Τίτλος:
Angiographic findings and embolotherapy in renal arterial trauma
Γλώσσες Τεκμηρίου:
Αγγλικά
Περίληψη:
Purpose: To evaluate the angiographic findings and embolotherapy in the
management of traumatic renal arterial injury. Methods: This is a
retrospective review of 22 patients with renal trauma who underwent
arteriography and percutaneous embolization from December 1995 to
January 2002. Medical records, imaging studies and procedural reports
were reviewed to assess the type of injury, arteriographic findings and
immediate embolization results. Long-term clinical outcome was obtained
by communication with the trauma physicians and by clinical chart
review. Results: Arteriography was performed in 125 patients admitted to
a State Trauma Center with suspected internal bleeding. Renal arterial
injury was documented in 22 and was the result of a motor-vehicle
accident (10), auto-pedestrian accident (1), gunshot (4) or stab wounds
(6) and a fall (1). Percutaneous renal arterial embolization was
undertaken in 22 of 125 (18%) patients to treat extravasation (11).
arterial pedicle rupture (5), abnormal arteriovenous (3) or
arteriocalyceal (2) communication and pseudoaneurysm (3). One of the
pseudoaneurysms and one of the arteriovenous fistulae were found in
addition to extravasation. All 22 patients (16 men, 6 women) were
hemodynamically stable, or controlled during arteriography and
embolotherapy. Selective and/or superselective embolization of the
abnormal vessels was performed using coils in 9 patients, microcoils in
9 patients and Gelfoam pledgets in 3 patients. In one patient Gelfoam
pledgets mixed with polyvinyl alcohol (PVA) particles were used for
embolization. Immediate angiographic evidence of hemostasis was
demonstrated in all cases. Two initial technical failures were treated
with repeat arteriography and embolization. There was no
procedure-related death. There was no non-target embolization. One
episode of renal abscess after embolization was treated by nephrectomy
and 3 patients underwent elective post-embolization nephrectomy to
prevent infection. Follow-up ranged from 1 month to 7 years (mean 31
months). No procedure-related or delayed onset of renal insufficiency
occurred. Conclusion: In hemodynamically stable and controlled patients
selective and superselective embolization is a safe and effective method
for the management of renal vascular injury.
Συγγραφείς:
Sofocleous, CT
Hinrichs, C
Hubbi, B
Brountzos, E
Kaul, S
and Kannarkat, G
Bahramipour, P
Barone, A
Contractor, DG and
Shah, T
Περιοδικό:
CardioVascular and Interventional Radiology
Λέξεις-κλειδιά:
embolization; aneurysm; arterial injuries; arteriography; renal trauma;
arteriovenous fistula; angiography; extravasation; arterial bleeding
DOI:
10.1007/s00270-004-0042-4
