title: Contemporary comparison of surgical and interventional arteriography management of blunt renal injury.
abstract: OBJECTIVE
  High-grade renal injuries have traditionally been treated operatively. Alternatively, embolotherapy is used to control hemorrhage, but there are few studies that validate this practice after renal injury. Embolotherapy may offer an effective and safe means to arrest hemorrhage after high-grade blunt renal injury.
  
  
  METHODS
  Retrospective analysis was performed of high-grade renal injury (grade III or higher). Patients who were initially treated with arteriography were compared with those who underwent surgery. Statistical analysis was performed with Wilcoxon rank-sum and χ(2) tests.
  
  
  RESULTS
  Sixty-nine patients were identified, 28 of whom had contrast agent extravasation on computed tomography (CT). Of these 69 patients, 17 underwent operation and 20 underwent arteriography. The surgical cohort had a higher injury severity score (39.6 vs 24.2; P < .01), but there was no difference in renal injury grade (P = .9). The arteriography cohort received significantly more contrast medium (P < .001). Contrast agent extravasation was confirmed angiographically in six of 12 patients who had this finding on CT, and embolotherapy controlled bleeding in all six. No significant difference was noted in transfusion need, recurrent hemorrhage, creatinine level at discharge, glomerular filtration rate, or length of stay (P > .4 for each endpoint). There was a trend toward a longer stay in the intensive care unit in the surgical cohort and a higher likelihood of discharge to home in the arteriography group (P = .08 for each endpoint).
  
  
  CONCLUSIONS
  Embolotherapy offers a safe means to diagnose and arrest hemorrhage after renal injury. The additional contrast agent needed for imaging does not increase the incidence of nephropathy irrespective of renal injury grade.
authors.affiliation: Department of Surgery, Division of Traumatology, Surgical Critical Care, and Emergency Surgery, Hospital of University of Pennsylvania, Philadelphia, Pennsylvania, USA. saranib@uphs.upenn.edu
authors.forename: Babak
authors.initials: B
authors.lastname: Sarani
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Powell
authors.forename: Joseph
authors.initials: J
authors.lastname: Taddeo
authors.forename: Brendan
authors.initials: B
authors.lastname: Carr
authors.forename: Aalpen
authors.initials: A
authors.lastname: Patel
authors.forename: Mark
authors.initials: M
authors.lastname: Seamon
authors.forename: Jessica
authors.initials: J
authors.lastname: Wobb
authors.forename: Carrie
authors.initials: C
authors.lastname: Sims
authors.forename: Jose
authors.initials: J
authors.lastname: Pascual
authors.forename: C William
authors.initials: CW
authors.lastname: Schwab
mesh_terms: D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood; D001803:Blood Transfusion; D016009:Chi-Square Distribution; D003287:Contrast Media; D003404:Creatinine / Q000097:blood; D004621:Embolization, Therapeutic / Q000009:adverse effects / Q000401:mortality; D005260:Female; D005919:Glomerular Filtration Rate; D006470:Hemorrhage / Q000000981:diagnostic imaging / Q000209:etiology / Q000401:mortality / Q000601:surgery / Q000628:therapy*; D006801:Humans; D007362:Intensive Care Units; D007668:Kidney / Q000000981:diagnostic imaging / Q000293:injuries / Q000601:surgery*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge; D015143:Philadelphia; D015641:Radiography, Interventional / Q000009:adverse effects / Q000401:mortality; D012008:Recurrence; D012042:Registries; D012044:Regression Analysis; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D012866:Skilled Nursing Facilities; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D014193:Trauma Centers; D016896:Treatment Outcome; D013520:Urologic Surgical Procedures / Q000009:adverse effects / Q000401:mortality; D014949:Wounds, Nonpenetrating / Q000150:complications / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery / Q000628:therapy*; D055815:Young Adult
chemical_list: D015415:Biomarkers; D003287:Contrast Media; D003404:Creatinine