Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2011 Apr;185(4):1316-20.
doi: 10.1016/j.juro.2010.12.003. Epub 2011 Feb 22.

Analysis of diagnostic angiography and angioembolization in the acute management of renal trauma using a national data set

James M Hotaling  1 , Mathew D Sorensen, Thomas G Smith 3rd, Frederick P Rivara, Hunter Wessells, Bryan B Voelzke
Affiliations

Analysis of diagnostic angiography and angioembolization in the acute management of renal trauma using a national data set

James M Hotaling et al. J Urol. 2011 Apr.

Abstract

Purpose: To our knowledge data on diagnostic angiography and angioembolization after renal trauma have been limited to single institution series with small numbers. We used the National Trauma Data Bank® to investigate national patterns of diagnostic angiography and angioembolization after blunt and penetrating renal trauma.

Materials and methods: All renal injuries treated between 2002 and 2007 were identified in the National Trauma Data Bank by Abbreviated Injury Scale codes and converted to American Association for the Surgery of Trauma renal injury grades. Diagnostic angiography and angioembolization were identified by ICD-9 codes and examined. Initial angioembolization was considered a failure if subsequent therapy was needed. Repeat diagnostic angiography was not considered a failure.

Results: A total of 9,002 renal injuries were available for analysis. A total of 165 patients (2%) underwent diagnostic angiography after renal injury, including 77 (47%) who underwent concomitant angioembolization. Of the patients 78% sustained grade III-V renal injuries. Of the 77 patients with initial angioembolization 68 required successive therapy. Repeat angioembolization was the most common management choice (29% of patients). Secondary angioembolization was durable during the index hospitalization with success in 35 of 36 cases. Successive therapy was required after initial angioembolization for all grade IV and V renal injuries in 48 patients. The overall renal salvage rate was 92%, including 88% for grade IV and V injuries.

Conclusions: Successive therapy is common after initial management of renal injury by angioembolization. Close observation is highly recommended after initial angioembolization for grade IV-V renal injuries. National agreement on the use of diagnostic angiography and angioembolization is needed since these procedures may be overused after grade I-III renal injuries.

PubMed Disclaimer

Figures

None
Repeat procedures in patients with grade IV or V injury who underwent AE. NX, nephrectomy. PCN, percutaneous nephrostomy. URS/RTG, ureteroscopy/retrograde nephroureterogram.
See this image and copyright information in PMC

References

    1. Roberts RA, Belitsky P, Lannon SG, et al. Conservative management of renal lacerations in blunt trauma. Can J Surg. 1987;30:253. - PubMed
    1. Matthews LA, Smith EM, Spirnak JP. Nonoperative treatment of major blunt renal lacerations with urinary extravasation. J Urol. 1997;157:2056. - PubMed
    1. Kuan JK, Wright JL, Nathens AB, et al. American Association for the Surgery of Trauma Organ Injury Scale for kidney injuries predicts nephrectomy, dialysis, and death in patients with blunt injury and nephrectomy for penetrating injuries. J Trauma. 2006;60:351. - PubMed
    1. Miller KS, McAninch JW. Radiographic assessment of renal trauma: our 15-year experience. J Urol. 1995;154:352. - PubMed
    1. Breyer BN, McAninch JW, Elliott SP, et al. Minimally invasive endovascular techniques to treat acute renal hemorrhage. J Urol. 2008;179:2248. - PubMed