Profile of renal artery embolization (RAE) for renal trauma: A comparison of data from two major trauma centers

Abstract Background: The aim of this article is to elucidate the current situation of renal interventional therapy and discuss the indications for this treatment. Methods: A retrospective study was performed evaluating the electronic medical records of all patients with renal trauma admitted to two major comprehensive hospitals in Shantou city from January 2006 to December 2015. Results: There were 264 and 304 renal traumatic patients admitted to hospital A and B, respectively. low-grade renal trauma(LGRT) was the reason for presentation in the majority of patients (522, 91.9%). A total of 534 (94.0%) patients were treated conservatively. RAE was performed in 9 patients from 2012 to 2015 at hospital A, including in 6 patients (6/9, 66.7%) with LGRT, and 3 patients (3/9, 33.3%) with high-grade renal trauma (HGRT). No patient underwent interventional therapy (RAE) at hospital B during the same period. No significant differences in the operative rate of hospital A were observed between the two time periods (2006-2011 and 2012-2015). The operative rate for LGRT between the two hospitals from 2006 to 2011 and 2012 to 2015 was not significantly different. Hospital A showed a significant decrease in the rate of conservative treatment for patients with LGRT. In the univariate analyses, the American Association for the Surgery of Trauma (AAST) renal grade was significantly associated with undergoing RAE. Additionally, in the multivariate analysis, only the AAST renal grade (odds ratio [OR], 13.56; 95% confidence interval [CI], 2.91-63.06) was significantly associated with undergoing RAE. Conclusions: LGRT was present in the majority of patients, and most cases of renal trauma could be treated with conservative treatment. RAE was well utilized for the treatment of renal trauma. However, some patients with LGRT were treated with unnecessary interventional therapy.

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Profile of renal artery embolization (RAE) for renal trauma: A comparison of data from two major trauma center

International braz j urol ◽

10.1590/s1677-5538.ibju.2019.0506 ◽

2020 ◽

Vol 46 (2) ◽

pp. 194-202

Author(s):

Jie Chen ◽

Weicong Cai ◽

Liping Li

Keyword(s):

Renal Artery ◽

Trauma Center ◽

Major Trauma ◽

Renal Trauma ◽

Artery Embolization ◽

Renal Artery Embolization

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Superselective transcatheter renal artery embolization for the treatment of hemorrhage from non-iatrogenic blunt renal trauma: report of 16 clinical cases

Therapeutics and Clinical Risk Management ◽

10.2147/tcrm.s59671 ◽

2014 ◽

pp. 455

Author(s):

Liping Xie ◽

Dapang Rao ◽

Haibo Zhu ◽

Shixiang Jin ◽

Kaiyuan Yu ◽

...

Keyword(s):

Renal Artery ◽

Renal Trauma ◽

Artery Embolization ◽

Renal Artery Embolization ◽

Clinical Cases

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Trauma to the urinary tract and other urological emergencies

Oxford Handbook of Urology ◽

10.1093/med/9780198783480.003.0011 ◽

2019 ◽

pp. 515-554

Author(s):

John Reynard ◽

Simon F Brewster ◽

Suzanne Biers ◽

Naomi Laura Neal

Keyword(s):

Urinary Tract ◽

Renal Artery ◽

Renal Trauma ◽

Artery Embolization ◽

Surgical Exploration ◽

The Third ◽

Renal Artery Embolization ◽

Urological Emergencies

Management of urological trauma remains much as it was at the time of the third edition of this handbook, though selective renal artery embolization is increasingly used when compared with surgical exploration for renal trauma with persistent bleeding.

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Renal artery embolization in blunt renal trauma a systematic review

European Urology Open Science ◽

10.1016/s2666-1683(20)33605-3 ◽

2020 ◽

Vol 19 ◽

pp. e1514

Author(s):

G. Liguori ◽

G. Rebez ◽

M. Rizzo ◽

N. Pavan ◽

C. Trombetta

Keyword(s):

Systematic Review ◽

Renal Artery ◽

Renal Trauma ◽

Artery Embolization ◽

Renal Artery Embolization

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Non-Permanent Transcatheter Proximal Renal Artery Embolization for a Grade 5 Renal Injury with Delayed Recanalization and Preserved Renal Parenchymal Enhancement

Journal of Trauma and Injury ◽

10.20408/jti.2020.0075 ◽

2021 ◽

Vol 34 (3) ◽

pp. 198-202

Author(s):

Abhishek Jairam ◽

Bradley King ◽

Zachary Berman ◽

Gerant Rivera-Sanfeliz

Keyword(s):

Renal Artery ◽

Renal Injury ◽

Renal Perfusion ◽

Embolic Agent ◽

Low Grade ◽

Artery Embolization ◽

Grade 5 ◽

Efficient Alternative ◽

Renal Artery Embolization ◽

And Function

Super-selective renal artery embolization is an increasingly popular technique for the management of traumatic, low-grade renal trauma. When performed in distal arterial branches, this intervention enables tissue preservation and arrest of hemorrhage, but it may not be practical in cases of multifocal, high-grade renal injuries. In such cases, surgical nephrectomy remains the more common treatment modality to ensure hemodynamic control. We present the unique case of a patient who presented in hemorrhagic shock following a major trauma that resulted in a grade 5 renal injury treated with complete renal artery embolization using Gelfoam, resulting in hemodynamic stabilization. Interestingly, imaging 1 month after embolization revealed residual enhancement of the inferior pole of the kidney, suggesting reconstitution of flow and partial renal salvage. Ultimately, transcatheter “nephrectomy” with careful selection of a temporary embolic agent may serve as a safe and efficient alternative to surgical nephrectomy with the added possibility of preserving partial renal perfusion and function in the emergent setting.

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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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The Development of Major Trauma Centers in the United Kingdom: Revisited Problems and Data from the First Year of Operation of a New Neurotrauma Center in St Mary's Hospital in London

Journal of Neurological Surgery Part A Central European Neurosurgery ◽

10.1055/s-0032-1316264 ◽

2012 ◽

Vol 73 (S 03) ◽

Author(s):

R. Iorga ◽

S. Agius ◽

A. Hussein ◽

R. Morris ◽

M. Wilson

Keyword(s):

United Kingdom ◽

Major Trauma ◽

First Year ◽

Trauma Centers ◽

The United Kingdom

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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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