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Interventional radiology in the management of renal vascular injury: A prospective study
INTRODUCTION: Endovascular and percutaneous interventions are promising alternatives to surgical management of traumatic renal injuries and often avert the need for nephrectomies. In this study, we aimed to evaluate the role of interventional radiology and angiographic interventions in the managemen...
Autores principales: | , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Wolters Kluwer - Medknow
2020
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7759163/ https://www.ncbi.nlm.nih.gov/pubmed/33376268 http://dx.doi.org/10.4103/iju.IJU_92_20 |
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author | Garg, Puneet Paruthi, Charu Bhardwaj, Krishna Krishnan, Venkatram Bajaj, Sunil Kumar Misra, Ritu Nair |
author_facet | Garg, Puneet Paruthi, Charu Bhardwaj, Krishna Krishnan, Venkatram Bajaj, Sunil Kumar Misra, Ritu Nair |
author_sort | Garg, Puneet |
collection | PubMed |
description | INTRODUCTION: Endovascular and percutaneous interventions are promising alternatives to surgical management of traumatic renal injuries and often avert the need for nephrectomies. In this study, we aimed to evaluate the role of interventional radiology and angiographic interventions in the management of renal vascular injury. MATERIALS AND METHODS: Our prospective study was performed over a period of 6 months. Twenty-five patients who presented with either persistent hematuria or hemodynamic instability after traumatic or iatrogenic renal injuries were selected. Angiographic embolization using varying combinations of coils, glue, and Gelfoam(®) was performed to address the vascular injuries, either directly in hemodynamically unstable patients or after preprocedural imaging in hemodynamically stable patients. Patients were then followed up till discharge from hospital 48 h later and at 2 weeks and 4 weeks postprocedure for any recurrence of hematuria or hemodynamic instability. Technical and clinical success rates were calculated using descriptive statistics. RESULTS: Pseudoaneurysms were the most common form of arterial injury (22 cases), followed by arteriovenous fistula (8) and active extravasation (5). Segmental arteries are the most commonly involved (12 cases), followed by interlobar (9) and arcuate (3) arteries. Gelfoam(®) was used in five patients with active contrast extravasation and was 100% effective in arresting active bleeding. Coiling alone had a 79.16% technical success rate in management, while additional use of glue in four failed cases led to a 95.83% technical success rate in the first attempt. The ultimate technical and clinical success rate of interventional radiology in renal trauma management (after the second attempt in one failed case) was 100%. CONCLUSION: Endovascular management is an effective and safe alternative to surgical management of both iatrogenic and accidental renal vascular injuries. |
format | Online Article Text |
id | pubmed-7759163 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2020 |
publisher | Wolters Kluwer - Medknow |
record_format | MEDLINE/PubMed |
spelling | pubmed-77591632020-12-28 Interventional radiology in the management of renal vascular injury: A prospective study Garg, Puneet Paruthi, Charu Bhardwaj, Krishna Krishnan, Venkatram Bajaj, Sunil Kumar Misra, Ritu Nair Indian J Urol Original Article INTRODUCTION: Endovascular and percutaneous interventions are promising alternatives to surgical management of traumatic renal injuries and often avert the need for nephrectomies. In this study, we aimed to evaluate the role of interventional radiology and angiographic interventions in the management of renal vascular injury. MATERIALS AND METHODS: Our prospective study was performed over a period of 6 months. Twenty-five patients who presented with either persistent hematuria or hemodynamic instability after traumatic or iatrogenic renal injuries were selected. Angiographic embolization using varying combinations of coils, glue, and Gelfoam(®) was performed to address the vascular injuries, either directly in hemodynamically unstable patients or after preprocedural imaging in hemodynamically stable patients. Patients were then followed up till discharge from hospital 48 h later and at 2 weeks and 4 weeks postprocedure for any recurrence of hematuria or hemodynamic instability. Technical and clinical success rates were calculated using descriptive statistics. RESULTS: Pseudoaneurysms were the most common form of arterial injury (22 cases), followed by arteriovenous fistula (8) and active extravasation (5). Segmental arteries are the most commonly involved (12 cases), followed by interlobar (9) and arcuate (3) arteries. Gelfoam(®) was used in five patients with active contrast extravasation and was 100% effective in arresting active bleeding. Coiling alone had a 79.16% technical success rate in management, while additional use of glue in four failed cases led to a 95.83% technical success rate in the first attempt. The ultimate technical and clinical success rate of interventional radiology in renal trauma management (after the second attempt in one failed case) was 100%. CONCLUSION: Endovascular management is an effective and safe alternative to surgical management of both iatrogenic and accidental renal vascular injuries. Wolters Kluwer - Medknow 2020 2020-10-01 /pmc/articles/PMC7759163/ /pubmed/33376268 http://dx.doi.org/10.4103/iju.IJU_92_20 Text en Copyright: © 2020 Indian Journal of Urology http://creativecommons.org/licenses/by-nc-sa/4.0 This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms. |
spellingShingle | Original Article Garg, Puneet Paruthi, Charu Bhardwaj, Krishna Krishnan, Venkatram Bajaj, Sunil Kumar Misra, Ritu Nair Interventional radiology in the management of renal vascular injury: A prospective study |
title | Interventional radiology in the management of renal vascular injury: A prospective study |
title_full | Interventional radiology in the management of renal vascular injury: A prospective study |
title_fullStr | Interventional radiology in the management of renal vascular injury: A prospective study |
title_full_unstemmed | Interventional radiology in the management of renal vascular injury: A prospective study |
title_short | Interventional radiology in the management of renal vascular injury: A prospective study |
title_sort | interventional radiology in the management of renal vascular injury: a prospective study |
topic | Original Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7759163/ https://www.ncbi.nlm.nih.gov/pubmed/33376268 http://dx.doi.org/10.4103/iju.IJU_92_20 |
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