title: Renal function outcomes following selective angioembolization for iatrogenic vascular lesions after partial nephrectomy.
abstract: OBJECTIVE
  To report one of the largest series of clinical and renal function outcomes of treated iatrogenic vascular lesions (IVL) after partial nephrectomy (PN). Angioembolization (AE) is the treatment of choice for patients with these lesions, but the additional renal injury conferred by this treatment has not been well described.
  
  
  METHODS
  Patients who underwent open, laparoscopic, or robot-assisted PN from 2002 to 2012 were identified and those with AE were selected. Patients' charts were reviewed, and renal function was analyzed using estimated glomerular filtration rate (eGFR) and progression of chronic kidney disease (CKD) classification before and after PN and AE.
  
  
  RESULTS
  There were 849 patients who underwent PN and an IVL developed in 28 (3.3%). Twenty (71%) presented with gross hematuria at a mean of 10.2 ± 7.7 days after PN and 8 (28%) needed transfusion. All patients had identifiable IVL at the time of selective AE, and technical success was achieved in 24/28 (86%), although 4 needed subsequent additional AE. The paired decrease in eGFR after PN was significant (P<0.01), while the paired change in eGFR after AE was not with either short-term (2.8 days) or intermediate-term (362 days) follow-up (P=0.50). Four patients experienced transient worsening in CKD classification after AE, although three experienced CKD stage improvement.
  
  
  CONCLUSIONS
  Selective AE for IVL after PN is safe, efficacious, and does not lead to a significant impairment of renal function. It remains the preferred approach for the evaluation and management of post-PN hemorrhage.
authors.affiliation: 1 Department of Urology, University of Texas Southwestern Medical Center , Dallas, Texas.
authors.forename: Jeffrey C
authors.initials: JC
authors.lastname: Gahan
authors.forename: Mansi
authors.initials: M
authors.lastname: Gaitonde
authors.forename: Luis
authors.initials: L
authors.lastname: Wadskier
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Cadeddu
authors.forename: Clayton
authors.initials: C
authors.lastname: Trimmer
mesh_terms: D000328:Adult; D000368:Aged; D002292:Carcinoma, Renal Cell / Q000473:pathology / Q000503:physiopathology / Q000601:surgery; D018450:Disease Progression; D004621:Embolization, Therapeutic / Q000379:methods*; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D007049:Iatrogenic Disease; D007668:Kidney / Q000098:blood supply / Q000503:physiopathology*; D007680:Kidney Neoplasms / Q000503:physiopathology / Q000601:surgery*; D010535:Laparoscopy / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000009:adverse effects* / Q000379:methods; D019106:Postoperative Hemorrhage / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D012077:Renal Artery / Q000293:injuries; D016896:Treatment Outcome