Endovascular management of vascular renal injuries: outcomes and comparison between traumatic and iatrogenic settings

Purpose: To evaluate the efficacy of endovascular treatment for vascular renal injuries (VRIs) like bleeding, pseudoaneurysm and artero-venous fistula (AVF) and to compare patients with blunt trauma (T-VRIs) with those with iatrogenic damage (I-VRIs). Methods: We retrospectively assessed 49 renal artery embolizations performed to treat T-VRIs (26.5%) and I-VRIs (73.5%). Different embolic materials were used based on the type of lesion. Technical success was defined as the complete occlusion of target arteries with no further visualization of VRIs. Clinical success was defined if no recurrence was present and if renal function (difference between creatinine after and before treatment <0.5 mg/dl) was preserved after 1 month. Results: Angiography showed bleeding in 27 patients, pseudoaneurysm in 29 and an AVF in 6. Embolic agents used were coils in 39 procedures, coils with sponge in four and others in six. Technical success was 100% while clinical success was 85.7% due to seven patients with recurrence. The group I-VRIs showed a higher rate of clinical success than the group T-VRIs (94.4% vs 61.5%; p < 0.05). Moreover, the group I-VRIs had a higher incidence of pseudoaneurysms and AVFs compared with the group T-VRIs (69.4% vs 30.8% and 16.7% vs 0%; p < 0.05). Conclusion: Endovascular treatment for VRIs showed satisfactory results and no patient had a worsening of renal function. I-VRIs had better clinical success and more frequently appeared as pseudoaneurysms compared to T-VRIs: probably iatrogenic injury is localized and pseudoaneurysm is easily identifiable and treatable with endovascular treatment.

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Urgent Transcatheter Arterial Embolization for Wunderlich Syndrome With Hypovolemic Shock Secondary to Ruptured Renal Angiomyolipoma

Frontiers in Surgery ◽

10.3389/fsurg.2021.704478 ◽

2021 ◽

Vol 8 ◽

Author(s):

Maofeng Gong ◽

Zhengli Liu ◽

Haobo Su ◽

Boxiang Zhao ◽

Jie Kong ◽

...

Keyword(s):

Transcatheter Arterial Embolization ◽

Clinical Success ◽

Hypovolemic Shock ◽

Arterial Embolization ◽

Renal Angiomyolipoma ◽

Technical Success ◽

Embolic Agents ◽

Nontarget Embolization ◽

Glubran 2 ◽

Embolic Materials

Purpose: Wunderlich syndrome (WS) with hypovolemic shock secondary to ruptured renal angiomyolipoma (rAML) represents an urgent condition. Hence, we reported our experience with transcatheter arterial embolization (TAE) using different embolic materials under this condition.Methods: This retrospective study consisted of 22 patients. Embolic materials including particles, microcoils, and liquid embolic agents were selectively used based on the decisions of interventional radiologists. Technical success was defined as the complete occlusion of bleeding vessels on the final renal angiogram. Clinical success was defined as the absence of re-hemorrhage needed for repeat endovascular or surgery treatment after TAE.Results: The articulated materials were used when WS presented without aneurysms; a combination of particulate materials and microcoils or Glubran 2 alone were used for WS with aneurysms. The technical success based on 24 episodes of TAEs in 22 patients was 100% (24 of 24). Repeat TAE was achieved in two patients with hemorrhages re-occurring two days after the initial embolization with microcoils alone. The clinical success was 90.9% (20 of 22). No nontarget embolization or embolization-related complications occurred during the TAE procedure. Of the patients, 27.3% (6 of 22) experienced minor complications of post-embolization syndrome (PES). During a median follow-up time of 34 months, no recurrent hemorrhage that required repeat endovascular or surgical treatment for hemostasis occurred.Conclusion: Urgent TAE with the selective use of different embolic materials is an effective alternative to control WS with hypovolemic shock secondary to ruptured rAML. The condition of presenting with or without aneurysms may determine the embolic materials employed.

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Endovascular Treatment of 12 Cases of Renal Arteriovenous Malformations: The Experience of 1 Center and an Overview of the Literature

Vascular and Endovascular Surgery ◽

10.1177/1538574417740509 ◽

2017 ◽

Vol 52 (1) ◽

pp. 46-51 ◽

Cited By ~ 2

Author(s):

Zhen-Yu Jia ◽

Chun-Gao Zhou ◽

Jin-Guo Xia ◽

Lin-Bo Zhao ◽

Wen Zhang ◽

...

Keyword(s):

Endovascular Treatment ◽

Arteriovenous Malformations ◽

Clinical Success ◽

Vascular Diseases ◽

Arterial Embolization ◽

Renal Arteries ◽

Proximal Portion ◽

Technical Success ◽

Treatment Techniques ◽

Embolic Materials

Objectives: Congenital renal arteriovenous malformations (rAVMs) represent rare vascular diseases. The heterogeneous vascular architecture of each rAVM determines the endovascular treatment techniques employed. We reported our experience with the endovascular treatment of a series of rAVMs. Materials: This retrospective study consisted of 12 patients with 12 rAVMs who underwent renal arterial embolization (RAE) in our hospital. Embolic materials, including particles, liquid embolic agents (n-butyl 2-cyanoacrylate, Onyx, and ethanol), and coils, were selectively used based on the decisions of interventional radiologists. Technical success was defined as the complete occlusion of the feeding arteries and nidus on postprocedure renal arteriography. Clinical success was defined as the resolution of hematuria or the disappearance of rAVM-relevant symptoms. Results: The median follow-up period was 13.5 months (range: 4-72). The technical success based on 12 procedures in 12 patients was 83.3% (10 of 12). In the 2 procedures that technically failed, the existence of multiple fine feeding arteries arising from the proximal portion of different segmental renal arteries explains the incomplete embolization. One of the 2 patients achieved clinical success without additional RAE. The other patient had recurrent hematuria 25 months after initial treatment, which was successfully managed conservatively with hemostatic agents. Thus, the clinical success was 91.7% (11 of 12). Conclusions: Renal artery embolization with the selective use of various embolic materials is an effective treatment for patients with rAVMs. The existence of multiple fine feeding vessels arising from the proximal portion of different segmental renal arteries is likely to affect the technical success of treatment.

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Renal artery embolization for iatrogenic renal vascular injuries management: 5 years’ experience

British Journal of Radiology ◽

10.1259/bjr.20190256 ◽

2020 ◽

Vol 93 (1106) ◽

pp. 20190256 ◽

Cited By ~ 1

Author(s):

Andrea Contegiacomo ◽

Enrico Maria Amodeo ◽

Alessandro Cina ◽

Carmine Di stasi ◽

Roberto Iezzi ◽

...

Keyword(s):

Serum Creatinine ◽

Renal Artery ◽

Clinical Success ◽

Clinical Success Rate ◽

Vascular Injuries ◽

Technical Success ◽

Artery Embolization ◽

Renal Artery Embolization ◽

Embolic Materials ◽

Renal Vascular

Objective: Evaluate the efficacy and safety of renal artery embolization (RAE) for iatrogenic renal vascular injuries (IRVI) management at Fondazione Policlinico Universitario "A. Gemelli" IRCCS, in the last 5 years. Methods: Retrospective analysis of all RAE procedures performed from January 2013 to December 2017. Patients-related (age, sex, vascular variants, hemoglobin and serum creatinine), IRVI-related (type and vascular level of IRVI, presence and extension of hematoma), management-related (temporal interval between diagnostic imaging and RAE) and procedure-related (embolic materials, technical success, clinical success and complications) parameters were evaluated. Results: 28 RAE procedures performed on 28 patients (21 males; 7 females) were included. 19/28 patients had pseudoaneurysm, 7/28 active bleeding and 1/28 arteriovenous fistula; 4/28 patients had a combination of 2 IRVI. The extent of perirenal hematoma showed correlation with the cause of IRVI (p = 0.028). Technical success was achieved in all patients whereas clinical success in 25/28 (89.3%), with 3 patients requiring re-treatment. Minor complications were observed during 2/28 (7.1%) endovascular procedures. No major complications occurred. A longer procedural time was observed in patients with lower pre-procedural levels of hemoglobin (p = 0.016). No differences were found in mean serum creatinine (p = 0.23) before and immediately after treatment, while values of creatinine at 1 week from the procedure were significantly lower (p = 0.04). Conclusion: RAE is safe and effective for the management of iatrogenic IRVI showing high technical and clinical success rate and low complication rate. Advances in knowledge: Low pre-procedural hemoglobin levels increase procedural duration time. Glue alone or in combination with other materials is as safe as coils.

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Emerging Concepts in the Treatment of Intracranial Aneurysms: Stents, Coated Coils, and Liquid Embolic Agents

Neurosurgery ◽

10.1227/01.neu.0000170538.74899.7f ◽

2005 ◽

Vol 57 (3) ◽

pp. 449-459 ◽

Cited By ~ 43

Author(s):

Giuseppe Lanzino ◽

Yassine Kanaan ◽

Paolo Perrini ◽

Hayan Dayoub ◽

Kenneth Fraser

Keyword(s):

Endovascular Treatment ◽

Effective Treatment ◽

Coil Embolization ◽

Intracranial Aneurysms ◽

Clinical Experiences ◽

Endovascular Techniques ◽

Future Directions ◽

Embolic Agents ◽

Liquid Embolic ◽

Embolic Materials

ABSTRACT ENDOVASCULAR TECHNIQUES FOR the treatment of intracranial aneurysms are rapidly evolving. Modifications of more traditional coils have been introduced. Such modifications include newer coils coated with various polymers to increase both coil thrombogenicity and degree of aneurysm packing. In addition, newer coil designs aimed at improving the conformability of the coil to the aneurysm have been used with promising preliminary results. The availability of a newer generation of stents specifically designed for intracranial navigation allows for more effective treatment of aneurysms with wide necks, which usually have been considered unsuitable for optimal endovascular treatment. Endovascular alternatives to coil embolization, such as liquid embolic materials, also have been explored for the treatment of intracranial aneurysms, with varying results. We summarize the rationale for use of these newer devices and early clinical experiences. Areas of current research and future directions of endovascular aneurysm treatment also are discussed.

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Endovascular treatment of obstructive iliac artery dissections

Acta Radiologica ◽

10.1080/02841850510021166 ◽

2005 ◽

Vol 46 (4) ◽

pp. 359-365 ◽

Cited By ~ 11

Author(s):

B. Önal ◽

E. T. Ilgit ◽

S. Akpek ◽

G. Erbas ◽

A. Akkaya

Keyword(s):

Endovascular Treatment ◽

Iliac Artery ◽

Clinical Success ◽

Symptom Relief ◽

False Lumen ◽

Complete Relief ◽

Technical Success ◽

Technical Success Rate ◽

Presenting Symptoms

Purpose: To report our results from a study of the endovascular treatment of flow restricting chronic atherosclerotic or catheter‐induced segmental iliac artery dissections with bare stents. Material and Methods: Thirty symptomatic patients with 32 lesions, including chronic atherosclerotic ( n = 21) and catheter‐induced ( n = 11) segmental arterial dissections, were treated with primary stenting. The common iliac artery was involved in 19 lesions and the external iliac artery in the remaining 13. Two patients had two lesions in the same vessel. Technical success was defined as restoration of the smooth contoured luminal patency with no more than 20% residual stenosis in diameter in atherosclerotic dissections associated with plaque formation or total obliteration of the false lumen in catheter‐induced dissections. Complete relief of, or marked improvements in, presenting symptoms, or at least single category improvement, was assessed for clinical success. Results: Technical success rate was 100%. No procedure‐related complications such as distal emboli or early occlusions were observed. Complete symptom relief was achieved in all patients with catheter‐induced dissection and in all but three cases with chronic spontaneous atherosclerotic dissection. In two cases, occlusion of the stents occurred during the follow‐up period. Clinical and radiological mean follow‐up for 24 months (range 3–55) revealed patency of all other stented segments. Cumulative primary patency rate was 97% over 12 months and 90% over 24 months. Conclusion: Endovascular treatment of chronic atherosclerotic and catheter‐induced short obstructive iliac arterial dissections with bare stents is safe and effective. Patency of the diseased arterial segment with a smooth lumen can be sustained for an extensive period.

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Transcatheter Arterial Embolization in Acute Non-Variceal Gastrointestinal Bleedings: A Ten-Year Single-Center Experience in 91 Patients and Review of the Literature

Journal of Clinical Medicine ◽

10.3390/jcm10214979 ◽

2021 ◽

Vol 10 (21) ◽

pp. 4979

Author(s):

Federico Fontana ◽

Filippo Piacentino ◽

Christian Ossola ◽

Andrea Coppola ◽

Marco Curti ◽

...

Keyword(s):

Gastrointestinal Bleeding ◽

Upper Gastrointestinal Bleeding ◽

Clinical Success ◽

Therapeutic Option ◽

Arterial Embolization ◽

Gelatin Sponge ◽

Technical Success ◽

Single Center Experience ◽

Embolic Agents ◽

Upper Gastrointestinal

Objective: To report the safety and efficacy of trans-arterial embolization (TAE) for upper gastrointestinal bleeding (UGIB) and lower gastrointestinal bleeding (LGIB) due to different etiologies in 91 patients for ten years. Methods: A retrospective analysis of GIB treated between January 2010 and December 2020 was performed. TAE was performed using different embolic agents (coils, particles, glue, gelatin sponge, and EVOH-based agents). Technical success, secondary technical success, clinical success, and complications were evaluated. Results: Technical success was achieved in 74/91 (81.32%) patients. Seventeen patients (18.68%) required re-intervention. Secondary technical success was achieved in all cases (100.0%). Clinical success was achieved in 81/91 patients (89.01%). No major complications were recorded; overall, minor complications occurred in 20/91 patients. Conclusions: TAE is a technically feasible and safe therapeutic option for patients with GIB from a known or blind anatomic source where endoscopic therapy has failed or is deemed unfeasible.

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Endovascular treatment of visceral artery aneurysms and pseudoaneurysms - evaluation of efficacy and safety based on long-term results

Polish Journal of Surgery ◽

10.5604/01.3001.0013.5895 ◽

2019 ◽

Vol 92 (1) ◽

pp. 1-5

Author(s):

Krzysztof Pyra ◽

Maciej Szmygin ◽

Michał Sojka ◽

Anna Drelich-Zbroja ◽

Tomasz Jargiełło

Keyword(s):

Endovascular Treatment ◽

Clinical Success ◽

Long Term Results ◽

Visceral Artery ◽

Covered Stents ◽

Efficacy And Safety ◽

Technical Success ◽

Visceral Artery Aneurysms ◽

Life Threatening

Background: With estimated prevalence of 1% of the general population, visceral artery aneurysms are not a frequent pathology, however, their rupture is a life-threatening occurrence with mortality rate ranging from 10% to 25%, up to 75% in case of pregnant women. Therefore, the identification and treatment of visceral artery aneurysms is of great importance in the prevention of early rupture. Purpose: To assess the effectiveness and safety of treatment of visceral artery aneurysms with various endovascular methods focusing on technical aspects, complications and long-term clinical outcome. Materials and Methods: 60 patients with visceral artery aneurysms were treated percutaneously. Various techniques were used: coiling (23), covered stents (15), thrombin (7), and other mixed techniques. Aneurysm characteristics, size and localization, procedural data, peri-procedural complications, technical success, 90- and 180-day clinical success and follow-up period (aneurysm exclusion, patency of the artery and complications) were prospectively analyzed. Results: Te procedure was performed in 57 of 60 patients. In 56 of 57 patients aneurysms ware effectively excluded. Te success rate was 93.3% (56 of 60 enrolled patients). Technical success after the intervention was 82.4%, after second 98.2%. Embolization with covered stents ware characterized by highest efficiency. Serious complications occurred in 1.8% of cases. Conclusions. The minimally invasive endovascular treatment of visceral artery aneurysms is characterized by high efficacy and safety. Good treatment results depend on proper assessment of the aneurysm’s morphology as well as on selection of the appropriate vascular approach and endovascular technique.

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Endovascular management of traumatic pseudoaneurysms

CVIR Endovascular ◽

10.1186/s42155-020-00182-7 ◽

2020 ◽

Vol 3 (1) ◽

Author(s):

Lauren Shreve ◽

Maha Jarmakani ◽

Hanna Javan ◽

Ivan Babin ◽

Kari Nelson ◽

...

Keyword(s):

Endovascular Treatment ◽

Successful Treatment ◽

Clinical Success ◽

Traumatic Injury ◽

Complication Rates ◽

Technical Failure ◽

Technical Success ◽

Academic Level ◽

Risk Of Rupture

Abstract Background Pseudoaneurysms (PAs) caused by traumatic injury to the arterial vasculature have a high risk of rupture, leading to life-threatening hemorrhage and mortality, requiring urgent treatment. The purpose of this study was to determine the technical and clinical outcomes of endovascular treatment of visceral and extremity traumatic pseudoaneurysms. Methods Clinical data were retrospectively collected from all patients presenting for endovascular treatment of PAs between September 2012 and September 2018 at a single academic level one trauma center. Technical success was defined as successful treatment of the PA with no residual filling on post-embolization angiogram. Clinical success was defined as technical successful treatment with no rebleeding throughout the follow-up period and no reintervention for the PA. Results Thirty-five patients (10F/25M), average age (± stdev) 41.7 ± 20.1 years, presented with PAs secondary to blunt (n = 31) or penetrating (n = 4) trauma. Time from trauma to intervention ranged from 2 h - 75 days (median: 4.4 h, IQR: 3.5–17.1 h) with 27 (77%) of PAs identified and treated within 24 h of trauma. Average hospitalization was 13.78 ± 13.4 days. Ten patients underwent surgery prior to intervention. PA number per patient ranged from 1 to 5 (multiple diffuse). PAs were located on the splenic (n = 12, 34.3%), pelvic (n = 11, 31.4%), hepatic (n = 9, 25.7%), upper extremity/axilla (n = 2, 5.7%), and renal arteries (n = 1, 2.9%). Technical success was 85.7%. Clinical success was 71.4%, for technical failure (n = 5), repeat embolization (n = 1) or post-IR surgical intervention (n = 4). There was no PA rebleeding or reintervention for any patient after discharge over the reported follow-up periods. Three patients died during the trauma hospitalization for reasons unrelated to the PAs. Conclusions Endovascular treatment of traumatic visceral and extremity PAs is efficacious with minimal complication rates and low reintervention requirements.

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Value of cone beam computed tomography to evaluate complication of intracranial haemorrhage in endovascular treatment (evt): a case report

Journal Of Cardiovascular, Neurovascular & Stroke ◽

10.32896/cvns.v1n1.16-18 ◽

2019 ◽

Vol 1 (1) ◽

pp. 16-18 ◽

Cited By ~ 1

Author(s):

Norafida Bahari ◽

Nik Azuan Nik Ismail ◽

Jegan Thanabalan ◽

Ahmad Sobri Muda

Keyword(s):

Computed Tomography ◽

Arteriovenous Malformation ◽

Endovascular Treatment ◽

Cone Beam Computed Tomography ◽

Diagnostic Value ◽

Cone Beam ◽

Brain Arteriovenous Malformation ◽

Embolic Materials

In this article, we evaluate the effectiveness of Cone Beam Computed Tomography, through a case study, in assessing the complication of intracranial bleeding during an endovascular treatment of brain arteriovenous malformation when compared to Multislice-Detector Computed Tomography performed immediately after the procedure. The image quality of Cone Beam Computed Tomography has enough diagnostic value in differentiating between haemorrhage, embolic materials and the arteriovenous malformation nidus to facilitate physicians to decide for further management of the patient.

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