Incidence of postembolization syndrome after complete renal angioinfarction: a single-institution experience over four years.
OBJECTIVE
Renal angioinfarction (RAI) has been used for various indications in the management of renal tumors. While historically used for palliation of local symptoms (pain or hematuria), this technique has theoretical use in facilitating radical nephrectomy by allowing early ligation of the renal vein, decreasing blood loss and creating edema in resection planes. A common impediment to embolization is the development of postembolization syndrome (PES), which has been reported to have an incidence as high as 89%. This study reports the authors' experience with RAI as a safe palliative and adjunctive procedure over 4 years.


METHODS
From 2008 to 2011, 113 patients underwent complete RAI at Washington Hospital Center for palliative or adjunctive therapy by an interventional radiologist. Procedures were performed in a radiology suite using mild sedation with vascular access obtained by femoral artery puncture. RAI was performed by subsegmental injection of polyvinyl alcohol particles.


RESULTS
All 113 patients underwent successful RAI with confirmation of total arterial flow ablation via postprocedure arteriogram: 38 underwent embolization for preoperative adjunctive therapy, 34 for palliation of renal mass, 36 for trauma/hemorrhage and five for symptomatic renal artery pseudoaneurysm after partial nephrectomy. PES occurred in 33 out of 75 patients (44.0%), with symptomatic PES in only two patients (2.6%). No major complications (>Clavien grade III) occurred. Thirty-eight patients were excluded from analysis as they underwent radical nephrectomy within 24 h, preventing accurate assessment of PES.


CONCLUSIONS
RAI is a safe and reliable procedure for palliation of renal masses, as an adjunctive procedure for radical nephrectomy, and for conservative management of renal hemorrhage or aneurysm. PES occurs in relatively few patients, with no major complications, and should not impede clinical consideration of this procedure.
Departments of Urology, Washington Hospital Center , Washington DC , USA.
Anup
A
Vora
Rachel
R
Brodsky
John
J
Nolan
Sathya
S
Ram
Lee
L
Richter
Christopher
C
Yingling
Krishnan
K
Venkatesan
Reza
R
Ghasemian
Jonathan
J
Hwang
Keith
K
Horton
Mohan
M
Verghese
D000328:Adult; D000368:Aged; D000783:Aneurysm / Q000628:therapy*; D015331:Cohort Studies; D004621:Embolization, Therapeutic / Q000009:adverse effects*; D005260:Female; D005334:Fever / Q000209:etiology*; D006801:Humans; D007418:Intestinal Pseudo-Obstruction / Q000209:etiology*; D007668:Kidney / Q000293:injuries; D007680:Kidney Neoplasms / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009325:Nausea / Q000209:etiology*; D009392:Nephrectomy; D010146:Pain / Q000209:etiology*; D010166:Palliative Care; D012077:Renal Artery; D012189:Retrospective Studies; D013577:Syndrome
postembolization syndrome; renal angioinfarction; renal embolization