Multiple Renal Artery Pseudoaneurysms in Patients Undergoing Renal Artery Embolization Following Partial Nephrectomy: Correlation with RENAL Nephrometry Scores.
OBJECTIVE
To describe the incidence of multiple renal artery pseudoaneurysms (PSA) in patients referred for renal artery embolization following partial nephrectomy and to study its relationship to RENAL nephrometry scores.


METHODS
The medical records of 25 patients referred for renal artery embolization after partial nephrectomy were retrospectively reviewed for the following parameters: size and number of tumors, RENAL nephrometry scores, angiographic abnormalities, technical and clinical outcomes, and estimated glomerular filtration rates (eGFRs) after embolization.


RESULTS
Twenty-four patients had primary renal tumors, while 1 patient had a pancreatic tumor invading the kidney. Multiple tumors were resected in 4 patients. Most patients (92 %) were symptomatic, presenting with gross hematuria, flank pain, or both. Angiography revealed PSA with (n = 5) or without (n = 20) AV fistulae. Sixteen patients (64 %) had multiple PSA involving multiple renal vessels. Higher RENAL nephrometry scores were associated with an increasing likelihood of multiple PSA. Multiple vessels were embolized in 14 patients (56 %). Clinical success was achieved after one (n = 22) or two (n = 3) embolization sessions in all patients. Post-embolization eGFR values at different time points after embolization were not significantly different from the post-operative eGFR.


CONCLUSIONS
A majority of patients requiring renal artery embolization following partial nephrectomy have multiple pseudoaneurysms, often requiring selective embolization of multiple vessels. Higher RENAL nephrometry score is associated with an increasing likelihood of multiple pseudoaneurysms. We found transarterial embolization to be a safe and effective treatment option with no long-term adverse effect on renal function in all but one patient with a solitary kidney.
Houston Methodist Hospital, Houston, TX, USA.
Nakul
N
Gupta
The University of Texas Southwestern Medical Center, Dallas, TX, USA.
Anish
A
Patel
The Houston Methodist Cancer Center, Houston Methodist Research Institute, Houston, TX, USA.
Joe
J
Ensor
Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Unit 1471, PO Box 301402, Houston, TX, 77230-1402, USA.
Kamran
K
Ahrar
Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Unit 1471, PO Box 301402, Houston, TX, 77230-1402, USA.
Judy
J
Ahrar
Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Unit 1471, PO Box 301402, Houston, TX, 77230-1402, USA.
Alda
A
Tam
Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Unit 1471, PO Box 301402, Houston, TX, 77230-1402, USA.
Bruno
B
Odisio
Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Unit 1471, PO Box 301402, Houston, TX, 77230-1402, USA.
Stephen
S
Huang
Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Unit 1471, PO Box 301402, Houston, TX, 77230-1402, USA.
Ravi
R
Murthy
Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Unit 1471, PO Box 301402, Houston, TX, 77230-1402, USA.
Armeen
A
Mahvash
Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Unit 1471, PO Box 301402, Houston, TX, 77230-1402, USA.
Rony
R
Avritscher
Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Unit 1471, PO Box 301402, Houston, TX, 77230-1402, USA.
Stephen
S
McRae
Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Unit 1471, PO Box 301402, Houston, TX, 77230-1402, USA.
Sharjeel
S
Sabir
Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Unit 1471, PO Box 301402, Houston, TX, 77230-1402, USA.
Michael
M
Wallace
Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
Surena
S
Matin
Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Unit 1471, PO Box 301402, Houston, TX, 77230-1402, USA. sgupta@mdanderson.org.
Sanjay
S
Gupta
D000368:Aged; D000369:Aged, 80 and over; D017541:Aneurysm, False / Q000150:complications / Q000000981:diagnostic imaging* / Q000473:pathology; D004621:Embolization, Therapeutic / Q000379:methods*; D005260:Female; D006801:Humans; D007668:Kidney / Q000601:surgery; D007680:Kidney Neoplasms / Q000150:complications / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000503:physiopathology; D012077:Renal Artery / Q000000981:diagnostic imaging / Q000473:pathology / Q000503:physiopathology*; D012189:Retrospective Studies; D016896:Treatment Outcome
Partial nephrectomy; Renal artery embolization; Renal artery pseudoaneurysms