Emergency intervention therapy for renal vascular injury

• Published in: Chinese journal of traumatology Vol. 12; no. 2; pp. 81 - 86
• Main Author: 刘凤永 王茂强 樊庆胜 王志军 段峰 宋鹏
• Format: Journal Article
• Language: English
• Published: China Elsevier B.V 01.04.2009; Department of Interventional Radiology,Clinical Division of Medicine,General Hospital of PLA,Beijing 100853,China
• Subjects: Adult; Aged; Arteriovenous Fistula - therapy; Embolization, Therapeutic; Emergency Medical Services; Female; Humans; Iatrogenic Disease - epidemiology; Kidney; Low Back Pain - etiology; Male; Middle Aged; Radiography; Renal artery; Renal Artery - diagnostic imaging; Renal Artery - injuries; Renal Veins - diagnostic imaging; Renal Veins - injuries; 多器官功能衰竭; 干预治疗; 聚乙烯醇颗粒; 肾功能不全; 肾功能受损; 肾血管损伤; 超选择性动脉栓塞; 选择性肾动脉栓塞术; Embolization, therapeutic; Renal artery; Kidney; Embolization,therapeutic; Renalartery
• ISSN: 1008-1275
• DOI: 10.3760/cma.j.issn.1008-1275.2009.02.004

Objective： To evaluate the efficacy and safety of the interventional techniques in the treatment of renal vascular injury. Methods： A total of 16 patients with renal vascular injuries were treated by superselective arterial embolization. The renal injuries resulted from renal biopsy in 7 patients, endovascular intervention in 2, percutaneous puncture and pyelostomy in 2, local resection of renal tumor in 1 and trauma in 4. With regards to clinical manifestations, there was hemorrhagic shock in 8 patients, severe flank pain in 14, and hematuria in 14. CT and ultrasonography confirmed that 15 patients had perirenal hematoma. The embolization was performed with microcoils in 13 and standard stainless steel coils in 3 patients, associated with polyvinyl alcohol particles （PVA） in 9, and gelfoam particles in 6 cases. Results： Renal angiogram revealed arterlovenous fistula in renal parenchyma in 9 cases, pseudoaneurysm in 3 and extravasation of contrast media in 4. The arterial embolization was successful in all 16 cases in a single session. The angiography at the end of therapy showed that abnormal vessels had disappeared without other major intrarenal arterial branch occlusion. In 13 patients with hemodynamical compromise, blood loss-related symptoms were immediately relieved after blood transfusion. In 14 patients with severe flank pain, the pain was progressively relieved. Hematuria ceased in 14 patients 2-14 days after the embolization procedures. The renal function was impaired after the procedure in 6 cases, in which preoperative renal insufficiency was exacerbated in 3 and developed new renal dysfunction in 3, 2 of whom received hemodialysis. The ultrasonography showed that perirenal hematoma was gradually absorbed within 2-6 months after the procedure. All patients were followed up in 6-78 months （mean, 48 months）. Six patients died of primary diseases （5 cases of renal failure and multiple organ failure and l case of malignant tumor）. Ten patients survived without bleeding and further intervention. The deterioration of renal function did not occur and the serum creatinine and blood urea were in normal range. Conclusion： Transcatheter selective renal arterial embolization is a safe and effective method in the treatment of renal vascular injuries.