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, 2019, 6265183

The Efficacy and Safety of Transcatheter Arterial Embolization to Treat Renal Hemorrhage After Percutaneous Nephrolithotomy


The Efficacy and Safety of Transcatheter Arterial Embolization to Treat Renal Hemorrhage After Percutaneous Nephrolithotomy

Nan Du et al. Biomed Res Int.


Purpose: The aim of this study was to evaluate the safety and efficacy of transcatheter arterial embolization (TAE) in patients with renal hemorrhage after percutaneous nephrolithotomy (PCNL) and evaluate the risk factors that may result in severe bleeding requiring TAE.

Methods: We retrospectively reviewed 121 patients with post-PCNL renal hemorrhage. Thirty-two patients receiving endovascular embolization were compared with 89 patients only receiving conservative treatment. The demographic and clinical data were recorded and compared between the two groups. The values of estimated glomerular filtration rate (eGFR) and serum creatinine (SCr) were recorded preoperatively, postoperatively, and at last follow-up and analyzed to evaluate the safety and efficiency of TAE.

Results: The successful hemostasis rate of conservative therapy was 73.6% (89/121) and that of TAE was 100% (32/32). SCr and eGFR were not significantly different before PCNL and after the last follow-up of TAE (SCr: 0.95 vs. 0.95 mg/dl, P=0.857; eGFR: 86.77 vs. 86.18 ml/min/1.73m2, P=0.715). The univariate analysis demonstrated that advanced age, urinary tract infection, and diabetes mellitus were significantly associated with severe bleeding during PCNL. Multivariate analysis further identified that diabetes mellitus was an independent risk factor for severe bleeding needing TAE [odds ratio (OR): 3.778, 95% confidence interval (CI):1.276-11.190, and P=0.016].

Conclusion: TAE is a safe and effective procedure to treat renal hemorrhage that cannot be resisted by conservative treatment after PCNL. Diabetes mellitus was associated with high risks of severe bleeding needing TAE after PCNL.


Figure 1
Figure 1
(a) Selective renal arteriography shows a PA arising from the right inferior anterior interlobar artery in a 49-year-old woman with renal hemorrhage 5 days after PCNL. (b) After finding the responsible vessel and embolized with NBCA and coils, angiographic imaging shows the disappearance of the PA.
Figure 2
Figure 2
(a) The angiographic imaging in a 56-year-old man with renal hemorrhage 3 days after PCNL indicates a PA arise from the superior anterior interlobar artery (thin arrow). (b) Angiographic imaging show that an AVF (thick arrowhead) arise from the posterior and superior anterior interlobar artery. (c, d) Angiogram after coil embolization demonstrates complete occlusion of the PA and AVF.
Figure 3
Figure 3
(a) Selective renal arteriogram shows a PA arise from the left posterior anterior segmental artery in a 54-year-old man. (b) Renal arteriography during the arterial phase shows a PA (thin arrow) and contrast agent extravasation along the drainage pipe (thick arrowhead) arising from the posterior and superior anterior interlobar artery. (c) After embolization with 3 coils (TORNADO MWCE-18S-3.0-2, Cook Inc.), there is no contrast medium extravasation again under angiogram. (d) After embolization, digital subtraction angiographic imaging shows complete occlusion of the PA and contrast agent retention.
Figure 4
Figure 4
Secondary embolization in a patient with PA after PCNL. (a) Abdominal aorta angiography cannot show the number of left renal artery clearly because of the interference of intestinal gas. (b, c) Selective left renal arteriography shows a PA (red arrow). (d) Angiogram after coil embolization showing complete occlusion of the PA. (e-h) Angiogram 3-day after first time TAE shows a new PA (red arrow) arising from accessory left renal artery, which arises at approximately the inferior level of third Lumbar vertebra. (i) After coil embolization, angiogram shows complete occlusion of the PA. (j, k) The CT image shows the location of left renal artery and accessory left renal artery.

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