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Akut Renal Arter Kanamalarında Endovasküler Tedavi: Etkinliği ve Böbrek Fonksiyonlarına Etkisi

Year 2022, Volume: 24 Issue: 2, 136 - 141, 30.08.2022
https://doi.org/10.18678/dtfd.1092474

Abstract

Amaç: Bu çalışmanın amacı akut renal arter kaynaklı hemorajilerin endovasküler tedavisinin etkinliğini ve komplikasyonlarını ile kanamaya neden olan etiyolojiyi araştırmaktır.
Gereç ve Yöntemler: 2016 ve 2020 yılları arasında akut renal arter kanaması nedeni ile endovasküler embolizasyon yapılan yirmi iki hasta geriye dönük olarak değerlendirildi. Akut renal arter hemorajisinin etiyolojisi araştırıldı. Tedavinin etkinliği ve gelişen komplikasyonlar için laboratuvar ve klinik takip bilgileri analiz edildi. Hastaların işlem öncesi ve işlem sonrası serum kreatinin düzeyleri karşılaştırıldı.
Bulgular: Toplam 22 hastaya selektif renal arter embolizasyonu işlemi uygulandı. Bu 22 hastanın 10 (%45,5) tanesi erkek ve 12 (%54,5) tanesi kadın idi. Hastaların yaşları 5 ile 79 yıl arasında değişmekteydi ve hastaların ortalama yaşı 51,5±18,6 yıl olarak saptandı. Embolizasyon işlemlerinin %91,7’sinde klinik başarı sağlandı. Hastaların işlem sonrasındaki serum kreatinin düzeylerinde, anjiyografi işleminden 24 saat öncesine göre istatistiksel olarak anlamlı bir artış görüldü (ortanca: 0,97’ye karşı 0,93; p=0,046). Serum kan üre nitrojeni ve tahmini glomerüler filtrasyon hızı düzeylerinde anlamlı bir değişiklik gözlenmedi (sırasıyla p=0,338 ve p=0,067). Komplikasyon olarak sadece bir hastada akut böbrek yetmezliği ve postembolizasyon sendromu izlendi. Komplikasyon oranı %4,5 olarak bulundu.
Sonuç: Akut renal arter kanamalarında renal arterin selektif embolizasyonu renal fonksiyonlarda bozulmaya neden olmadan yüksek bir klinik başarıya sahiptir. Tedavinin genel anesteziye gerek olmaması ve düşük komplikasyon oranları gibi avantajları vardır.

References

  • Poyraz N, Balasar M, Gökmen İE, Koç O, Sönmez MG, Aydın A, et al. Clinical efficacy and safety of transcatheter embolization for vascular complications after percutaneous nephrolithotomy. Wideochir Inne Tech Maloinwazyjne. 2017;12(4):403-8.
  • Muller A, Rouvière O. Renal artery embolization-indications, technical approaches and outcomes. Nat Rev Nephrol. 2015;11(5):288-301.
  • Sam K, Gahide G, Soulez G, Giroux MF, Oliva VL, Perreault P, et al. Percutaneous embolization of iatrogenic arterial kidney injuries: safety, efficacy, and impact on blood pressure and renal function. J Vasc Interv Radiol. 2011;22(11):1563-8.
  • Öcal O, Puhr-Westerheide D, Mühlmann M, Deniz S, Fabritius MP, Weinhold P, et al. iRESCUE - Interventional embolization of Renal artEries after SurgiCal or traUmatic injury with hEmorrhage. Eur J Radiol. 2021;136:109540.
  • Murray TE, Doyle F, Lee M. Transarterial embolization of angiomyolipoma: a systematic review. J Urol. 2015;194(3):635-9.
  • Inci K, Cil B, Yazici S, Peynircioglu B, Tan B, Sahin A, et al. Renal artery pseudoaneurysm: complication of minimally invasive kidney surgery. J Endourol. 2010;24(1):149-54.
  • Jain S, Nyirenda T, Yates J, Munver R. Incidence of renal artery pseudoaneurysm following open and minimally invasive partial nephrectomy: a systematic review and comparative analysis. J Urol. 2013;189(5):1643-8.
  • Hong Y, Xiong L, Ye H, An L, Huang X, Xu Q. Outcome of selective renal artery embolization in managing severe bleeding after percutaneous nephrolithotomy. Urol Int. 2020;104(9-10):797-802.
  • Jinga V, Dorobat B, Youssef S, Radavoi GD, Braticevici B, Filipoiu F, et al. Transarterial embolization of renal vascular lesions after percutaneous nephrolithotomy. Chirurgia (Bucur). 2013;108(4):521-9.
  • Morey AF, Brandes S, Dugi DD 3rd, Armstrong JH, Breyer BN, Broghammer JA, et al. Urotrauma: AUA guideline. J Urol. 2014;192(2):327-35.
  • Sauk S, Zuckerman DA. Renal artery embolization. Semin Intervent Radiol. 2011;28(4):396-406.
  • Salcedo A, Ordoñez CA, Parra MW, Osorio JD, Leib P, Caicedo Y, et al. Damage Control for renal trauma: the more conservative the surgeon, better for the kidney. Colomb Med (Cali). 2021;52(2):e4094682.
  • Bryk DJ, Zhao LC. Guideline of guidelines: a review of urological trauma guidelines. BJU Int. 2016;117(2):226-34.
  • Salem MS, Urry RJ, Kong VY, Clarke DL, Bruce J, Laing GL. Traumatic renal injury: Five-year experience at a major trauma centre in South Africa. 2020;51(1):39-44.
  • Sarang B, Raykar N, Gadgil A, Mishra G, Wärnberg MG, Rattan A, et al. Towards Improved Trauma Care Outcomes TITCO-India. Outcomes of renal trauma in Indian urban tertiary healthcare centres: a multicentre cohort study. World J Surg. 2021;45(12):3567-74.
  • Sarani B, Powell E, Taddeo J, Carr B, Patel A, Seamon M, et al. Contemporary comparison of surgical and interventional arteriography management of blunt renal injury. J Vasc Interv Radiol. 2011;22(5):723-8.
  • Bhatt JR, Richard PO, Kim NS, Finelli A, Manickavachagam K, Legere L, et al. Natural history of renal angiomyolipoma (AML): most patients with large AMLs >4cm can be offered active surveillance as an initial management strategy. Eur Urol. 2016;70(1):85-90.
  • Ouzaid I, Autorino R, Fatica R, Herts BR, McLennan G, Remer EM, et al. Active surveillance for renal angiomyolipoma: outcomes and factors predictive of delayed intervention. BJU Int. 2014;114(3):412-7.
  • Liu L, Wu R, Xia Y, Wang J, Xiong Y, Qu Y, et al. A preliminary study on classification and therapeutic strategies for spontaneous perirenal hemorrhage. Int J Surg. 2018;54(Pt A):86-91.
  • Faddegon S, So A. Treatment of angiomyolipoma at a tertiary care centre: the decision between surgery and angioembolization. Can Urol Assoc J. 2011;5(6):E138-41.
  • Regine R, Palmieri F, De Siero M, Rescigno A, Sica V, Cantarela R, et al. Embolization of traumatic and non-traumatic peripheral vascular lesions with Onyx. Interv Med Appl Sci. 2015;7(1):22-9.
  • Sayani R, Azeemuddin M, ul Haq T, Hamid RS, Salam B. An institutional review of transarterial embolization in haemorrhagic urological emergencies. J Pak Med Assoc. 2012;62(2):107-11.
  • Strobl FF, D'Anastasi M, Hinzpeter R, Franke PS, Trumm CG, Waggershauser T, et al. 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(2):188-94.
  • Piasecki P, Ząbkowski T, Brzozowski K, Narloch J, Zięcina P, Dziuk M, et al. The assessment of the risk of acute kidney injury in patients undergoing an urgent endovascular treatment due to severe renal bleeding. Cardiovasc Intervent Radiol. 2018;41(3):398-405.

Endovascular Treatment of Acute Renal Artery Hemorrhages: Efficacy and Effect on Renal Functions

Year 2022, Volume: 24 Issue: 2, 136 - 141, 30.08.2022
https://doi.org/10.18678/dtfd.1092474

Abstract

Aim: The aim of this study was to investigate the efficacy and complications of endovascular treatment of acute renal artery hemorrhage and the etiology of the condition.
Material and Methods: Twenty-two patients who underwent endovascular embolization with renal acute artery hemorrhage between 2016 and 2020 were evaluated retrospectively. Etiologies of the acute renal artery hemorrhage were investigated. Laboratory and clinical follow-up information were analyzed for the efficacy and the complication of the treatment. The serum creatinine levels of the patients before and after the procedure were compared.
Results: Selective renal artery embolization procedures were performed in a total of 22 patients. Of the 22 patients, 10 (45.5%) were male and 12 (54.5%) were female. The patients' ages ranged from 5 to 79 years, and the mean age of the patients was 51.5±18.6 years. Clinical success was achieved in 91.7% of embolization procedures. A statistically significant increase was seen in the serum creatinine levels of the patients after the procedure compared to 24 hours before the angiography procedure (median: 0.97 vs. 0.93, p=0.046). No significant change was observed in serum blood urea nitrogen and the estimated glomerular filtration rate levels (p=0.338, and p=0.067, respectively). Acute renal failure and postembolization syndrome were observed in only one patient as complications. The complication rate was found to be 4.5%.
Conclusion: Selective embolization of the renal artery has high clinical success in acute renal artery hemorrhages without impairing renal function. The treatment has advantages such as no need for general anesthesia, and low complication rates.

References

  • Poyraz N, Balasar M, Gökmen İE, Koç O, Sönmez MG, Aydın A, et al. Clinical efficacy and safety of transcatheter embolization for vascular complications after percutaneous nephrolithotomy. Wideochir Inne Tech Maloinwazyjne. 2017;12(4):403-8.
  • Muller A, Rouvière O. Renal artery embolization-indications, technical approaches and outcomes. Nat Rev Nephrol. 2015;11(5):288-301.
  • Sam K, Gahide G, Soulez G, Giroux MF, Oliva VL, Perreault P, et al. Percutaneous embolization of iatrogenic arterial kidney injuries: safety, efficacy, and impact on blood pressure and renal function. J Vasc Interv Radiol. 2011;22(11):1563-8.
  • Öcal O, Puhr-Westerheide D, Mühlmann M, Deniz S, Fabritius MP, Weinhold P, et al. iRESCUE - Interventional embolization of Renal artEries after SurgiCal or traUmatic injury with hEmorrhage. Eur J Radiol. 2021;136:109540.
  • Murray TE, Doyle F, Lee M. Transarterial embolization of angiomyolipoma: a systematic review. J Urol. 2015;194(3):635-9.
  • Inci K, Cil B, Yazici S, Peynircioglu B, Tan B, Sahin A, et al. Renal artery pseudoaneurysm: complication of minimally invasive kidney surgery. J Endourol. 2010;24(1):149-54.
  • Jain S, Nyirenda T, Yates J, Munver R. Incidence of renal artery pseudoaneurysm following open and minimally invasive partial nephrectomy: a systematic review and comparative analysis. J Urol. 2013;189(5):1643-8.
  • Hong Y, Xiong L, Ye H, An L, Huang X, Xu Q. Outcome of selective renal artery embolization in managing severe bleeding after percutaneous nephrolithotomy. Urol Int. 2020;104(9-10):797-802.
  • Jinga V, Dorobat B, Youssef S, Radavoi GD, Braticevici B, Filipoiu F, et al. Transarterial embolization of renal vascular lesions after percutaneous nephrolithotomy. Chirurgia (Bucur). 2013;108(4):521-9.
  • Morey AF, Brandes S, Dugi DD 3rd, Armstrong JH, Breyer BN, Broghammer JA, et al. Urotrauma: AUA guideline. J Urol. 2014;192(2):327-35.
  • Sauk S, Zuckerman DA. Renal artery embolization. Semin Intervent Radiol. 2011;28(4):396-406.
  • Salcedo A, Ordoñez CA, Parra MW, Osorio JD, Leib P, Caicedo Y, et al. Damage Control for renal trauma: the more conservative the surgeon, better for the kidney. Colomb Med (Cali). 2021;52(2):e4094682.
  • Bryk DJ, Zhao LC. Guideline of guidelines: a review of urological trauma guidelines. BJU Int. 2016;117(2):226-34.
  • Salem MS, Urry RJ, Kong VY, Clarke DL, Bruce J, Laing GL. Traumatic renal injury: Five-year experience at a major trauma centre in South Africa. 2020;51(1):39-44.
  • Sarang B, Raykar N, Gadgil A, Mishra G, Wärnberg MG, Rattan A, et al. Towards Improved Trauma Care Outcomes TITCO-India. Outcomes of renal trauma in Indian urban tertiary healthcare centres: a multicentre cohort study. World J Surg. 2021;45(12):3567-74.
  • Sarani B, Powell E, Taddeo J, Carr B, Patel A, Seamon M, et al. Contemporary comparison of surgical and interventional arteriography management of blunt renal injury. J Vasc Interv Radiol. 2011;22(5):723-8.
  • Bhatt JR, Richard PO, Kim NS, Finelli A, Manickavachagam K, Legere L, et al. Natural history of renal angiomyolipoma (AML): most patients with large AMLs >4cm can be offered active surveillance as an initial management strategy. Eur Urol. 2016;70(1):85-90.
  • Ouzaid I, Autorino R, Fatica R, Herts BR, McLennan G, Remer EM, et al. Active surveillance for renal angiomyolipoma: outcomes and factors predictive of delayed intervention. BJU Int. 2014;114(3):412-7.
  • Liu L, Wu R, Xia Y, Wang J, Xiong Y, Qu Y, et al. A preliminary study on classification and therapeutic strategies for spontaneous perirenal hemorrhage. Int J Surg. 2018;54(Pt A):86-91.
  • Faddegon S, So A. Treatment of angiomyolipoma at a tertiary care centre: the decision between surgery and angioembolization. Can Urol Assoc J. 2011;5(6):E138-41.
  • Regine R, Palmieri F, De Siero M, Rescigno A, Sica V, Cantarela R, et al. Embolization of traumatic and non-traumatic peripheral vascular lesions with Onyx. Interv Med Appl Sci. 2015;7(1):22-9.
  • Sayani R, Azeemuddin M, ul Haq T, Hamid RS, Salam B. An institutional review of transarterial embolization in haemorrhagic urological emergencies. J Pak Med Assoc. 2012;62(2):107-11.
  • Strobl FF, D'Anastasi M, Hinzpeter R, Franke PS, Trumm CG, Waggershauser T, et al. 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(2):188-94.
  • Piasecki P, Ząbkowski T, Brzozowski K, Narloch J, Zięcina P, Dziuk M, et al. The assessment of the risk of acute kidney injury in patients undergoing an urgent endovascular treatment due to severe renal bleeding. Cardiovasc Intervent Radiol. 2018;41(3):398-405.
There are 24 citations in total.

Details

Primary Language English
Subjects Clinical Sciences
Journal Section Research Article
Authors

Alperen Kayalı 0000-0002-9862-8925

Sadık Görür 0000-0002-3458-5428

Publication Date August 30, 2022
Submission Date March 24, 2022
Published in Issue Year 2022 Volume: 24 Issue: 2

Cite

APA Kayalı, A., & Görür, S. (2022). Endovascular Treatment of Acute Renal Artery Hemorrhages: Efficacy and Effect on Renal Functions. Duzce Medical Journal, 24(2), 136-141. https://doi.org/10.18678/dtfd.1092474
AMA Kayalı A, Görür S. Endovascular Treatment of Acute Renal Artery Hemorrhages: Efficacy and Effect on Renal Functions. Duzce Med J. August 2022;24(2):136-141. doi:10.18678/dtfd.1092474
Chicago Kayalı, Alperen, and Sadık Görür. “Endovascular Treatment of Acute Renal Artery Hemorrhages: Efficacy and Effect on Renal Functions”. Duzce Medical Journal 24, no. 2 (August 2022): 136-41. https://doi.org/10.18678/dtfd.1092474.
EndNote Kayalı A, Görür S (August 1, 2022) Endovascular Treatment of Acute Renal Artery Hemorrhages: Efficacy and Effect on Renal Functions. Duzce Medical Journal 24 2 136–141.
IEEE A. Kayalı and S. Görür, “Endovascular Treatment of Acute Renal Artery Hemorrhages: Efficacy and Effect on Renal Functions”, Duzce Med J, vol. 24, no. 2, pp. 136–141, 2022, doi: 10.18678/dtfd.1092474.
ISNAD Kayalı, Alperen - Görür, Sadık. “Endovascular Treatment of Acute Renal Artery Hemorrhages: Efficacy and Effect on Renal Functions”. Duzce Medical Journal 24/2 (August 2022), 136-141. https://doi.org/10.18678/dtfd.1092474.
JAMA Kayalı A, Görür S. Endovascular Treatment of Acute Renal Artery Hemorrhages: Efficacy and Effect on Renal Functions. Duzce Med J. 2022;24:136–141.
MLA Kayalı, Alperen and Sadık Görür. “Endovascular Treatment of Acute Renal Artery Hemorrhages: Efficacy and Effect on Renal Functions”. Duzce Medical Journal, vol. 24, no. 2, 2022, pp. 136-41, doi:10.18678/dtfd.1092474.
Vancouver Kayalı A, Görür S. Endovascular Treatment of Acute Renal Artery Hemorrhages: Efficacy and Effect on Renal Functions. Duzce Med J. 2022;24(2):136-41.