Long-term functional and morphological effects of transcatheter arterial embolization of traumatic renal vascular injury

Abstract

Objective: To assess the long-term morphological and functional outcome of superselective transarterial embolization (TAE) for treating traumatic renal vascular injury.

Patients and methods: The surgical records of 124 patients with traumatic renal vascular injury managed by TAE between 1990 and 2004 were reviewed, of whom 81 completed a long- term follow-up and were included in the final analysis. Patients were followed using serum creatinine levels, grey-scale ultrasonography, intravenous urography (IVU) and radioisotopic renography using (99m)Tc-mercapto-acetyl triglycine (MAG3) and (99m)Tc-dimercaptosuccinic acid (DMSA).

Results: Embolization resulted in the cessation of haematuria in all patients but two (97.5%). At 3 months, serum creatinine levels increased in four of nine patients with a solitary kidney, but only one of them required haemodialysis. After a mean follow-up of 4.6 years, IVU showed a normal calyceal configuration in 70% of renal units, pyelonephritic changes in 26% and no dye excretion in 4%. DMSA scans showed no evidence of photopenic areas in 17 renal units (21%). The mean (sd) percentage of DMSA uptake by the corresponding kidney improved from 24 (9)% at the 3-month scans to 32 (10)% at the last follow-up scan (P < 0.001). Using MAG3, the mean (sd) glomerular filtration rate improved significantly from 26 (11) mL/min at the 3-month scan to 32 (9) mL/min at the last follow-up (P < 0.05).

Conclusions: Superselective TAE is safe and effective for traumatic renal vascular injury. The short-term deleterious effects were more pronounced in patients with a solitary kidney. The long-term follow-up showed functional and morphological improvements in the embolized renal units.