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2015 ; 94
(42
): e1667
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Emergency Transcatheter Arterial Embolization for Acute Renal Hemorrhage
#MMPMID26496273
Wang HL
; Xu CY
; Wang HH
; Xu W
Medicine (Baltimore)
2015[Oct]; 94
(42
): e1667
PMID26496273
show ga
The aims of this study were to identify arteriographic manifestations of acute
renal hemorrhage and to evaluate the efficacy of emergency embolization.
Emergency renal artery angiography was performed on 83 patients with acute renal
hemorrhage. As soon as bleeding arteries were identified, emergency embolization
was performed using gelatin sponge, polyvinyl alcohol particles, and coils. The
arteriographic presentation and the effect of the treatment for acute renal
hemorrhage were analyzed retrospectively. Contrast extravasation was observed in
41 patients. Renal arteriovenous fistulas were found in 12 of the 41 patients. In
all, 8 other patients had a renal pseudoaneurysm, 5 had pseudoaneurysm rupture
complicated by a renal arteriovenous fistula, and 1 had pseudoaneurysm rupture
complicated by a renal artery-calyceal fistula. Another 16 patients had tumor
vasculature seen on arteriography. Before the procedure, 35 patients underwent
renal artery computed tomography angiography (CTA). Following emergency
embolization, complete hemostasis was achieved in 80 patients, although
persistent hematuria was present in 3 renal trauma patients and 1 patient who had
undergone percutaneous nephrolithotomy (justifying surgical removal of the
ipsilateral kidney in this patient). Two-year follow-up revealed an overall
effective rate of 95.18 % (79/83) for emergency embolization. There were no
serious complications. Emergency embolization is a safe, effective, minimally
invasive treatment for renal hemorrhage. Because of the diversified
arteriographic presentation of acute renal hemorrhage, proper selection of the
embolic agent is a key to successful hemostasis. Preoperative renal CTA plays an
important role in diagnosing and localizing the bleeding artery.