Percutaneous transcatheter super-selective renal arterial embolization with N-butyl cyanoacrylate for iatrogenic renal hemorrhage

Abstract

Background: To evaluate the safety and efficacy of percutaneous transcatheter super-selective renal arterial embolization (SRAE) with N-butyl cyanoacrylate (NBCA) for iatrogenic renal hemorrhage.

Methods: Between January 2014 and December 2019, 45 patients (including 18 patients with coagulopathy), who underwent percutaneous transcatheter SRAE with NBCA for iatrogenic renal hemorrhage at our institution, were retrospectively reviewed. The technical success rate, clinical success rate, and embolization-related complications were analyzed. The values of estimated glomerular filtration rate (eGFR), serum creatinine (sCr), and serum urea (sUr) were analyzed at the time of pre-SRAE, post-SRAE, and last follow-up to evaluate the effects of NBCA-based SRAE on renal function.

Results: Diagnostic renal arteriography revealed contrast extravasation in 18 patients and pseudoaneurysms in 27 patients. NBCA mixed with iodized oil in a 1:2-1:4 ratio was the sole embolic agent. No procedure-related mortality or major complications occurred. The technical and clinical success rates were both 100%. The values of eGFR, sCr and sUr were not found to be significantly different between pre-SRAE, post-SRAE and last follow-up (eGFR: 91.52 ​± ​21.17 vs. 90.98 ​± ​22.11 vs. 92.14 ​± ​23.51 ​mL/min/1.73 ​m², p ​= ​0.729; sCr: 74.73 ​± ​11.08 vs. 75.27 ​± ​12.43 vs. 73.95 ​± ​10.14 ​μmol/L, p ​= ​0.543; sUr: 5.69 ​± ​0.84 vs. 5.71 ​± ​0.96 vs. 5.70 ​± ​0.79, p ​= ​0.515, respectively).

Conclusions: Percutaneous transcatheter SRAE with NBCA is a safe and effective treatment modality for iatrogenic renal hemorrhage with no deterioration of renal function.

Keywords: Iatrogenic; N-butyl cyanoacrylate; Renal arterial embolization; Renal hemorrhage; Super-selective.

Fig. 1

Case 1, Male, 35 years, After the left renal percutaneous lithotripsy, coil embolization was performed in another hospital for renal hemorrhage, and the left side continued low back pain accompanied by hematuria lasted 1 week. CT scan revealed a slightly high-density area in the left renal parenchyma, which was considered to be an active hemorrhagic hematoma(a1). The selective and super-selective DSA angiography, respectively, identify the rupture of the small artery branch of the left renal artery with contrast agent extravasation (a3∼4). The contrast extravasation disappeared after 0.4 ​mL ​NBCA glue embolization(a5). 1 month later, CT reexamination of renal low-density area considered hematoma absorption(a2).

Fig. 2

Case 2, Male, 48 years, T tube continued hematuria for 1 day after the left renal biopsy. DSA angiography suggested a ruptured branch of the left renal artery with contrast agent extravasation(b1). After super-selective intubation into the bleeding artery, 0.3 ​ml of NBCA glue was injected, and the bleeding disappeared(b2∼3). No signs of bleeding were found in the 7-day post-SRAE CT scan, and high density NBCA glue was found in the left renal parenchyma(b4).

Fig. 3

Case 3, Male, 64 years, double J tube with hematuria for 4 days after the right renal percutaneous nephrolithotomy. CT scan revealed a high-density area in the right renal parenchyma, which was considered to be an active hemorrhage(c1). The selective DSA and super-selective DSA were performed to determine the formation of pseudoaneurysm in the right inferior pole branch(c2∼3). After super-selective intubation, 1 ​ml NBCA glue was embolized (c4) and the contrast extravasation disappeared(c5). Post-SRAE CT examination of high density NBCA glue in the right renal parenchyma(c6).