Renal Artery Embolization for Partial Nephrectomy Bleeding Management
CUA Online Library. Rendon R. 06/22/13; 31437; UP-58
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Abstract
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Introduction: Renal cell carcinomas (RCC) represent 80-85% of primary renal neoplasms. For patients with isolated, solid renal masses , partial nephrectomy represents the preferred treatment.
With renal-sparing surgery, post-operative bleeding may occur and lead to significant morbidity. Superselective renal artery embolization has shown promise as an effective tool in the management of hemorrhagic complication.
Our intent is to evaluate the angiographic characteristics and utility of superselective renal artery embolization in the management of bleeding after partial nephrectomy.
Methods:
We performed a retrospective analysis of patients that underwent open or laparoscopic partial nephrectomy between 2002 and 2012. A total of 244 patients were evaluated. Pre-operative imaging was assessed with R.E.N.A.L score. Embolization imaging and technique were reviewed and categorized.
Results:
A total of 18 patients had post partial nephrectomy bleeding managed with embolization. Three additional patients underwent angiography with intention to treat but no abnormality was identified and they were successfully managed with conservative measures. Five patients bled but were managed conservatively and did not undergo conventional angiography.
Nine patients had active contrast extravasation/bleeding at the time of intervention, six had pseudoaneurysm formation, one had an arteriovenous fistula, one had abrupt vessel cutoff sign and one had an arterial dissection.
The average R.E.N.A.L score for patients undergoing embolization was 8 (range: 6-10). More were anterior than posterior. The average R.E.N.A.L score for patients managed conservatively was 6.4 (range: 5-9).
All embolization procedures were technically successful. One patient required a second separate embolization for persistent bleeding. Two others were readmitted to hospital for suspected bleeding but were managed conservatively.
Average hospital stay for those embolized was 9.6 days (range: 2-29). Average hospital stay for those managed conservatively was 13.4 days (range: 4-30).
No significant complications were noted after embolization. Minor complications were treated symptomatically.
Conclusions:
Hemorrhage following partial nephrectomy is associated with significant morbidity and protracted stay in-hospital. Superselective arterial embolization is safe and effective. It should be strongly considered in patients with post partial nephrectomy bleeding.
With renal-sparing surgery, post-operative bleeding may occur and lead to significant morbidity. Superselective renal artery embolization has shown promise as an effective tool in the management of hemorrhagic complication.
Our intent is to evaluate the angiographic characteristics and utility of superselective renal artery embolization in the management of bleeding after partial nephrectomy.
Methods:
We performed a retrospective analysis of patients that underwent open or laparoscopic partial nephrectomy between 2002 and 2012. A total of 244 patients were evaluated. Pre-operative imaging was assessed with R.E.N.A.L score. Embolization imaging and technique were reviewed and categorized.
Results:
A total of 18 patients had post partial nephrectomy bleeding managed with embolization. Three additional patients underwent angiography with intention to treat but no abnormality was identified and they were successfully managed with conservative measures. Five patients bled but were managed conservatively and did not undergo conventional angiography.
Nine patients had active contrast extravasation/bleeding at the time of intervention, six had pseudoaneurysm formation, one had an arteriovenous fistula, one had abrupt vessel cutoff sign and one had an arterial dissection.
The average R.E.N.A.L score for patients undergoing embolization was 8 (range: 6-10). More were anterior than posterior. The average R.E.N.A.L score for patients managed conservatively was 6.4 (range: 5-9).
All embolization procedures were technically successful. One patient required a second separate embolization for persistent bleeding. Two others were readmitted to hospital for suspected bleeding but were managed conservatively.
Average hospital stay for those embolized was 9.6 days (range: 2-29). Average hospital stay for those managed conservatively was 13.4 days (range: 4-30).
No significant complications were noted after embolization. Minor complications were treated symptomatically.
Conclusions:
Hemorrhage following partial nephrectomy is associated with significant morbidity and protracted stay in-hospital. Superselective arterial embolization is safe and effective. It should be strongly considered in patients with post partial nephrectomy bleeding.
Introduction: Renal cell carcinomas (RCC) represent 80-85% of primary renal neoplasms. For patients with isolated, solid renal masses , partial nephrectomy represents the preferred treatment.
With renal-sparing surgery, post-operative bleeding may occur and lead to significant morbidity. Superselective renal artery embolization has shown promise as an effective tool in the management of hemorrhagic complication.
Our intent is to evaluate the angiographic characteristics and utility of superselective renal artery embolization in the management of bleeding after partial nephrectomy.
Methods:
We performed a retrospective analysis of patients that underwent open or laparoscopic partial nephrectomy between 2002 and 2012. A total of 244 patients were evaluated. Pre-operative imaging was assessed with R.E.N.A.L score. Embolization imaging and technique were reviewed and categorized.
Results:
A total of 18 patients had post partial nephrectomy bleeding managed with embolization. Three additional patients underwent angiography with intention to treat but no abnormality was identified and they were successfully managed with conservative measures. Five patients bled but were managed conservatively and did not undergo conventional angiography.
Nine patients had active contrast extravasation/bleeding at the time of intervention, six had pseudoaneurysm formation, one had an arteriovenous fistula, one had abrupt vessel cutoff sign and one had an arterial dissection.
The average R.E.N.A.L score for patients undergoing embolization was 8 (range: 6-10). More were anterior than posterior. The average R.E.N.A.L score for patients managed conservatively was 6.4 (range: 5-9).
All embolization procedures were technically successful. One patient required a second separate embolization for persistent bleeding. Two others were readmitted to hospital for suspected bleeding but were managed conservatively.
Average hospital stay for those embolized was 9.6 days (range: 2-29). Average hospital stay for those managed conservatively was 13.4 days (range: 4-30).
No significant complications were noted after embolization. Minor complications were treated symptomatically.
Conclusions:
Hemorrhage following partial nephrectomy is associated with significant morbidity and protracted stay in-hospital. Superselective arterial embolization is safe and effective. It should be strongly considered in patients with post partial nephrectomy bleeding.
With renal-sparing surgery, post-operative bleeding may occur and lead to significant morbidity. Superselective renal artery embolization has shown promise as an effective tool in the management of hemorrhagic complication.
Our intent is to evaluate the angiographic characteristics and utility of superselective renal artery embolization in the management of bleeding after partial nephrectomy.
Methods:
We performed a retrospective analysis of patients that underwent open or laparoscopic partial nephrectomy between 2002 and 2012. A total of 244 patients were evaluated. Pre-operative imaging was assessed with R.E.N.A.L score. Embolization imaging and technique were reviewed and categorized.
Results:
A total of 18 patients had post partial nephrectomy bleeding managed with embolization. Three additional patients underwent angiography with intention to treat but no abnormality was identified and they were successfully managed with conservative measures. Five patients bled but were managed conservatively and did not undergo conventional angiography.
Nine patients had active contrast extravasation/bleeding at the time of intervention, six had pseudoaneurysm formation, one had an arteriovenous fistula, one had abrupt vessel cutoff sign and one had an arterial dissection.
The average R.E.N.A.L score for patients undergoing embolization was 8 (range: 6-10). More were anterior than posterior. The average R.E.N.A.L score for patients managed conservatively was 6.4 (range: 5-9).
All embolization procedures were technically successful. One patient required a second separate embolization for persistent bleeding. Two others were readmitted to hospital for suspected bleeding but were managed conservatively.
Average hospital stay for those embolized was 9.6 days (range: 2-29). Average hospital stay for those managed conservatively was 13.4 days (range: 4-30).
No significant complications were noted after embolization. Minor complications were treated symptomatically.
Conclusions:
Hemorrhage following partial nephrectomy is associated with significant morbidity and protracted stay in-hospital. Superselective arterial embolization is safe and effective. It should be strongly considered in patients with post partial nephrectomy bleeding.
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