Minimally invasive endovascular techniques to treat acute renal hemorrhage

Abstract

Purpose: We evaluated the effectiveness of endovascular therapy for severe renal hemorrhage.

Materials and methods: We retrospectively reviewed cases compiled from the trauma database, billing records and interventional radiology logs at our institution from 1990 to 2007. Technical success was defined as the cessation of bleeding after angiographic embolization. Clinical success was defined as the absence of recurrent hematuria without the need for additional embolization.

Results: A total of 26 patients underwent angiography and endovascular treatment for renal hemorrhage. Mean patient age was 42 years (median 37, range 7 to 70). There were 20 males and 6 females. Mean clinical followup was 11.7 months. The mechanisms of injury were iatrogenic in 6 cases (renal biopsy in 5 and post-percutaneous nephrostomy placement in 1), trauma in 16 (blunt in 10 and penetrating in 6) and spontaneous rupture of a renal mass in 4. At presentation 16 patients (62%) were hemodynamically stable, while 10 (38%) were in shock. A total of 11 patients (42%) presented with gross hematuria, 7 (27%) had microscopic hematuria and 8 (31%) had no evidence of hematuria. A total of 16 patients (62%) had kidney injuries alone, while 10 (38%) also had significant concurrent injuries. Treatment failed in all 5 grade 5 acute renal injuries (100%) caused by external trauma. Technical and clinical success was achieved in 22 (85%) and 17 patients (65%), respectively.

Conclusions: Superselective embolization therapy for renal trauma provides an effective and minimally invasive means to stop bleeding. Overall our complication rate was minimal. Most renal traumas, including most grade 4 injuries, were effectively managed by conservative therapy. Embolization proved effective for grade 4 renal trauma for which conservative therapy failed. In our series embolization failed when applied to grade 5 injuries.