Transcatheter renal arterial embolization for intractable urinary fistula occurring after robot-assisted partial nephrectomy: a case report.

Partial nephrectomy is the standard surgical procedure for small renal tumors. Since the advent of robot-assisted partial nephrectomy (RAPN), the number of cases of renal tumors undergoing the procedure has increased exponentially. Urinary fistula is a complication of partial nephrectomy. Conservative management using ureteral stents is useful in most cases of urinary fistulas. However, some patients develop intractable urinary fistulas. Herein, we report a case in which vascular embolization was useful for treating an infected and intractable urinary fistula that developed after RAPN. A 59-year-old man was accidentally found to have a right renal tumor (approximately 3 cm in diameter) during a physical examination. Pathology was clear cell carcinoma. RAPN was performed owing to the small size of the renal tumor; however, postoperatively, an intractable urinary fistula with an isolated calyx developed, which was successfully treated with transcatheter renal arterial embolization (TAE). We encountered a rare case of infected refractory urinary fistula with an isolated calyx in which TAE was successful. TAE seems useful in treating intractable urinary fistulas with an isolated calyx occurring after RAPN.

Renal arterial embolization: Indications, angiographic findings, and outcomes in a series of 170 patients.

Background: The lack of overall experience and reporting on angiographic findings in previously published studies of renal arterial embolization (RAE) compelled us to report our overall experience on a series of patients. Materials and methods: A retrospective study was performed analyzing data of patients enrolled for RAE between 2010 and 2019. History, physical examination, and laboratory data were reviewed for all patients. Abdominal ultrasound was the initial imaging study, and all patients underwent subsequent computed tomography or magnetic resonance imaging. The outcome of RAE was determined based on radiographic and clinical findings. Results: Data from 202 patients were analyzed, with a mean age of 45 ± 15 years, and 71.3% of patients were male. Iatrogenic injury was the most common indication for RAE (54%), followed by renal tumors, trauma, and spontaneous, in 27.7%, 10.4%, and 8.4% of patients, respectively. Renal angiography revealing pseudoaneurysm alone or with other pathology in the lower pole of the kidney was the most common finding (40.6%), whereas no lesions were identified on angiography in 32 patients (15.8%), after which RAE was subsequently aborted. Renal arterial embolization was successful in 158 of 170 patients (92.9%) after 1 or more trials (maximum of 4). Microcoil alone or with other embolic materials was the most commonly used material for embolization (85%). Conclusions: Iatrogenic injury was the most common indication for RAE. Pseudoaneurysm alone or with other lesions was the most common lesion on renal angiography; however, angiography showed a negative result in 16% of patients, even those with symptoms. When lesions are present on angiography, the overall success of repeated trials of RAE reached 92.9%.

Superselective renal arterial embolization for severe postpercutaneous nephrolithotomy haemorrhage: clinical characteristics and risk factors for initial failure.

OBJECTIVE: To identify the clinical characteristics of patients who underwent superselective renal arterial embolization (SRAE) after percutaneous nephrolithotomy (PCNL) and to explore the risk factors for failed initial SRAE after PCNL. MATERIALS AND METHODS: Patients who underwent SRAE for severe haemorrhage following PCNL between January 2014 and December 2020 were included in the study. The clinical data of those patients and the parameters and characteristics of the perioperative PCNL and SRAE procedures were collected and analysed. RESULTS: A total of 243 patients were included in this study. A total of 139 patients (57.2%) had a pseudoaneurysm, 25 (10.3%) had an arteriovenous fistula, 50 (20.6%) patients had both a pseudoaneurysm and an arteriovenous fistula, and 29 (11.9%) had an arterial laceration. In 177 patients with single percutaneous access, 125 (70.6%) patients exhibited nontract haemorrhage, and 55 (31.1%) patients exhibited multiple bleeding sites. In 66 patients with multiple percutaneous access, 44 (66.7%) patients exhibited nontract haemorrhage, and 32 (48.5%) patients exhibited multiple bleeding sites. The decrease in Hb before SRAE was 41.4 ± 19.8 g/L. The mean time between PCNL surgery and initial SRAE was 6.4 ± 4.9 days. Serum creatinine was increased after the SRAE procedure. Initial SRAE was successful in 229 (94.2%) patients and failed in 14 (5.8%) patients. Multivariate regression demonstrated that hydronephrosis < 20 mm, total ultrasonographic guidance, solitary kidney, previous ipsilateral renal surgery, PCNL duration > 90 min and multiple bleeding sites were potential risk factors for initial embolization failure. CONCLUSION: Percutaneous access was not the most important reason for post-PCNL severe haemorrhage. SRAE is effective for the treatment of severe haemorrhage following PCNL; however, several factors have an impact on the success of initial SRAE. Additionally, the SRAE procedure may affect renal function.

Percutaneous transcatheter super-selective renal arterial embolization with N-butyl cyanoacrylate for iatrogenic renal hemorrhage.

Background: To evaluate the safety and efficacy of percutaneous transcatheter super-selective renal arterial embolization (SRAE) with N-butyl cyanoacrylate (NBCA) for iatrogenic renal hemorrhage. Methods: Between January 2014 and December 2019, 45 patients (including 18 patients with coagulopathy), who underwent percutaneous transcatheter SRAE with NBCA for iatrogenic renal hemorrhage at our institution, were retrospectively reviewed. The technical success rate, clinical success rate, and embolization-related complications were analyzed. The values of estimated glomerular filtration rate (eGFR), serum creatinine (sCr), and serum urea (sUr) were analyzed at the time of pre-SRAE, post-SRAE, and last follow-up to evaluate the effects of NBCA-based SRAE on renal function. Results: Diagnostic renal arteriography revealed contrast extravasation in 18 patients and pseudoaneurysms in 27 patients. NBCA mixed with iodized oil in a 1:2-1:4 ratio was the sole embolic agent. No procedure-related mortality or major complications occurred. The technical and clinical success rates were both 100%. The values of eGFR, sCr and sUr were not found to be significantly different between pre-SRAE, post-SRAE and last follow-up (eGFR: 91.52 â€‹± â€‹21.17 vs. 90.98 â€‹± â€‹22.11 vs. 92.14 â€‹± â€‹23.51 â€‹mL/min/1.73 â€‹m2, p â€‹= â€‹0.729; sCr: 74.73 â€‹± â€‹11.08 vs. 75.27 â€‹± â€‹12.43 vs. 73.95 â€‹± â€‹10.14 â€‹µmol/L, p â€‹= â€‹0.543; sUr: 5.69 â€‹± â€‹0.84 vs. 5.71 â€‹± â€‹0.96 vs. 5.70 â€‹± â€‹0.79, p â€‹= â€‹0.515, respectively). Conclusions: Percutaneous transcatheter SRAE with NBCA is a safe and effective treatment modality for iatrogenic renal hemorrhage with no deterioration of renal function.

Endovascular Management of Iatrogenic Renal Vascular Injuries: Case Series and Systematic Review.

Minimally invasive techniques for the treatment and diagnosis of kidney disease seek to preserve the greatest amount of parenchyma. Bleeding after these practices is rare, but must be treated quickly given its severity. Iatrogenic renal vascular injuries (IRVI) resulting from these procedures include active bleeding, arterial pseudoaneurysms, and arteriovenous fistulas. Renal artery embolization (RAE) is the main pillar in the treatment of this type of complications. OBJECTIVE: To assess the results of RAE for the treatment of IRVI and its impact on the renal function of patients. METHOD: Retrospective analysis of all patients who presented vascular complications after renal procedures and who were referred for management by RAE, between August 2012 and December 2020. RESULTS: 18 patients were included. 4 patients presented with pseudoaneurysm, 10 patients with active bleeding, and 1 patient with arteriovenous fistula; 2 patients had a combination of different IRVI; 1 patient did not present any findings at the time of renal angiography in dissonance with her computed tomography angiography. Technical and clinical success was achieved in all patients. One renal artery dissection was the only complication. No differences were found in serum creatinine (p = 0.51), urea (p = 0.37), hemoglobin (p = 0.26) and hematocrit (p = 0.24) after embolization. CONCLUSION: EAR is a safe and effective method for the treatment of IRVI, achieving a very high technical and clinical success rate with a low incidence of complications and without significant repercussions on the renal function of patients.

Use of Microballoon Catheter in Transarterial Ethanol Embolization of Renal Angiomyolipoma: A Retrospective Comparative Study with Historical Control?

Purpose: To clarify the utility of microballoon catheter in renal arterial ethanol embolization of renal angiomyolipoma (AML). Material and Methods: A total of 20 patients (15 women, 5 men) with median age of 45 years (39-60 years) underwent embolization to treat 22 AMLs. A mixture of ethanol and iodized oil was injected into the feeding arteries of 13 tumors using balloon occlusion (the balloon embolization group) with a microballoon catheter and 9 tumors without using balloon occlusion (the non-balloon embolization group). Changes in the maximum tumor diameter, tumor volume, and adverse events were evaluated. Result: The median baseline maximum tumor diameters and volumes were 6.3 cm and 61.4 cm3 in the balloon embolization group, and 4.6 cm and 40.1 cm3 in the non-balloon embolization group, respectively. Tumor enhancement disappeared on postembolization angiography in all cases. All tumors shrunk after embolization. There were no statistically significant differences in the percent decrease in the maximum tumor diameter and volume at 10-12 month between balloon occlusion group (31.5% and 67.9%) and control group (34.8% and 62.6%). Fever was significantly more frequent when balloon occlusion was used: 38% vs. 0% (p = 0.03). No major complication was observed in either patient group. Conclusions: Balloon occlusion may not affect tumor shrinkage when embolizing AMLs with a mixture of ethanol and lipiodol.

Endovascular Management of Iatrogenic Renal Vascular Injuries: Case Series and Systematic Review

Minimally invasive techniques for the treatment and diagnosis of kidney disease seek to preserve the greatest amount of parenchyma. Bleeding after these practices is rare, but must be treated quickly given its severity. Iatrogenic renal vascular injuries (IRVI) resulting from these procedures include active bleeding, arterial pseudoaneurysms, and arteriovenous fistulas. Renal artery embolization (RAE) is the main pillar in the treatment of this type of complications. Objective: To assess the results of RAE for the treatment of IRVI and its impact on the renal function of patients. Method: Retrospective analysis of all patients who presented vascular complications after renal procedures and who were referred for management by RAE, between August 2012 and December 2020. Results: 18 patients were included. 4 patients presented with pseudoaneurysm, 10 patients with active bleeding, and 1 patient with arteriovenous fistula; 2 patients had a combination of different IRVI; 1 patient did not present any findings at the time of renal angiography in dissonance with her computed tomography angiography. Technical and clinical success was achieved in all patients. One renal artery dissection was the only complication. No differences were found in serum creatinine (p = 0.51), urea (p = 0.37), hemoglobin (p = 0.26) and hematocrit (p = 0.24) after embolization. Conclusion: EAR is a safe and effective method for the treatment of IRVI, achieving a very high technical and clinical success rate with a low incidence of complications and without significant repercussions on the renal function of patients (AU)

Las técnicas miniinvasivas para tratamiento y diagnóstico de la patología renal, buscan preservar la mayorcantidad de parénquima. Los sangrados posteriores a estasprácticas son de rara presentación, pero deben ser tratadosrápidamente dada su gravedad. Las lesiones iatrogénicasvasculares (LIV) renales derivadas de estos procedimientos incluyen sangrados activos, pseudoaneurismas arteriales y fistulas arteriovenosas. La embolización arterial renal (EAR) es el principal pilar en el tratamiento de este tipode complicaciones.Objetivo: Evaluar los resultados de la EAR para eltratamiento de LIV y su impacto en la función renal de lospacientes.Método: Análisis retrospectivo de todos los pacientesque presentaron complicaciones vasculares posteriores aprocedimientos renales y que fueron derivados para manejomediante EAR, entre agosto de 2012 y diciembre de 2020.Resultados: Se incluyeron 18 pacientes. 4 pacientesdebutaron con pseudoaneurisma, 10 pacientes con sangradoactivo y 1 paciente con fístula arteriovenosa; 2 pacientestenían combinación de diferentes LIV; 1 paciente no presento ningún hallazgo al momento de la angiografía renalen disonancia con su angio-TC. El éxito técnico y clínicose logró en todos los pacientes. Una disección de arteriarenal fue la única complicación. No se encontraron diferencias en la creatinina sérica (p = 0,51), urea (p = 0,37),hemoglobina (p = 0,26) y hematocrito (p = 0,24) despuésde la embolización.Conclusión: La EAR es un método segúro y eficazpara el tratamiento de LIV, alcanzando una tasa de éxitotécnico y clínico muy alta con una baja incidencia de complicaciones y sin repercusiones significativas sobre la función renal de los pacientes. (AU)

Safety and efficacy of Endovascular Management of high-grade blunt renal injury.

Objectives: To provide data on the safety and efficacy of renal arterial embolization (RAE) in patients with high-grade blunt renal injury. Materials and methods: Fifteen patients with high-grade blunt renal injury (AAST grades IV-V) admitted to our hospital from July 2014 to December 2019 were retrospectively reviewed in this study. Their clinical success rate and complications were investigated accordingly. Results: Fifteen patients with high-grade blunt renal injury, 13 men and 2 women with an average age of 41.6 years, including 11 hemodynamically unstable patients and 4 stable patients, were treated with RAE. Among these patients, 73.3% (11 of 15) had grade IV, and 26.7% (4 of 15) had grade V injuries, while 53.3% (8 of 15) patients had concomitant injuries. One patient received main RAE and 14 patients received selective RAE. The clinical success rate after the first embolization was 93.3% (14 of 15). RAE was repeated and was successfully performed in one patient with sustained hematuria. No significant difference in creatinine levels was found before and after embolization. During the follow-up period of 2-82 months, two patients required tube drainage due to urine leaks, one patient developed renal failure requiring renal replacement therapy, and one patient developed secondary hypertension. Conclusions: RAE can provide a high success rate of hemostasis for both hemodynamically stable and unstable patients with high-grade blunt renal injury, and only minor complications are observed with this procedure.

Selectiv renal arterial embolization for mononephrous renal angiomyolipoma (report of 1 6 cases) / 实用放射学杂志

Objective To assess the value of selective renal arterial embolization in treating mononephrous renal angiomyolipoma. Methods 1 6 patients with mononephrous renal angiomyolipoma were retrospectively analyzed.To observe and analyze the changes in renal function,lesions reduction and its complications.Results Symptoms have been improved significantly after treatment,no se-rious complications were observed during operation and postoperation.The creatinine level in postoperation was lower than the pre-operative level,followed-up after 1year.Conclusion Selective renal artery embolization is a safe and effective method for the treat-ment of mononephrous renal angiomyolipoma.

Failure of initial renal arterial embolization for severe post-percutaneous nephrolithotomy hemorrhage: a multicenter study of risk factors.

PURPOSE: Severe hemorrhage after percutaneous nephrolithotomy is a rare but alarming event. If local tamponade fails to control bleeding, the current treatment of choice is superselective renal arterial embolization. If initial embolization is unsuccessful, repeat embolization or nephrectomy is often required. To our knowledge we report the first study of risk factors for failed initial superselective renal arterial embolization. MATERIALS AND METHODS: We retrospectively reviewed the records of 17,619 patients who underwent a total of 19,185 percutaneous nephrolithotomies from January 2007 to April 2012 at 6 centers. Study inclusion criteria were percutaneous nephrolithotomy and severe postoperative renal hemorrhage requiring superselective renal arterial embolization. Data on patients in whom initial embolization failed were compared to those on patients with successful embolization on univariate and multivariate analysis. RESULTS: Of the 17,619 patients 117 (0.6%), met study inclusion criteria, including 90 males and 27 females. Initial treatment failed in 12 patients (10.3%), 8 underwent repeat superselective renal arterial embolization, 3 required 3 embolizations and 1 underwent nephrectomy. Complete bleeding cessation was achieved in all 11 repeat embolization cases. We identified 3 risk factors for failure of initial superselective renal arterial embolization, including multiple percutaneous access sites, more than 2 bleeding sites identified on renal angiogram and gelatin sponge alone used as the embolic material. CONCLUSIONS: Carefully selecting patients for multitract percutaneous nephrolithotomy, making an extra effort to identify all bleeding vessels during angiography and not using gelatin sponge as the only embolic material could potentially decrease the risk of failure of initial superselective renal arterial embolization after percutaneous nephrolithotomy.

Arterial embolization for treating post-transplanted renal failure / 介入放射学杂志

20%),but turning negative with 3 of them after 3 weeks.All the transplanted kidneys revealed different degrees of atrophy but 4 of them obtained chances of successful retransplantation 3-6 months after the procedure,3 of them with follow up of 1-3 years were being well.Conclusions Renal arterial embolization is a safe,efficient measure for treating post-transplanted renal failure with obvious decrease of correlative clinical symptoms and providing conditions for renal retransplantation.

Transcatheter Renal Arterial Embolization of a Polycystic Kidney for Control of Persistent Hemorrhage / 대한신장학회잡지

We report a patient with autosomal dominant polycystic kidney disease(ADPKD) undergoing maintenance hemodialysis who underwent transcatheter arterial embolization(TAE) of the renal arteries to control the persistent renal hemorrhage. In 1991, the patient had been diagnosed as having ADPKD by computed tomography(CT) of abdomen. In 1997, the patient started hemodialysis. In October 2000, she was admitted to our hospital because of gross hematuria and both flank pain. Abdominal CT showed marked enlargement of the bilateral kidneys with numerous cysts. Renal angiography using the Seldinger technique showed stretched and deformed segmental renal arteries without active bleeding. Renal hemorrhage was continued despite of medical treatment. TAE with stainless steel coils was performed on both renal arteries. Renal bleeding was stopped immediately after TAE and anemia was improved and stabilized thereafter. Follow-up CT after five months later TAE showed the marked decrease in size of both kidneys, and patient's abdominal symptoms were disappeared too. This report shows that TAE is a safe and effective therapy for ADPKD patients with persistent renal bleeding refractory to medical therapy.

Three cases of Renal Arterial Embolization and Nephrectomy in Renal cell Carcinoma / 대한비뇨기과학회지

Before nephrectomy three patients with hypernephroma underwent occlusion of the renal arteries with Gelform via selective catheterization. This technique facilitated nephrectomy, decreased blood loss and prevented the dissemination of tumor cells or septic emboli from organ manipulation. Reduction of the vascular bed of the tumors shortened operative time and simplified the procedure. We report three cases with review of literature.

Renal Arterial Embolization in Metastatic Renal Cell Carcinoma with Absolute Ethanol / 대한비뇨기과학회지

Transcatheter embolization of renal artery has been used therapeutically in variable condition of renal cell carcinoma, and it may also augument immunologic reactivity against tumor cell. Embolization with absolute ethanol was used successfully for palliation in one patient of inoperable metastatic renal cell carcinoma; Severe hematuria and flank pain disappeared. The major risk of infarction using absolute ethanol injection, resulting in inadvertant damage to vessels or tissue remote from the target organ, was not noticed during follow-up. Postinfarction syndrome is minimal in comparison with other methods of renal arterial occlusion.The mechanism of action of intraarterial ethanol is proposed and the general concept of renal arterial embolization is discussed.