Transarterial Embolization of Renal Vascular Lesions after Percutaneous Nephrolithotomy

  • T Chandru Associate Professor, Department of Urology
  • R Neelakandan Assistant Professor, Department of Urology
  • K Natarajan Professor, Department of Urology
Keywords: Angioembolization, Post-PCNL bleeding, Renal pseudoaneurysms

Abstract

Introduction: Percutaneous nephrolithotomy (PCNL) is a safe and effective procedure in the surgical management of renal stone disease. Hematuria is one of the most common complications following PCNL. In most cases, the bleeding is self-limited and do not require surgical intervention. Renal arteriography with selective angiographic embolization is required in patients with massive hemorrhage or continuous hematuria. Our aim was to evaluate the effectiveness of percutaneous transarterial embolization for the treatment of renal pseudoaneurysms following post-PCNL bleeding.
Materials and Methods: A total of 852 patients who underwent PCNL for renal calculus, between March 2014 and October 2017 and included 12 patients who had undergone renal embolization due to significant post-PCNL renal artery bleeding. The site, number, and type of bleeding lesions, and the result of the embolization procedure were recorded. We report on the incidence, treatment, radiological and clinical results of these serious vascular injuries at our institution.
Results: Our study has included a large group of patients, the 100% angiographic success rate confirming that percutaneous transcatheter embolization is a valuable treatment for most renal vascular injuries. Renal angiography revealed pseudoaneurysm in 10 patients, arteriovenous fistula in 1, and arterial laceration in 1 patients. Significant risk factors on univariate analysis for severe hematuria requiring superselective angiography were multiple/staghorn calculi, upper calix puncture, and history of pyelonephritis. The severity of the hematuria after PCNL is influenced by many factors, including mean stone size and mean operative time, and is correlated with duration of hospitalization and mean hemoglobin drop.
Conclusions: Percutaneous transarterial embolization of the injured vessel is an effective,f minimally invasive and relatively easy procedure in experienced centers, with a high rate of success and immediate benefits, thus saving the patient from the morbidity that result from severe renal bleeding.

Author Biographies

T Chandru, Associate Professor, Department of Urology

Sri Ramachandra Medical Centre, Chennai, Tamil Nadu, India

R Neelakandan, Assistant Professor, Department of Urology

Sri Ramachandra Medical Centre, Chennai, Tamil Nadu, India

K Natarajan, Professor, Department of Urology

Sri Ramachandra Medical Centre, Chennai, Tamil Nadu, India

References

1. Ritter M, Krombach P, Michel M. Percutaneous stone removal. Eur Urol
Suppl 2011;10:433-9.
2. Geavlete P, Mulaescu R, Geavlete B. Endoscopic surgery for urolithiasis:
What does “stone free” mean in 2012. Chirurgia (Bucur) 2012;107:693-6.
3. Geavlete P, Mulaescu R, Jecu M, Georgescu D, Geavlete BP. Percutaneous
approach in the treatment of matrix lithiasis. Experience of the urological
department of “Saint John” Emergency Clinical Hospital. Chirurgia (Bucur)
2009;104:447-51.
4. Skolarikos A, Alivizatos G, de la Rosette JJ. Percutaneous nephrolithotomy
and its legacy. Eur Urol 2005;47:22-8.
5. Kim SC, Kuo RL, Lingeman JE. Percutaneous nephrolithotomy: An update.
Curr Opin Urol 2003;13:235-41.
6. Srivastava A, Singh KJ, Suri A, Dubey D, Kumar A, Kapoor R, et al.
Vascular complications after percutaneous nephrolithotomy: Are there any
predictive factors? Urology 2005;66:38-40.
7. El-Nahas AR, Shokeir AA, El-Assmy AM, Mohsen T, Shoma AM, Eraky I,
et al. Post-percutaneous nephrolithotomy extensive hemorrhage: A study of
risk factors. J Urol 2007;177:576-9.
8. Brandes SB, McAninch JW. Urban free falls and patterns of renal injury:
A 20-year experience with 396 cases. J Trauma 1999;47:643-9.
9. Mavili E, Donmez H, Ozcan N, Sipahioğlu M, Demirtaş A. 529 Transarterial
embolisation for renal arterial bleeding. Diagn Interv Radiol 2009;15:143-7.
10. Summerton DJ, Kitrey ND, Lumen N, Serafetinidis E, Djakovic N,
European Association of Urology. Et al. EAU guidelines on iatrogenic
trauma. Eur Urol 2012;62:628-39.
11. el-Nahas AR, Shokeir AA, Mohsen T, Gad H, el-Assmy AM,
el-Diasty T, et al. Functional and morphological effects of postpercutaneous
nephrolithotomy superselective renal angiographic embolization. Urology
2008;71:408-12.
12. Kessaris DN, Bellman GC, Pardalidis NP, Smith AG. Management of
hemorrhage after percutaneous renal surgery. J Urol 1995;153:604-8.
13. Cope C, Zeit RM. Pseudoaneurysms after nephrostomy. AJR Am J
Roentgenol 1982;139:255-61.
14. Poulakis V, Ferakis N, Becht E, Deliveliotis C, Duex M. Treatment of renalvascular
injury by transcatheter embolization: Immediate and long-term
effects on renal function. J Endourol 2006;20:405-9.
15. Martin X, Murat FJ, Feitosa LC, Rouvière O, Lyonnet D, Gelet A,
et al. Severe bleeding after nephrolithotomy: Results of hyperselective
embolization. Eur Urol 2000;37:136-9.
16. Stoller ML, Wolf JS Jr., St Lezin MA. Estimated blood loss and
transfusion rates associated with percutaneous nephrolithotomy. J Urol
1994;152:1977-81.
17. Lee WJ, Smith AD, Cubelli V, Badlani GH, Lewin B, Vernace F, et al.
Complications of percutaneous nephrolithotomy. AJR Am J Roentgenol
1987;148:177-80.
18. Sacha K, Szewczyk W, Bar K. Massive haemorrhage presenting as a
complication after percutaneous nephrolithotomy (PCNL). Int Urol
Nephrol 1996;28:315-8.
19. Cantasdemir M, Adaletli I, Cebi D, Kantarci F, Selcuk ND, Numan F,
et al. Emergency endovascular embolization of traumatic intrarenal arterial
pseudoaneurysms with N-butyl cyanoacrylate. Clin Radiol 2003;58:560-5.
20. Huppert PE, Duda SH, Erley CM, Roth M, Lauchart W, Dietz K, et al.
Embolization of renal vascular lesions: Clinical experience with microcoils
and tracker catheters. Cardiovasc Intervent Radiol 1993;16:361-7.
21. Kish JW, Katz MD, Marx MV, Harrell DS, Hanks SE. N-butyl cyanoacrylate
embolization for control of acute arterial hemorrhage. J Vasc Interv Radiol
2004;15:689-95.
22. Schwartz MJ, Smith EB, Trost DW, Vaughan ED Jr. Renal artery
embolization: Clinical indications and experience from over 100 cases. BJU
Int 2007;99:881-6.
23. Gavant ML, Gold RE, Church JC. Delayed rupture of renal pseudoaneurysm:
Complication of percutaneous nephrostomy. AJR Am J Roentgenol
1982;138:948-9.
24. Ghoneim TP, Thornton RH, Solomon SB, Adamy A, Favaretto RL,
Russo P, et al. Selective arterial embolization for pseudoaneurysms and
arteriovenous fistula of renal artery branches following partial nephrectomy.
J Urol 2011;185:2061-5.
25. Lam HS, Lingeman JE, Mosbaugh PG, Steele RE, Knapp PM, Scott JW,
et al. Evolution of the technique of combination therapy for staghorn
calculi: A decreasing role for extracorporeal shock wave lithotripsy. J Urol
1992;148:1058-62.
26. Huang WH, Jiann BP, Lee YH, Wu T, Yu CC, Tsai JY, et al. Risk factors of
massive bleeding after percutaneous nephrolithotomy and its management.
JTUA 2003;14:65.
Published
2021-10-05