scholarly journals Successful Nonoperative Management of High-Grade Blunt Renal Injuries

2016 ◽  
Vol 2016 ◽  
pp. 1-5 ◽  
Author(s):  
Allison M. May ◽  
Oussama Darwish ◽  
Brian Dang ◽  
John J. Monda ◽  
Prajakta Adsul ◽  
...  
Keyword(s):  
Nonoperative Management ◽  
Operative Management ◽  
Renal Trauma ◽  
High Grade ◽  
Current Management ◽  
Entire Cohort ◽  
Injury Grade ◽  
Level I ◽  
Salvage Rate ◽  
Renal Injuries

Current management of high-grade blunt renal trauma favors a nonoperative approach when possible. We performed a retrospective study of high grade blunt renal injuries at our level I trauma center to determine the indications and success of nonoperative management (NOM). 47 patients with blunt grade IV or V injuries were identified between October 2004 and December 2013. Immediate operative patients (IO) were compared to nonoperatively managed (NOM). Of the 47 patients, 3 (6.4%) were IO and 44 (95.6%) NOM. IO patients had a higher heart rate on admission, 133 versus 100 in NOM (P=0.01). IO patients had a higher rate of injury to the renal vein or artery (100%) compared to NOM group (18%) (P=0.01). NOM failed in 3 of 44 patients (6.8%). Two required nonemergent nephrectomy and one required emergent exploration resulting in nephrectomy. Six NOM patients had kidney-related complications (13.6%). The renal salvage rate for the entire cohort was 87.2% and 93.2% for NOM. Nonoperative management for hemodynamically stable patients with high-grade blunt renal trauma is safe with a low risk of complications. Management decisions should consider hemodynamic status and visualization of active renal bleeding as well as injury grade in determining operative management.

scholarly journals The role of angioembolization in the management of blunt renal injuries: a systematic review

BMC Urology ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Giovanni Liguori ◽  
Giacomo Rebez ◽  
Alessandro Larcher ◽  
Michele Rizzo ◽  
Tommaso Cai ◽  
...  
Keyword(s):  
Operative Management ◽  
Renal Trauma ◽  
High Grade ◽  
Contrast Extravasation ◽  
Newcastle Ottawa Scale ◽  
Grade Ii ◽  
Non Operative Management ◽  
Grade Iii ◽  
Renal Injuries

Abstract Background Recently, renal angioembolization (RAE) has gained an important role in the non-operative management (NOM) of moderate to high-grade blunt renal injuries (BRI), but its use remains heterogeneous. The aim of this review is to examine the current literature on indications and outcomes of angioembolization in BRI. Methods We conducted a search of MEDLINE, EMBASE, SCOPUS and Web of Science Databases up to February 2021 in accordance with PRISMA guidelines for studies on BRI treated with RAE. The methodological quality of eligible studies and their risk of bias was assessed using the Newcastle–Ottawa scale Results A total of 16 articles that investigated angioembolization of blunt renal injury were included in the study. Overall, 412 patients were included: 8 presented with grade II renal trauma (2%), 97 with grade III renal trauma (23%); 225 with grade IV (55%); and 82 with grade V (20%). RAE was successful in 92% of grade III–IV (294/322) and 76% of grade V (63/82). Regarding haemodynamic status, success rate was achieved in 90% (312/346) of stable patients, but only in 63% (42/66) of unstable patients. The most common indication for RAE was active contrast extravasation in hemodynamic stable patients with grade III or IV BRI. Conclusions This is the first review assessing outcomes and indication of angioembolization in blunt renal injuries. The results suggest that outcomes are excellent in hemodynamic stable, moderate to high-grade renal trauma.

scholarly journals Splenic Artery Embolization for Patients with High-Grade Splenic Trauma: Indications, Techniques, and Clinical Outcomes

2021 ◽  
Vol 38 (01) ◽  
pp. 105-112
Author(s):  
Majd Habash ◽  
Darrel Ceballos ◽  
Andrew J. Gunn
Keyword(s):  
Clinical Outcomes ◽  
Splenic Artery ◽  
Splenic Injury ◽  
Nonoperative Management ◽  
Operative Management ◽  
Splenic Trauma ◽  
Trauma Patients ◽  
High Grade ◽  
Artery Embolization ◽  
Splenic Artery Embolization

AbstractThe spleen is the most commonly injured organ in blunt abdominal trauma. Patients who are hemodynamically unstable due to splenic trauma undergo definitive operative management. Interventional radiology plays an important role in the multidisciplinary management of the hemodynamically stable trauma patient with splenic injury. Hemodynamically stable patients selected for nonoperative management have improved clinical outcomes when splenic artery embolization is utilized. The purpose of this article is to review the indications, technical aspects, and clinical outcomes of splenic artery embolization for patients with high-grade splenic injuries.

Administering DVT Prophylaxis Sooner Than 48 Hours Does Not Increase Failure of Nonoperative Management of High-Grade (Grades III-V) Splenic Injuries

2020 ◽  
pp. 000313482095030
Author(s):  
Jared Griffard ◽  
Bethany Sappington ◽  
Megan Griffard ◽  
Reagan Bollig ◽  
James McMillen ◽  
...  
Keyword(s):  
Failure Rate ◽  
Nonoperative Management ◽  
Linear Regression Analysis ◽  
P Value ◽  
High Grade ◽  
Dvt Prophylaxis ◽  
Significant Difference ◽  
Before And After ◽  
Injury Grade ◽  
Grade 3

Splenic injuries are mostly treated with nonoperative management (NOM) with observation to monitor for continued hemorrhage and holding early chemical DVT prophylaxis to reduce the risk of NOM failure. Eberle et al demonstrated chemoprophylaxis prior to 72 hours didn’t increase failure rate of NOM. We chose to extrapolate this finding and compare outcomes in high-grade splenic injuries (HGSI) with chemoprophylaxis before and after 48 hours. From January 2013 to December 2017, 104 patients with HGSI received chemoprophylaxis with unfractionated heparin (UH) or low molecular weight heparin (LMWH) within 72 hours of diagnosis. Of these, 8 patients received chemoprophylaxis within 24 hours, 46 between 24 and 48 hours, and 50 patients between 48 and 72 hours. This population consisted of 70 males and 34 females, with an average age of 40.1 years. The average ISS was 23 and the majority (77%) were grade 3 injuries. We observed 6 failures of NOM: 1 in the <24 hour group, 3 in the 24-48 hour group, and 2 in the 48-72 hour group. There was no statistically significant difference between the <24 hour and >24 groups or between the <48 hour and 48-72 hour groups. A linear regression analysis created a model describing the time to initiation of DVT prophylaxis using age, sex, splenic injury grade, and ISS; the failure rate decreased by 0.00002% for each hour prior to giving DVT prophylaxis, with a P value of .111. We conclude a noninferiority statement that DVT prophylaxis prior to 48 hours does not increase the risk of NOM failure.

230 HIGH GRADE RENAL INJURIES: APPLICATION OF PARKLAND HOSPITAL'S PREDICTORS OF INTERVENTION FOR RENAL BLEEDING TO A LARGE SERIES OF PATIENTS WITH BLUNT RENAL TRAUMA

2012 ◽  
Vol 187 (4S) ◽  
Author(s):  
Miranda Hardee ◽  
Mark Stevens ◽  
Raminder Nirula ◽  
William Lowrance ◽  
William Brant ◽  
...  
Keyword(s):  
Large Series ◽  
Renal Trauma ◽  
High Grade ◽  
Renal Injuries

scholarly journals Non-Operative Management with Angioembolization of Grade IV and V Renal Injuries in a Hybrid Emergency Room System

2021 ◽  
Vol 34 (3) ◽  
pp. 191-197
Author(s):  
So Ra Ahn ◽  
Sang Hyun Seo ◽  
Joo Hyun Lee ◽  
Chan Yong Park
Keyword(s):  
Emergency Room ◽  
Trauma Center ◽  
Arterial Embolization ◽  
Operative Management ◽  
University Hospital ◽  
Percutaneous Catheter Drainage ◽  
High Grade ◽  
Kidney Preservation ◽  
Non Operative Management ◽  
Renal Injuries

Renal injuries occur in more than 10% of patients who sustain blunt abdominal injuries. Non-operative management (NOM) is the established treatment strategy for lowgrade (I–III) renal injuries. However, despite some evidence that NOM can be successfully applied to high-grade (IV, V) renal injuries, it remains unclear whether NOM is appropriate in such cases. The authors report two cases of high-grade renal injuries that underwent NOM after embolization in a hybrid emergency room (ER) system with a 24/7 in-house interventional radiology (IR) team. A 29-year-old male visited Wonkwang University Hospital Regional Trauma Center complaining of right abdominal pain after being hit by a rope. Computed tomography (CT) was performed 16 minutes after arrival, and the CT scan indicated a grade V right renal injury. Arterial embolization was initiated within 31 minutes of presentation. A 56-year-old male was transferred to Wonkwang University Hospital Regional Trauma Center with a complaint of right flank pain. He had initially presented to a nearby hospital after falling from a 3-m height. Thanks to the key CT images sent from the previous hospital prior to the patient’s arrival, angiography was performed within 8 minutes of the patient’s arrival and arterial embolization was completed within 25 minutes. Both patients were treated successfully through NOM with angioembolization and preserved kidneys. Hematoma in the first patient and urinoma in the second patient resolved with percutaneous catheter drainage. The authors believe that the hybrid ER system with an in-house IR team could contribute to NOM and kidney preservation even in high-grade renal injuries.

Imaging characteristics associated with failure of nonoperative management in high-grade pediatric blunt renal trauma

2016 ◽  
Vol 12 (5) ◽  
pp. 294.e1-294.e6 ◽  
Author(s):  
J.K. Au ◽  
X. Tan ◽  
M. Sidani ◽  
I. Stanasel ◽  
D.R. Roth ◽  
...  
Keyword(s):  
Nonoperative Management ◽  
Renal Trauma ◽  
High Grade ◽  
Imaging Characteristics

Management of renal injury in a UK major trauma centre

Trauma ◽  
2018 ◽  
Vol 22 (1) ◽  
pp. 26-31
Author(s):  
Robert Torrance ◽  
Abigail Kwok ◽  
David Mathews ◽  
Matthew Elliot ◽  
Andrew Baird ◽  
...  
Keyword(s):  
Renal Injury ◽  
Major Trauma ◽  
Trauma Centre ◽  
University Hospital ◽  
Research Network ◽  
Renal Trauma ◽  
High Grade ◽  
Major Trauma Centre ◽  
Renal Injuries

Introduction This study reviews the type, severity, management and follow-up of renal trauma presenting to a major trauma centre in the northwest of England in the four years following inception of the major trauma centre. Given the recent introduction of major trauma centres nationally, research is needed within every specialty to ensure that the centralisation of services benefits all patients affected by these changes. Methods Patients presenting to Aintree University Hospital with renal trauma between June 2012 and June 2016 were identified using the Trauma Audit and Research Network (TARN) database. The data gathered retrospectively for each patient included mechanism of injury, injury severity score, American Association for the Surgery of Trauma (AAST) grading, management of injury, and follow-up. Results Out of a total of 2595 trauma patients, 33 renal injuries were identified. The 31 patients who received imaging were classified according to AAST grading, with 8 Grade I (25.8%), 4 Grade II (12.9%), 8 Grade III (25.8%), 4 Grade IV (12.9%), and 7 Grade V (22.6%) injuries. Twenty-five out of the 30 surviving patients received conservative treatment, three patients received angioembolisation (AE), one patient received a laparotomy with renal suturing, and one patient required a nephrectomy. Of these 30 surviving patients, seven received urology follow-up in clinic (23%). Conclusion The findings appear to support the growing trend towards the conservative management of high-grade renal injuries, and provide further evidence for the value of AE in renal trauma. The success of AE in this study appears to support the centralisation of services in renal trauma; however, the low nephrectomy rate could be interpreted as suggestive of the opposite. The study revealed that improvements to follow-up are needed, and that further research should seek to inform the optimal radiological follow-up of high-grade renal injury.

scholarly journals Is Nonoperative Management the Best First-line Option for High-grade Renal trauma? A Systematic Review

2019 ◽  
Vol 5 (2) ◽  
pp. 290-300 ◽  
Author(s):  
Arunan Sujenthiran ◽  
Pieter Jan Elshout ◽  
Erik Veskimae ◽  
Steven MacLennan ◽  
Yuhong Yuan ◽  
...  
Keyword(s):  
Systematic Review ◽  
Nonoperative Management ◽  
Renal Trauma ◽  
High Grade ◽  
First Line

scholarly journals The Role of Angioembolization In the Management of Blunt Renal Injuries: A Systematic Review

2021 ◽  
Author(s):  
Giovanni Liguori ◽  
Giacomo Rebez ◽  
Andrea Salonia
Keyword(s):  
Systematic Review ◽  
Success Rate ◽  
Clinical Success ◽  
Clinical Success Rate ◽  
Operative Management ◽  
Low Grade ◽  
High Grade ◽  
Contrast Extravasation ◽  
Renal Injuries

Abstract Background Non-operative management is established for low-grade (I-III) blunt renal injuries but it is getting increasingly popular even in high grade BRI thanks to angioembolization of active bleedings. To date a systematic review to assess the role of Angioembolization (RAE) in Blunt Renal Injuries (BRI) is not yet present in the literature. Methods a literature search was performed, 169 unilateral BRI were included; 124 high grade BRI (92 grade IV and 32 grade V renal injuries, respectively). Most common indication was hemodynamically stable patients with BRI grades II to IV and active contrast extravasation. Results Overall, the clinical success rate of RAE was 90% (range 73% − 100%). The rate of re-do embolization was 4.5% gaining a 100% success rate with a second attempt. Some authors reported successful RAE even in patients with grade V BRI, without major abdominal organ injuries and no pelvic fractures. RAE was performed also as adjunctive therapy prior to surgery. Most used agent was micro coils. Nephrectomy rate was 5.8%, mortality rate was 3.2%. Conclusions A multidisciplinary approach between interventional radiology and urology should be pursued to make every effort to perform endovascular therapy unless there are multiple visceral injuries or renal pedicle avulsion or expanding retroperitoneal hematoma necessitating surgery.

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