The Efficacy and Safety of Transcatheter Arterial Embolization to Treat Renal Hemorrhage after Percutaneous Nephrolithotomy

Purpose. The aim of this study was to evaluate the safety and efficacy of transcatheter arterial embolization (TAE) in patients with renal hemorrhage after percutaneous nephrolithotomy (PCNL) and evaluate the risk factors that may result in severe bleeding requiring TAE. Methods. We retrospectively reviewed 121 patients with post-PCNL renal hemorrhage. Thirty-two patients receiving endovascular embolization were compared with 89 patients only receiving conservative treatment. The demographic and clinical data were recorded and compared between the two groups. The values of estimated glomerular filtration rate (eGFR) and serum creatinine (SCr) were recorded preoperatively, postoperatively, and at last follow-up and analyzed to evaluate the safety and efficiency of TAE. Results. The successful hemostasis rate of conservative therapy was 73.6% (89/121) and that of TAE was 100% (32/32). SCr and eGFR were not significantly different before PCNL and after the last follow-up of TAE (SCr: 0.95 vs. 0.95 mg/dl, P=0.857; eGFR: 86.77 vs. 86.18 ml/min/1.73m2, P=0.715). The univariate analysis demonstrated that advanced age, urinary tract infection, and diabetes mellitus were significantly associated with severe bleeding during PCNL. Multivariate analysis further identified that diabetes mellitus was an independent risk factor for severe bleeding needing TAE [odds ratio (OR): 3.778, 95% confidence interval (CI):1.276-11.190, and P=0.016]. Conclusion. TAE is a safe and effective procedure to treat renal hemorrhage that cannot be resisted by conservative treatment after PCNL. Diabetes mellitus was associated with high risks of severe bleeding needing TAE after PCNL.

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Transcatheter Arterial Embolization with N-butyl-2 Cyanoacrylate Glubrans 2 for the Treatment of Acute Renal Hemorrhage Under Coagulopathic Condition

10.21203/rs.3.rs-26879/v1 ◽

2020 ◽

Author(s):

Maofeng Gong ◽

Xu He ◽

Boxiang Zhao ◽

Jie Kong ◽

Tao Wang ◽

...

Keyword(s):

Transcatheter Arterial Embolization ◽

Clinical Success ◽

Arterial Embolization ◽

Hemodynamic Instability ◽

Attractive Alternative ◽

Safe Alternative ◽

Renal Hemorrhage ◽

Active Hemorrhage ◽

Significant Difference

Abstract Background:The efficacy and safety of transcatheter arterial embolization (TAE) using the N-butyl-2 cyanoacrylate (NBCA) Glubran2 in the treatment of acute renal hemorrhage (RH) under coagulopathic conditionsarestill no consensus.Methods: Between February 2014 and June 2019, 8 patients underwent TAE with the NBCA Glubran2 for acute RH under coagulopathic conditions. Coagulopathy was defined as abnormal values of prothrombin time and activated partial thromboplastin time and/or a reduced platelet count.Angiograms and medical records were retrospectively reviewed to determine technical/clinical success, complications and recurrent hemorrhage after TAE, and follow-up outcomes were assessed.Results: Of note, one patient presented with severe coagulopathy, and three presented with severe RH and hemodynamic instability. The NBCA Glubran2 was employed as a sole embolic material in sixpatients. In the remaining two patients, it was employed for secondary embolization.Under coagulopathic conditions, due to the use of the NBCA Glubran2, both technical success and clinical success for acute RH were achieved in all patients. Duringa mean follow-up time of 30.1 months (range, 3-84 months), neither persistent nor recurrent active hemorrhage required repeat endovascular or surgical treatment for hemostasis. No Glubran2related complications occurred mid-TAE pro-cedure. In addition, renal function information was available for all patients, and there was no significant difference between the serum creatinine levels [(83.8 ± 15.5) vs (85.8 ± 32.2) μmol/L] before and one week after Glubran2 embolization (p=0.89; CI, -34.5 to 30.5).Conclusions: The present findings suggest that TAE with the NBCA Glubran2 may be a safe alternative treatment for the management of RH under coagulopathic conditions. In particular, this method appears to be a potentially attractive alternative when con-ventional embolic materials fail in patients with ongoing hemodynamic instability or even under severe coagulopathic conditions.

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Transcatheter arterial embolization of abnormal vessels as a treatment for lateral epicondylitis refractory to conservative treatment: a pilot study with a 2-year follow-up

Journal of Shoulder and Elbow Surgery ◽

10.1016/j.jse.2017.03.026 ◽

2017 ◽

Vol 26 (8) ◽

pp. 1335-1341 ◽

Cited By ~ 8

Author(s):

Wataru Iwamoto ◽

Yuji Okuno ◽

Noboru Matsumura ◽

Takao Kaneko ◽

Hiroyasu Ikegami

Keyword(s):

Pilot Study ◽

Conservative Treatment ◽

Transcatheter Arterial Embolization ◽

Lateral Epicondylitis ◽

Arterial Embolization

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The Analysis of Risk Factors Associated with Transcatheter Arterial Embolization for Percutaneous Nephrolithotomy

10.21203/rs.2.12932/v1 ◽

2019 ◽

Author(s):

Hongfei Miao ◽

Yong Chen ◽

Peng Ye ◽

Qingle Zeng ◽

Huajin Pang

Keyword(s):

Risk Factors ◽

Percutaneous Nephrolithotomy ◽

Transcatheter Arterial Embolization ◽

Clinical Success ◽

Univariate Analysis ◽

Postoperative Bleeding ◽

Arterial Embolization ◽

Gelatin Sponge ◽

Bleeding Control ◽

Embolic Material

Abstract Abstract Background: This study aimed to evaluate the risk factors of transcatheter arterial embolization (TAE) in managing haemorrhage associated with percutaneous nephrolithotomy (PCNL) to improve the surgical effect. Methods: From May 2007 to June 2018, 112 patients (31–60 years) who underwent TAE treatment for haemorrhage after PCNL were retrospectively analyzed. All patient data and embolization details were retrieved from medical records. Univariate analysis was used to identify the risk factors related to clinical outcomes. Results: Technical and clinical success rates were 100% and 93%, respectively. On angiography, we observed injury to the main artery in 1 patient, to secondary branch in 22, to tertiary branch in 58, and to both secondary and tertiary branches in 31. Embolic agents were coils (n =31), gelatin sponge (n=15), and gelatin sponge with coils/microcoils (n =66). Bleeding control failed in 8 patients. Eight patients opted for a second operation, 6 by repeat TAE and 2 by surgery. Bleeding was eventually controlled in all patients. Univariate analysis indicated that extent of transfusion, embolic material used, and injured branches were significantly associated with clinical failure. Conclusions: TAE is effective and safe in treating postoperative bleeding after PCNL. Massive transfusion, embolic material used, and injured branches were related to failure of bleeding control.

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Hemorrhagic complications after percutaneous nephrolithotomy: angiographic diagnosis and management by transcatheter arterial embolization

Radiologia Brasileira ◽

10.1590/0100-3984.2019.0130 ◽

2020 ◽

Vol 53 (6) ◽

pp. 390-396

Author(s):

Vinicius Adami Vayego Fornazari ◽

Rômulo Florêncio Tristão Santos ◽

Thiago Franchi Nunes ◽

Rodrigo Perrella ◽

Tiago Magalhães Freire ◽

...

Keyword(s):

Percutaneous Nephrolithotomy ◽

Transcatheter Arterial Embolization ◽

Arterial Embolization ◽

Vascular Lesions ◽

Common Symptom ◽

Macroscopic Hematuria ◽

Hemorrhagic Complications ◽

Ethiodized Oil ◽

Angiographic Diagnosis

Abstract Objective: To identify the main hemorrhagic complications after percutaneous nephrolithotomy, as well as the results obtained with transcatheter arterial embolization (TAE) at an interventional radiology center. Materials and Methods: This was a retrospective analysis of patients undergoing TAE for the treatment of hemorrhagic complications after percutaneous nephrolithotomy. All patients underwent computed tomography angiography (CTA). Results: We evaluated a total of nine patients. At emergency department readmission, the most common symptom was macroscopic hematuria, which was seen in five patients. Three patients had an isolated pseudoaneurysm, two had a pseudoaneurysm together with active bleeding (perirenal hematoma), and one had a pseudoaneurysm together with arteriocalyceal fistula. Arteriovenous fistula was diagnosed in three patients and was not seen in combination with other vascular lesions. We did not identify arteriocalyceal fistula in isolation. Five patients underwent TAE with 6 × 15 mm and 6 × 20 mm microcoils. Four patients underwent TAE with n-butyl-2-cyanoacrylate and ethiodized oil. Follow-up CTAs revealed no complications. Conclusion: Because of its high diagnostic accuracy, CTA provides the interventional radiologist with valuable data for individualized therapeutic planning. The TAE procedure is safe and effective. It can therefore be used as a first-line treatment for hemorrhagic complications resulting from percutaneous renal procedures.

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The efficacy of transcatheter arterial embolization for knee pain on patients with knee osteoarthritis: A case series

Journal of Back and Musculoskeletal Rehabilitation ◽

10.3233/bmr-210043 ◽

2021 ◽

pp. 1-6

Author(s):

Kun Yung Kim ◽

Gi-Wook Kim

Keyword(s):

Conservative Treatment ◽

Knee Osteoarthritis ◽

Knee Pain ◽

Transcatheter Arterial Embolization ◽

Rating Scale ◽

Case Series ◽

Arterial Embolization ◽

Numeric Rating Scale ◽

Knee Oa ◽

Before And After

BACKGROUND: Knee osteoarthritis (OA) is accompanied by inflammation and angiogenesis. Modifying angiogenesis through transcatheter arterial embolization (TAE) can be a potential treatment for knee OA. OBJECTIVE: We subjected five OA knees in three patients to TAE and report the results of our post-treatment observations. CASE DESCRIPTION: Three patients that had experienced knee pain for a minimum of one year prior to the study, and whose pain had persisted despite conservative treatment, were included in this study. Patients more often chose conservative treatment over surgical treatment. Pain and functional scales were evaluated before, immediately, and 1 month after TAE using the Numeric Rating Scale (NRS) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). TAE was performed by an experienced interventional radiologist. The average values of NRS evaluated before and after 5 TAEs were 5.2 before TAE, 3 immediately after TAE, and 3.6 after 1 month of TAE, and the average values of WOMAC were 52, 38.4, and 36.4, respectively. There were no major adverse effects. CONCLUSION: The examined cases support the conclusion that TAE is an effective treatment for patients with knee OA. Substantial pain relief and WOMAC improvement were observed both immediately and one month after TAE.

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Palliative Treatment of Hepatocellular Carcinoma with Transcatheter Arterial Embolization

Acta Radiologica ◽

10.1177/028418519303400106 ◽

1993 ◽

Vol 34 (1) ◽

pp. 26-29 ◽

Cited By ~ 4

Author(s):

S. Savastano ◽

G. P. Feltrin ◽

D. Neri ◽

P. da Pian ◽

M. Chiesura-Corona ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

Transcatheter Arterial Embolization ◽

Palliative Treatment ◽

Arterial Embolization ◽

Percutaneous Ethanol Injection ◽

Ethanol Injection ◽

History Of ◽

The Mean ◽

Hcc Recurrence

Thirty-three consecutive patients with previously untreated hepatocellular carcinoma (HCC) and 6 patients with recurrent HCC were treated with transcatheter arterial embolization (TAE). The patients were not eligible for surgical resection or percutaneous ethanol injection. TAE was performed with Lipiodol Ultra-Fluid, epidoxorubicin and Gelfoam, with a mean of 1.7 treatments per patient. CT was performed 15 days after TAE. The mean cumulative survival was 14.2 months in patients with previously untreated HCC. The survival of patients stages Okuda I and II did not differ significantly (p > 0.05); tumor size did not affect survival (p > 0.05). Two patients with recurrent HCC died 7.0 and 9.3 months after the diagnosis of tumor recurrence; the remaining 4 patients are still alive with a maximum follow-up of 22.5 months from the diagnosis of HCC recurrence. Ten complications occurred in 8 patients, and were controlled by medical therapy. Eleven patients died during the study; no death was related to TAE. The series was not randomized, but comparison with the natural history of HCC suggests that TAE is effective as palliative treatment of advanced or recurrent HCC.

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Spontaneously ruptured hepatocellular carcinoma in Fontan-associated liver disease: A case report

SAGE Open Medical Case Reports ◽

10.1177/2050313x20922030 ◽

2020 ◽

Vol 8 ◽

pp. 2050313X2092203

Author(s):

Takahiro Kubo ◽

Yosuke Aihara ◽

Hideto Kawaratani ◽

Tadashi Namisaki ◽

Ryuichi Noguchi ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

Liver Disease ◽

Transcatheter Arterial Embolization ◽

Fontan Procedure ◽

Arterial Embolization ◽

Palliative Operation ◽

First Case ◽

Ruptured Hepatocellular Carcinoma ◽

Enhanced Computed Tomography

The prognosis of congenital heart disease is dramatically improved by cardiac surgery. The Fontan procedure is the definitive palliative operation for patients with single-ventricle physiology. In parallel with the longer survival time achieved with the Fontan procedure, the incidence of Fontan-associated liver disease is increasing. A 40-year-old man who underwent Fontan procedures at the ages of 9 was referred to our hospital for further evaluation of multiple hepatic tumors. Enhanced computed tomography showed large hepatocellular carcinomas with portal thrombi (Vp3). Spontaneous hepatocellular carcinoma rupture occurred 2 weeks after the first visit to our hospital, and emergent transcatheter arterial embolization of the hepatic artery was performed. Three months later, the patient died of liver failure. Autopsy findings showed moderately differentiated hepatocellular carcinoma with a cirrhotic liver characterized by centrilobular fibrosis and sinusoidal dilation similar to that in Fontan-associated liver disease. We reported the first case of spontaneously ruptured hepatocellular carcinoma treated by emergent transcatheter arterial embolization in Fontan-associated liver disease. As the early diagnosis of liver cirrhosis and hepatocellular carcinoma results in better patients’ outcome, cardiologists and hepatologists should be aware of Fontan-associated liver disease and advise patients to have regular follow-up of the liver.

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