Selective angioembolization for traumatic renal injuries: a survey on clinician practice

• Published in: World journal of urology Vol. 32; no. 3; pp. 821 - 827
• Main Authors: Glass, Allison S., Appa, Ayesha A., Kenfield, Stacey A., Bagga, Herman S., Blaschko, Sarah D., McGeady, James B., McAninch, Jack W., Breyer, Benjamin N.
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.06.2014; Springer Nature B.V
• Subjects: Abdominal Injuries - complications; Abdominal Injuries - diagnosis; Abdominal Injuries - surgery; Adult; Aged; Angiography - methods; Embolization, Therapeutic - methods; Female; Hemorrhage - diagnostic imaging; Hemorrhage - etiology; Hemorrhage - therapy; Humans; Kidney - blood supply; Kidney - diagnostic imaging; Kidney - injuries; Male; Medicine; Medicine & Public Health; Middle Aged; Nephrology; Oncology; Original Article; Renal Artery - diagnostic imaging; Renal Artery - injuries; Retrospective Studies; Tomography, X-Ray Computed; Treatment Outcome; Urology; High-grade renal trauma; Renal angioembolization; Imaging; Clinician survey
• ISSN: 0724-4983; 1433-8726
• DOI: 10.1007/s00345-013-1169-1

Purpose A variety of clinical and imaging findings are used by clinicians to determine utility of renal angioembolization (AE) in managing renal trauma. Our purpose was to investigate specific criteria that clinicians who manage high-grade renal trauma (HGRT) utilize in decision-making for primary or delayed AE. Methods A total of 413 urologists and interventional radiologists (IRs) who practice at level 1 or 2 trauma centers within the United States were provided an original survey via email on experience and opinions regarding the utility of AE for HGRT. We described overall practice patterns and assessed differences by clinician type, using the Fisher’s exact test. Results A total of 79 (20 %) clinicians completed the survey. All clinicians had AE capability for HGRT management. A higher proportion of IRs reported using AE for grade I–II (33 vs. 3 %, p  = 0.002), grade III (65 vs. 26 %, p  = 0.001), and penetrating injuries (83 vs. 58 %, p  = 0.02). A greater proportion of urologists reported using AE for grade V injuries (81 vs. 56 %, p  = 0.03). Clinicians most commonly cited computed tomography evidence of active arterial bleeding (97 %), or arteriovenous fistula/pseudoaneurysm (94 %) as indications for primary AE, and 62 % identified concurrent visceral injury as factor that would necessitate surgical intervention. Conclusion In a survey of clinicians, we report that IRs and urologists utilize AE differently when managing HGRT, as a higher proportion of IRs use AE to manage lower grade as well as penetrating injuries. Validation studies are needed to establish algorithms to identify patients with HGRT who would benefit from selective renal AE.