Long term renal function following selective angioembolization for iatrogenic vascular lesions after partial nephrectomy: A matched case-control study

Investig Clin Urol. 2021 May;62(3):267-273. doi: 10.4111/icu.20200510. Epub 2021 Mar 25.

Abstract

Purpose: Partial nephrectomy is associated with a 1%-2% risk of renal iatrogenic vascular lesion (IVL) that are commonly treated with selective angioembolization (SAE). The theoretical advantage of SAE is preservation of renal parenchyma by targeting only the bleeding portion of the kidney. Our study aims to assess the long-term effect of SAE on renal function, especially that this intervention requires potentially nephrotoxic contrast load injection.

Materials and methods: A retrospective review of patients undergoing partial nephrectomy between 2002 and 2018 was performed, and patients who developed IVL were identified. A 1:4 matched case-control analysis was performed. Paired t-test and χ² test were used for continuous and categorical variables, respectively. Multivariable logistic and Cox proportional hazards regression analyses were used to identify risk factors and confounders for SAE and postoperative renal function.

Results: Eighteen patients found to have an IVL after partial nephrectomy were matched with 72 control patients. IVL's were more common in patients after minimally invasive partial nephrectomy (89% vs. 70%, p=0.008) and in those with higher RENAL nephrometry scores (8.8±2.0 vs. 6.5±1.8, p<0.001). On multivariable analysis, lower RENAL scores proved to decrease the odds of requiring postoperative SAE. No significant difference in renal function outcomes was seen at 24 months of follow-up after surgery.

Conclusions: SAE for the management of IVL following partial nephrectomy is a safe and efficient procedure with no significant impact on short or long-term renal function. Less complex renal tumors with lower RENAL scores are less likely to require postoperative SAE.

Keywords: Embolization; Kidney function tests; Nephrectomy; Postoperative period.

MeSH terms

  • Aged
  • Case-Control Studies
  • Embolization, Therapeutic*
  • Female
  • Follow-Up Studies
  • Glomerular Filtration Rate
  • Humans
  • Iatrogenic Disease
  • Kidney / injuries*
  • Kidney Neoplasms / complications
  • Kidney Neoplasms / diagnosis
  • Kidney Neoplasms / surgery*
  • Logistic Models
  • Male
  • Middle Aged
  • Nephrectomy / adverse effects*
  • Postoperative Hemorrhage / diagnosis
  • Postoperative Hemorrhage / etiology
  • Postoperative Hemorrhage / therapy*
  • Proportional Hazards Models
  • Renal Insufficiency / diagnosis
  • Renal Insufficiency / epidemiology*
  • Risk Factors
  • Time Factors