title: Early postoperative screening by contrast-enhanced CT and prophylactic embolization of detected pseudoaneurysms prevents delayed hemorrhage after partial nephrectomy.
abstract: OBJECTIVE
  To evaluate retrospectively whether prophylactic embolization of pseudoaneurysms detected on early postoperative screening with computed tomography (CT) after partial nephrectomy can prevent delayed hemorrhage.
  
  
  METHODS
  Between January 2012 and May 2014, early postoperative contrast-enhanced CT was performed 3-5 days after partial nephrectomy in 312 patients (group A); CT was not performed in 65 patients (group B) because of renal insufficiency or contrast medium allergy. If pseudoaneurysms were detected on CT in group A, prophylactic embolization was performed. The frequency of delayed hemorrhage occurring more than 3 days after surgery in group A was compared with group B and with 212 patients (group C) who underwent partial nephrectomy between January 2010 and December 2011 without early postoperative CT. Changes in estimated glomerular filtration rate at discharge were compared among the groups.
  
  
  RESULTS
  Prophylactic embolization of pseudoaneurysms was performed in 26 patients (8%) in group A. Frequency of delayed hemorrhage in group A (0.6%) was significantly lower than in groups B (4.6%; P = .038) and C (4.7%; P = .005). No major complications attributable to prophylactic embolization were observed. The decrease in estimated glomerular filtration rate in group A (-2% ± 13%) was smaller than that in group B (-8% ± 13%; P < .001) and not worse than that in group C (-4% ± 14%; P = .108).
  
  
  CONCLUSIONS
  Prophylactic embolization of pseudoaneurysms detected on early postoperative CT can prevent delayed hemorrhage after partial nephrectomy, without major complications.
authors.affiliation: Department of Diagnostic Imaging and Nuclear Medicine (Radiology), Tokyo Women's Medical University Hospital, 8-1, Kawada-cho, Tokyo162-8666, Japan. Electronic address: i@imodey.com.
authors.forename: Satoru
authors.initials: S
authors.lastname: Morita
authors.affiliation: Department of Diagnostic Imaging and Nuclear Medicine (Radiology), Tokyo Women's Medical University Hospital, 8-1, Kawada-cho, Tokyo162-8666, Japan.
authors.forename: Tsuyoshi
authors.initials: T
authors.lastname: Tajima
authors.affiliation: Department of Diagnostic Imaging and Nuclear Medicine (Radiology), Tokyo Women's Medical University Hospital, 8-1, Kawada-cho, Tokyo162-8666, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Yamazaki
authors.affiliation: Department of Diagnostic Imaging and Nuclear Medicine (Radiology), Tokyo Women's Medical University Hospital, 8-1, Kawada-cho, Tokyo162-8666, Japan.
authors.forename: Yasuyuki
authors.initials: Y
authors.lastname: Sonoyama
authors.affiliation: Department of Diagnostic Imaging and Nuclear Medicine (Radiology), Tokyo Women's Medical University Hospital, 8-1, Kawada-cho, Tokyo162-8666, Japan.
authors.forename: Yu
authors.initials: Y
authors.lastname: Nishina
authors.affiliation: Department of Urology, Tokyo Women's Medical University Hospital, 8-1, Kawada-cho, Tokyo162-8666, Japan.
authors.forename: Omae
authors.initials: O
authors.lastname: Kenji
authors.affiliation: Department of Urology, Tokyo Women's Medical University Hospital, 8-1, Kawada-cho, Tokyo162-8666, Japan.
authors.forename: Toshio
authors.initials: T
authors.lastname: Takagi
authors.affiliation: Department of Urology, Tokyo Women's Medical University Hospital, 8-1, Kawada-cho, Tokyo162-8666, Japan.
authors.forename: Tsunenori
authors.initials: T
authors.lastname: Kondo
authors.affiliation: Department of Urology, Tokyo Women's Medical University Hospital, 8-1, Kawada-cho, Tokyo162-8666, Japan.
authors.forename: Kazunari
authors.initials: K
authors.lastname: Tanabe
authors.affiliation: Department of Diagnostic Imaging and Nuclear Medicine (Radiology), Tokyo Women's Medical University Hospital, 8-1, Kawada-cho, Tokyo162-8666, Japan.
authors.forename: Shuji
authors.initials: S
authors.lastname: Sakai
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017541:Aneurysm, False / Q000000981:diagnostic imaging* / Q000209:etiology / Q000628:therapy*; D003287:Contrast Media; D042241:Early Diagnosis; D004621:Embolization, Therapeutic / Q000009:adverse effects; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography; D009392:Nephrectomy / Q000009:adverse effects*; D019106:Postoperative Hemorrhage / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control*; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D003287:Contrast Media