title: Transcatheter embolisation of iatrogenic renal vascular injuries.
abstract: OBJECTIVE
  The aim of our study was to review our experience and long-term follow-up in the treatment of iatrogenic renal vascular injuries using transcatheter embolisation.
  
  
  METHODS
  Our retrospective analysis of cases collected in two interventional centres consists of a total of 21 patients who underwent renal arterial embolisation (RAE) for iatrogenic arterial kidney bleeding. Biopsy (n = 4), percutaneous nephrolithotomy (n = 4), nephron-sparing surgery (n = 4), guidewire-induced arterial perforation during coronary angiography or renal stenting (n = 3), percutaneous nephrostomy (n = 3), renal endopyelotomy/pyeloplasty (n = 2) and surgical nephrectomy were the iatrogenic causes. Seven patients presented with haemodynamic instability requiring blood transfusion (33.3%), the remaining were haemodynamically stable (66.7%). Diagnostic renal angiography revealed 9 actively bleeding vessels, 6 pseudoaneurysms, 4 arteriovenous fistulas and 1 arterio-calyceal fistula. In one patient selective renal arteriography was negative probably because the bleeding observed at CT angiography was self-limited. Twenty-one embolisation procedures were performed in 20 patients; one patient required a second embolisation 3 h after the first one. Embolisation was performed with microcoils, polyvinyl alcohol particles, embospheres, spongostan emulsion and vascular plug.
  
  
  RESULTS
  The technical success rate was 100%. The overall clinical success rate was 95%. Apart from a patient who died due to disseminated intravascular coagulation, no major complications requiring intensive care treatment were encountered during or after the procedures. No patient required emergency surgery or subsequent surgical treatment. No statistically significant differences in eGFR or renal function stage appeared after RAE.
  
  
  CONCLUSIONS
  Percutaneous treatment can be proposed as a first-line treatment in iatrogenic renal arterial injuries, resulting in a safe and effective procedure.
authors.affiliation: Interventional Radiology, Department of Radiology, Insubria University, Viale Borri 57, 21100, Varese, Italy.
authors.forename: Anna Maria
authors.initials: AM
authors.lastname: Ierardi
authors.forename: Chiara
authors.initials: C
authors.lastname: Floridi
authors.forename: Federico
authors.initials: F
authors.lastname: Fontana
authors.forename: Ejona
authors.initials: E
authors.lastname: Duka
authors.forename: Antonio
authors.initials: A
authors.lastname: Pinto
authors.forename: Mario
authors.initials: M
authors.lastname: Petrillo
authors.forename: Elias
authors.initials: E
authors.lastname: Kehagias
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Tsetis
authors.forename: Luca
authors.initials: L
authors.lastname: Brunese
authors.forename: Gianpaolo
authors.initials: G
authors.lastname: Carrafiello
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000792:Angiography; D001803:Blood Transfusion; D004621:Embolization, Therapeutic / Q000295:instrumentation / Q000379:methods*; D005260:Female; D006439:Hemodynamics; D006801:Humans; D007049:Iatrogenic Disease; D008297:Male; D008875:Middle Aged; D012077:Renal Artery / Q000293:injuries*; D012189:Retrospective Studies; D016896:Treatment Outcome; D057772:Vascular System Injuries / Q000209:etiology* / Q000628:therapy*