Clinical Results of Transarterial Embolization to Control Postoperative Vascular Complications after Partial Nephrectomy
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Abstract
Purpose:
We evaluated the safety and clinical efficacy of transarterial embolization of vascular complications after partial nephrectomy.
Materials and Methods:
This retrospective study included 1,187 patients who underwent partial nephrectomy between January 2006 and December 2017. A total of 36 patients were referred to the interventional radiology department for vascular complications after partial nephrectomy. Data on demographics, clinical manifestations, angiographic findings, the embolization procedure, perioperative details, and technical and clinical success rates were analyzed. Further, renal function was recorded at diagnosis, after embolization and at the last followup.
Results:
Hemorrhage was diagnosed a median of 5 days (range 0 to 89) postoperatively. The incidence of requiring embolization due to hemorrhage after laparoscopic surgery (5.9% or 17 of 289 cases) was higher than that after open surgery (1.8% or 8 of 440, p = 0.003) and robot-assisted surgery (2.4% or 11 of 458, p = 0.014). The technical and clinical success rates were 100% (36 of 36 patients) and 94.4% (34 of 36) with 2 patients requiring additional embolization with n-butyl-2-cyanoacrylate glue. The mean ± SD estimated glomerular filtration rate at diagnosis, after embolization and at last followup was 81.0 ± 21.6, 83.7 ± 21.0 and 84.9 ± 15.8 ml/minute/1.73 m2, respectively (p = 0.345). No major complication was observed during followup.
Conclusions:
Transarterial embolization is safe and effective for managing vascular complications after partial nephrectomy. Moreover, renal function was well preserved with super selective transarterial embolization.
References
- 1. : Nephron sparing surgery for renal cell carcinoma with normal contralateral kidney: 25 years of experience. J Urol 2006; 175: 2027. Link, Google Scholar
- 2. : Systematic review of perioperative and quality-of-life outcomes following surgical management of localised renal cancer. Eur Urol 2012; 62: 1097. Google Scholar
- 3. : Partial versus radical nephrectomy for 4 to 7 cm renal cortical tumors. J Urol 2009; 182: 2601. Link, Google Scholar
- 4. : Comparison of 1,800 laparoscopic and open partial nephrectomies for single renal tumors. J Urol 2007; 178: 41. Link, Google Scholar
- 5. : Robot-assisted partial nephrectomy: an international experience. Eur Urol 2010; 57: 815. Google Scholar
- 6. : Complications of radical and partial nephrectomy in a large contemporary cohort. J Urol 2004; 171: 130. Link, Google Scholar
- 7. : Incidence of renal artery pseudoaneurysm following open and minimally invasive partial nephrectomy: a systematic review and comparative analysis. J Urol 2013; 189: 1643. Link, Google Scholar
- 8. : Iatrogenic vascular lesions after minimally invasive partial nephrectomy: a multi-institutional study of clinical and renal functional outcomes. Urology 2011; 78: 820. Google Scholar
- 9. : Selective arterial embolization for pseudoaneurysms and arteriovenous fistula of renal artery branches following partial nephrectomy. J Urol 2011; 185: 2061. Link, Google Scholar
- 10. : Management of renal artery pseudoaneurysm after partial nephrectomy. World J Urol 2010; 28: 519. Google Scholar
- 11. : Renal function outcomes following selective angioembolization for iatrogenic vascular lesions after partial nephrectomy. J Endourol 2013; 27: 1516. Google Scholar
- 12. : Clinical results of renal artery embolization to control postoperative hemorrhage after partial nephrectomy. Acta Radiol Open 2016; 5: 2058460116655833. Google Scholar
- 13. : Coagulation concepts update. AJR Am J Roentgenol 2009; 193: 1656. Google Scholar
- 14. : Consensus guidelines for periprocedural management of coagulation status and hemostasis risk in percutaneous image-guided interventions. J Vasc Interv Radiol 2012; 23: 727. Google Scholar
- 15. : The R.E.N.A.L. nephrometry score: a comprehensive standardized system for quantitating renal tumor size, location and depth. J Urol 2009; 182: 844. Link, Google Scholar
- 16. : Society of Interventional Radiology clinical practice guidelines. J Vasc Interv Radiol, suppl., 2003; 14: S199. Google Scholar
- 17. : Renal pseudoaneurysms and arteriovenous fistulas as a complication of nephron-sparing partial nephrectomy: technical and functional outcomes of patients treated with selective microcoil embolization during a ten-year period. RoFo 2016; 188: 188. Google Scholar
- 18. : Renal artery pseudoaneurysm following laparoscopic partial nephrectomy. Urology 2009; 74: 819. Google Scholar
- 19. : Partial nephrectomy—contemporary indications, techniques and outcomes. Nat Rev Urol 2013; 10: 275. Google Scholar
- 20. : Robot assisted partial nephrectomy versus laparoscopic partial nephrectomy for renal tumors: a multi-institutional analysis of perioperative outcomes. J Urol 2009; 182: 866. Link, Google Scholar
- 21. : Renal arterial pseudoaneurysm and renal arteriovenous fistula following partial nephrectomy. Urol Int 2018; 100: 368. Google Scholar
- 22. : Renal artery pseudoaneurysm following laparoscopic partial nephrectomy. J Urol 2005; 174: 2256. Link, Google Scholar
- 23. : Early postoperative screening by contrast-enhanced CT and prophylactic embolization of detected pseudoaneurysms prevents delayed hemorrhage after partial nephrectomy. J Vasc Interv Radiol 2015; 26: 950. Google Scholar
- 24. : Enhanced computed tomography after partial nephrectomy in early postoperative period to detect asymptomatic renal artery pseudoaneurysm. Int J Urol 2014; 21: 880. Google Scholar
- 25. : Selective arterial embolization of life-threatening renal hemorrhage in four patients after partial nephrectomy. Diagn Interv Imaging 2014; 95: 601. Google Scholar
- 26. : Pseudoaneurysm of the renal artery following partial nephrectomy: imaging findings and coil embolization. Clin Radiol 2007; 62: 1104. Google Scholar
- 27. : Renal artery pseudoaneurysm after partial nephrectomy: three case reports and a literature review. Urology 2003; 62: 227. Google Scholar
- 28. : Transcatheter arterial embolization with N-butyl cyanoacrylate for nonvariceal upper gastrointestinal bleeding in hemodynamically unstable patients: results and predictors of clinical outcomes. J Vasc Interv Radiol 2014; 25: 1850. Google Scholar
- 29. : Clinical outcome of transcatheter arterial embolization with N-butyl-2-cyanoacrylate for control of acute gastrointestinal tract bleeding. AJR Am J Roentgenol 2015; 204: 662. Google Scholar
- 30. : Clinical outcome of transarterial embolization for postgastrectomy arterial bleeding. Gastric Cancer 2017; 20: 887. Google Scholar
The corresponding author certifies that, when applicable, a statement(s) has been included in the manuscript documenting institutional review board, ethics committee or ethical review board study approval; principles of Helsinki Declaration were followed in lieu of formal ethics committee approval; institutional animal care and use committee approval; all human subjects provided written informed consent with guarantees of confidentiality; IRB approved protocol number; animal approved project number.
No direct or indirect commercial, personal, academic, political, religious or ethical incentive is associated with publishing this article.
Department of Radiology, Yonsei University College of Medicine,
