q000379:methods; D015331:Cohort Studies; D004621:Embolization, Therapeutic / Q000009:adverse effects* / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007668:Kidney / Q000000981:diagnostic imaging / Q000293:injuries*; D007813:Laparotomy / Q000379:methods; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000379:methods; D015641:Radiography, Interventional / Q000379:methods; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment; D012737:Sex Factors; D017211:Treatment Failure; D014481:United States; D014949:Wounds, Nonpenetrating / Q000000981:diagnostic imaging* / Q000628:therapy*; D055815:Young Adult