Safety and Efficacy of Selective Renal Artery Embolization in the Management of Postprocedural Acute Renal Bleeding: Experience of A Tertiary Care Center

Abstract

Objective: Our objective was to evaluate the safety and efficacy of selective renal artery embolization in the management of post-procedural acute renal bleeding. Materials and Methods: This was a prospective observational study that included all patients who presented to us with acute renal bleeding the following kidney procedures. Demographic, radiological, and invasive angiographic data of patients were recorded. Selective renal artery embolization was performed by an interventional radiologist, and patients were observed for any complications. Results: We received 20 patients with an average age of 46.2±13.18 years having bleeding following procedures done on the kidney. Fifteen (75%) patients had undergone procedure for renal stone disease, 3 (15%) had bleeding following nephron-sparing surgery (NSS), 1 (5%) patient had undergone percutaneous nephrostomy tube placement, while another patient had undergone biopsy of renal allograft. The average drop in hemoglobin recorded before the embolization was 2.45±0.69 mg/dL in percutaneous nephrolithotomy patients, 3.05±1.28 mg/dL in nephrolithotomy patients and 3.32±0.82 mg/dL following NSS. Renal pseudoaneurysm was the most common vascular lesion identified on angiography in 50% of patients, followed by arteriovenous fistula (AVF) in 30% of patients. A combination of pseudoaneurysm and AVF was seen in 10% of patients, and 10% of patients had active extravasation from injured vessels. One (5%) patient required emergency nephrectomy after two failed attempts of angioembolization. There were no major complications recorded except for urosepsis in 2 (10%) patients and acute kidney injury in 1 (5%) patient. Conclusion: Transarterial selective renal artery embolization is a safe and highly effective method to control postprocedural acute renal bleeding.

Keywords

• arteriovenous fistula
• nephron sparing surgery
• percutaneous nephrolithotomy
• renal pseudoaneurysm
• selective renal artery embolization