Endovascular management of iatrogenic renal arterial lesions and clinical outcomes

Abstract

Purpose: We aimed to evaluate iatrogenic renal arterial lesions, including pseudoaneurysm, arteriovenous fistula, and arteriocaliceal fistula, their management by endovascular embolization, and the clinical results.

Methods: Fifty-five patients (forty males, fifteen females) with a median age of 40 years (range, 8-85 years), who underwent endovascular embolization of iatrogenic renal arterial lesions between March 2003 and December 2013 were included in this retrospective study. Types of iatrogenic lesions and details of embolization procedures were reported. Estimated glomerular filtration rate (eGFR), renal function tests, hemoglobin, and hematocrit levels before and after embolization were recorded and compared.

Results: Median follow-up was 24 months. We identified 53 pseudoaneurysms, 30 arteriovenous fistulas, and 11 arteriocaliceal fistulas in 55 patients, after percutaneous nephrolithotomy (n=26), renal biopsy (n=21), nephrostomy (n=3), renal surgery (n=3), and extracorporeal shock wave lithotripsy (n=2). Median number of pseudoaneurysms was 1 (range, 1-4) with a median size of 7 mm (range, 1.5-35 mm). Fifty-one patients underwent coil embolization. Median number of coils was 5 (range, 2-21) and median renal parenchymal loss was 5% (range, 1%-50%). There were no significant differences between pre- and postoperative eGFR and serum parameters.

Conclusion: Iatrogenic renal arterial lesion can be a life threatening condition. Superselective coil embolization is a safe, minimally invasive treatment option with minimal renal parenchymal loss and without significant change in renal function.

Figure 1. a–e.

Axial CT angiography image (a) of a 31-year-old male patient shows a pseudoaneurysm (arrow) in the left kidney and perirenal hematoma developed following biopsy. Coronal CT angiography reconstruction image (b) shows the pseudoaneurysm (arrow) in the middle segment of the kidney. Selective renal diagnostic angiography image (c) shows the pseudoaneurysm (arrowhead) and filling of renal vein (arrow) indicating an arteriovenous fistula. Superselective renal angiography image (d) shows the pseudoaneurysm (arrow). Control angiography (e) reveals total embolization with coils (arrow).

Figure 2. a–c.

Axial CT image (a) of a 75-year-old female patient who underwent percutaneous nephrolithotomy shows the right kidney (arrow) having hydronephrosis and nephrolithiasis. The left kidney (arrowhead) is atrophic. Selective renal diagnostic angiography image (b) shows caliceal filling (arrow) at the upper pole of right kidney indicating an arteriocaliceal fistula. Control angiography (c) reveals total embolization with coils (arrowhead) and parenchymal area devascularized by the embolization (arrow).

Figure 3. a–c.

Axial CT angiography image (a) of a 43-year-old male patient shows a pseudoaneurysm (arrowhead) in the left kidney, which occurred following partial nephrectomy and perirenal hematoma (arrow). Selective renal diagnostic angiography image (b) shows the pseudoaneurysm (arrow) at the upper pole of the kidney. Control angiography (c) reveals complete embolization with an Amplatzer vascular plug (arrow).