Evaluation of Selective Microcatheter Coil Embolization in the Treatment of Renal Artery Pseudoaneurysm Following Percutaneous Nephrolithotomy

Öz

Aim: To investigate the technical success of selective microcatheter coil embolization for the treatment of distal renal artery pseudoaneurysm and to determine the effect of parenchymal loss on renal function. 

Material and Methods: In this study, the medical files and imaging records of 516 patients who underwent percutaneous nephrolithotomy at our clinic from May 2015 to December 2018 were retrospectively reviewed. Eight (1.55%) patients with renal artery pseudoaneurysms were included in the study. Preoperative and postoperative serum urea, hemoglobin and GFR values were recorded. These data were compared statistically and the effect of parenchymal loss on renal function was evaluated. The technical success of the treatment was accepted as the absence of contrast filling after embolization and clinical success was accepted as the absence of hematuria. 

Results: Eight patients with renal artery pseudoaneurysm were included in the study. All of the aneurysms originated from the distal renal artery (interlobar / interlobuler). The mean size of the aneurysms was 23.25 (9-38) mm. The technical and clinical success rates of microcatheter embolization were 100%. Macroscopic hematuria disappeared at a mean of 2.8 days after treatment. Five patients had <5% parenchymal loss, two had 5-10% and one patient had 25-50%. There was no statistically significant difference between plasma hemoglobin, urea and GRF before and after embolization (p = 0.814, 0.076, 0.263, respectively). 

Conclusion: Selective microcatheter coil embolization is a safe and effective method for the treatment of renal artery pseudoaneurysms after percutaneous nephrolithotomy. 

Anahtar Kelimeler

• Renal Artery Pseudoaneurysm,Selective Microcatheter Coil Embolization,Hematuria,Percutaneous Nephrolithotomy

Perkütan Nefrolitotomi Sonrası Oluşan Renal Arter Psödoanevrizmanın Tedavisinde Selektif Mikrokateter Koil Embolizasyonunun Değerlendirilmesi

Öz

Amaç: Distal renal arter psödoanevrizma tedavisinde kullanılan selektif mikrokateter koil embolizasyonunun teknik başarısını ve sonrasında gelişen parankim kaybının böbrek fonksiyonları üzerine etkisini araştırmayı amaçladık. 

Gereç ve Yöntemler: Perkütan nefrolitotomi operasyonu olan 516 hastanın kayıtlı dosya bilgileri ve görüntüleme kayıtları tarandı. Psödoanevrizma etyolojili sekiz(%1.55) hasta çalışmaya dahil edildi. Hastaların demografik özellikleri ve klinik takip durumları kayıt edildi. Psödoanevrizma boyutu, lokalizasyonu ve embolizasyon sonrası parankim kaybı transkateter anjiyografi görüntüleri ile değerlendirildi. Parankimal kayıp embolizasyon öncesi ve sonrasında elde edilen anjiyografi görüntüleri karşılaştırılarak değerlendirildi.  Preoperatif ve postoperatif serum üre, hemoglobin ve GFR değerleri kaydedildi. Bu veriler istatiksel olarak karşılaştırıldı ve parankimal kaybın böbrek fonksiyonuna etkisi değerlendirildi. Tedavide teknik başarı embolizasyon sonrası anevrizmanın kontrast madde ile dolmaması ve klinik başarı hematüri semptomunun düzelmesi olarak kabul edildi. 

Bulgular: Sekiz psödoanevrizmanın tamamı distal renal arterden (interlobar/interlobuler) kaynaklanmıştır.  Ortalama boyutu 23.25(9-38) mm idi. Embolizasyon sonrası takipte ortalama 2.8 günde makroskopik hematüri bulgusu kayboldu. Selektif mikrokateter koil embolizasyonu teknik ve klinik başarı oranımız %100 oldu. Beş hastada <%5, iki hastada %5-10, bir hastada %25-50 oranında parankim kaybı izlendi. Plazma hemoglobin, üre ve GRF’da embolizasyon öncesi ve sonrası arasında istatistik olarak anlamlı farklılık saptanmadı(sırasıyla p= 0.814, 0.076, 0.263). 

Sonuç: Selektif mikrokateter koil embolizasyonu perkütan nefrolitotomi sonrası oluşan renal psödoanevrizma tedavisi için güvenli ve etkin bir yöntemdir. 

Anahtar Kelimeler

• renal arter psödoanevrizma,hematüri,selektif mikrokateter koil embolizasyonu,perkütan nefrolitotomi

Kaynakça

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