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

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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Color-coded summation images in the evaluation of renal artery stenosis before and after percutaneous transluminal angioplasty

BMC Medical Imaging ◽

10.1186/s12880-020-00540-w ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Anne Marie Augustin ◽

Stefan Welsch ◽

Thorsten Alexander Bley ◽

Kai Lopau ◽

Ralph Kickuth

Keyword(s):

Diabetes Mellitus ◽

Serum Creatinine ◽

Renal Artery ◽

Renal Artery Stenosis ◽

Clinical Success ◽

Flow Characteristics ◽

Artery Stenosis ◽

Technical Success ◽

Segmental Artery ◽

Before And After

Abstract Background Endovascular therapy is the gold standard in patients with hemodynamic relevant renal artery stenosis (RAS) resistant to medical therapy. The severity grading of the stenosis as well as the result assessment after endovascular approach is predominantly based on visible estimations of the anatomic appearance. We aim to investigate the application of color-coded DSA parameters to gain hemodynamic information during endovascular renal artery interventions and for the assessment of the procedures´ technical success. Methods We retrospectively evaluated 32 patients who underwent endovascular renal artery revascularization and applied color-coded summation imaging on selected monochromatic DSA images. The differences in time to peak (dTTP) of contrast enhancement in predefined anatomical measuring points were analyzed. Furthermore, differences in systolic blood pressure values (SBP) and serum creatinine were obtained. The value of underlying diabetes mellitus as a predictor for clinical outcome was assessed. Correlation analysis between the patients´ gender as well as the presence of diabetes mellitus and dTTP was performed. Results Endovascular revascularization resulted in statistically significant improvement in 4/7 regions of interest. Highly significant improvement of perfusion in terms of shortened TTP values could be found at the segmental artery level and in the intrastenotical segment (p < 0.001), significant improvement prestenotical and in the apical renal parenchyma (p < 0.05). In the other anatomic regions, differences revealed not to be significant. Differences between SBP and serum creatinine levels before and after the procedure were significant (p = 0.004 and 0.0004). Patients´ gender as well as the presence of diabetes mellitus did not reveal to be predictors for the clinical success of the procedure. Furthermore, diabetes and gender did not show relevant correlation with dTTP in the parenchymal measuring points. Conclusions The supplementary use of color-coding DSA and the data gained from parametric images may provide helpful information in the evaluation of the procedures´ technical success. The segmental artery might be a particularly suitable vascular territory for analyzing differences in blood flow characteristics. Further studies with larger cohorts are needed to further confirm the diagnostic value of this technique.

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Initial Experience With the Microvascular Plug in Selective Renal Artery Embolization

Vascular and Endovascular Surgery ◽

10.1177/1538574419897500 ◽

2020 ◽

Vol 54 (3) ◽

pp. 240-246 ◽

Cited By ~ 1

Author(s):

Thomas Jardinet ◽

Lawrence Bonne ◽

Raymond Oyen ◽

Geert Maleux

Keyword(s):

Renal Artery ◽

Renal Infarction ◽

Vascular Injuries ◽

Artery Embolization ◽

Clinical Events ◽

Renal Artery Embolization ◽

Technical Details ◽

The Cost ◽

Embolization Procedure ◽

Injured Artery

Purpose: To evaluate the safety and efficacy of the microvascular plug (MVP) for selective renal artery embolization. Methods: Retrospective review was performed on a cohort of 6 patients undergoing renal artery embolization using the MVP between July 2015 and August 2018. Patients’ demographics, indication for embolization, technical details of the embolization procedure, and clinical events were gathered from the patients’ electronic medical records. Results: The patients underwent selective renal artery embolization with a MVP for iatrogenic vascular injuries (n = 3), traumatic vascular injuries (n = 2), and for elective embolization of an angiomyolipoma (n = 1), in native kidneys (n = 4) or in renal allografts (n = 2). Immediate occlusion of the feeding artery was achieved with 1 MVP device in 4 patients. In 1 patient, a second MVP was needed, and in another patient, additional 0.018-inch microcoils were used to completely occlude the injured artery. Technical success was achieved in all patients. The volume of the resulting renal infarction was estimated less than 5% of the renal volume. No other procedure-related complications occurred. Conclusion: The MVP is a safe and effective device allowing superselective renal artery embolization. Therefore, we recommend the MVP as a valuable embolic in superselective renal artery embolization. Additionally, a single device is sufficient in most cases, potentially reducing the cost, duration, and radiation exposure of the procedure.

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Clinical outcome and safety of selective renal artery embolization using permanent occlusive agents for acute renal bleeding

Egyptian Journal of Radiology and Nuclear Medicine ◽

10.1186/s43055-020-00328-6 ◽

2020 ◽

Vol 51 (1) ◽

Author(s):

Mohamed S. Alwarraky ◽

Mohamed M. Abdallah ◽

Mohamed S. Elgharbawy

Keyword(s):

Renal Artery ◽

Medical Records ◽

Primary Outcome ◽

Clinical Success ◽

Single Session ◽

Artery Embolization ◽

Cyanoacrylate Glue ◽

Significant Difference ◽

Renal Artery Embolization ◽

Secondary Outcomes

Abstract Background To evaluate how far is selective renal artery embolization (RAE) using permanent agents effective in treating acute renal artery bleeding. We retrospectively reviewed the medical records of patients (n = 45) with renal bleeding who were managed by selective RAE using coils, N-butyl-cyanoacrylate glue (NBCA glue), and polyvinyl alcohol (PVA). Data retrieved included the cause, number, and type of the bleeding lesions as well as the results of the embolization for 1 year after RAE. Clinical success was the primary outcome while re-bleeding and complications were the secondary outcomes. Results There were 55 bleeding lesions detected by angiography in the included 45 patients. Coils were used in 23/45 patients (51.1%), NBCA glue in 15/45 patients (33.3%), and PVA in 7 patients (15.6%). Bleeding could be controlled with embolization in a single session in 41/45 patients with primary clinical success 91.1%. Four patients needed re-embolization sessions to control bleeding and only one patient was controlled, giving secondary clinical success of 92.3%. Three patients failed to respond to embolization and nephrectomy was done. Iatrogenic dissection of the segmental branch was seen in one patient. Post embolization syndrome was seen in 14/45 patients (31.1%). Non-target embolization was seen in 2 patients: one during treatment with NBCA glue and the other with PVA. No other complications were recorded. No significant differences between clinical success among coil, NBCA glue, and PVA subgroups (P > 0.05). Conclusion Selective RAE using permanent agents is effective in controlling renal bleeding and no significant difference among coil, NBCA glue, and PVA.

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Safety of Renal Biopsy by Physicians with Short Nephrology Experience

Healthcare ◽

10.3390/healthcare9040474 ◽

2021 ◽

Vol 9 (4) ◽

pp. 474

Author(s):

Kenta Torigoe ◽

Kumiko Muta ◽

Kiyokazu Tsuji ◽

Ayuko Yamashita ◽

Shinichi Abe ◽

...

Keyword(s):

Renal Artery ◽

Renal Biopsy ◽

Renal Diseases ◽

Complication Rates ◽

Artery Embolization ◽

Clinical Nephrology ◽

Percutaneous Renal Biopsy ◽

Artery Embolism ◽

Renal Artery Embolization ◽

Biopsy Complications

Percutaneous renal biopsy is an essential tool for diagnosing various renal diseases; however, little is known about whether renal biopsy performed by physicians with short nephrology experience is safe in Japan. This study included 238 patients who underwent percutaneous renal biopsy between April 2017 and September 2020. We retrospectively analyzed the frequency of post-renal biopsy complications (hemoglobin decrease of ≥10%, hypotension, blood transfusion, renal artery embolization, nephrectomy and death) and compared their incidence among physicians with varied experience in nephrology. After renal biopsy, a hemoglobin decrease of ≥10%, hypotension and transfusion occurred in 13.1%, 3.8% and 0.8% of patients, respectively. There were no cases of post-biopsy renal artery embolism, nephrectomy, or death. The composite complication rate was 16.0%. The incidence of post-biopsy complications was similar between physicians with ≥3 years and <3 years of clinical nephrology experience (12.5% vs. 16.8%, p = 0.64). Furthermore, the post-biopsy composite complication rates were similar between physicians with ≥6 months and <6 months of clinical nephrology experience (16.3% vs. 15.6%, p > 0.99). Under attending nephrologist supervision, a physician with short clinical nephrology experience can safely perform renal biopsy.

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Renal Artery Embolization for Neoplastic Conditions

Seminars in Interventional Radiology ◽

10.1055/s-0040-1715884 ◽

2020 ◽

Vol 37 (04) ◽

pp. 420-425

Author(s):

Alex Lionberg ◽

James Jeffries ◽

Thuong G. Van Ha

Keyword(s):

Renal Artery ◽

Artery Embolization ◽

Renal Artery Embolization

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Biopsy-Related Hemorrhage of Renal Allografts Treated by Percutaneous Superselective Segmental Renal Artery Embolization

Transplantation Proceedings ◽

10.1016/j.transproceed.2006.02.124 ◽

2006 ◽

Vol 38 (5) ◽

pp. 1375-1378 ◽

Cited By ~ 10

Author(s):

P. Pappas ◽

C. Constantinides ◽

P. Leonardou ◽

G. Zavos ◽

J. Boletis ◽

...

Keyword(s):

Renal Artery ◽

Artery Embolization ◽

Renal Allografts ◽

Renal Artery Embolization ◽

Segmental Renal Artery

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Predictors for Clinical Success at One Year following Renal Artery Stent Placement

Journal of Endovascular Therapy ◽

10.1177/152660280200900419 ◽

2002 ◽

Vol 9 (4) ◽

pp. 495-502 ◽

Cited By ~ 6

Author(s):

Trude C. Gill-Leertouwer ◽

Elma J. Gussenhoven ◽

Johanna L. Bosch ◽

Jaap Deinum ◽

Hans van Overhagen ◽

...

Keyword(s):

Renal Function ◽

Serum Creatinine ◽

Renal Artery ◽

Renal Artery Stenosis ◽

Stent Placement ◽

Clinical Success ◽

Artery Stenosis ◽

Renal Function Impairment ◽

Function Impairment ◽

Renal Artery Stent

Purpose: To determine pretreatment variables that may predict 1-year clinical outcome of stent placement for renal artery stenosis. Methods: In a prospective study, 40 consecutive patients (29 men; mean age 60 ± 9.1 years) with angiographically proven atherosclerotic renal artery stenosis were treated with stent placement because of drug resistant hypertension (n=14), renal function impairment (n=14), or both (n=12). Clinical success at 1 year was defined as a decrease of diastolic blood pressure ≥10 mmHg or a decrease in serum creatinine ≥20%, depending on the indication for treatment. Regression analysis was performed using anatomical parameters from angiography and intravascular ultrasound, estimates of renal blood flow from renal scintigraphy, and single-kidney renal function measurements. Results: Patients treated for hypertension had better outcome than those treated for renal function impairment, with clinical success rates of 85% and 35%, respectively. Preserved renal function, with low serum creatinine and high 2-kidney glomerular filtration rate at baseline, was associated with clinical success in the entire patient group at follow-up (p=0.02 and p=0.03, respectively). An elevated vein-to-artery renin ratio on the affected side was borderline predictive (p=0.06). In patients treated for renal impairment, lateralization to the affected kidney (affected kidney—to–2-kidney count ratio ≤0.45) on the scintigram emerged as a significant predictor for clinical success, with an odds ratio of 15 (p=0.048). Conclusions: Clinical success of renal artery stent placement is better for the treatment of hypertension than for preserving renal function. In patients with renal function impairment, lateralization to the affected kidney on the scintigram appears to be a predictor of clinical success.

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