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

Yıl 2019, Cilt: 3 Sayı: 3, 84 - 92, 31.12.2019

Bekir Turgut , Mahmud Zahid Ünlü

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

• 1. Dede O, Kayan D, Sezgin T, Aydoğmuş Y. Our experience of the first 70 percutaneous nephrolithotomy at Bitlis State Hospital; a retrospective analysis. The New Journal of Urology 2015; 10 (2): 06-11
• 2. Srivastava A, Singh KJ, Suri A, Dubey D, Kumar A, Kapoor R, et al. Vascular complications after percutaneous nephrolithotomy: are there any predictive factors? Urology. 2005;66(1):38-40.
• 3. Soyer P, Desgrippes A, Vallee J-N, Rymer R. Intrarenal pseudoaneurysm after percutaneous nephrostolithotomy: endovascular treatment with N-butyl-2-cyanoacrylate. European radiology. 2000;10(8):1358.
• 4. Falahatkar S, Hemmati H, Mokhtari G, Assadollahzadeh A, Allahkhah A. Intrarenal Pseuodoaneurysm after percutaneous nephrolithotomy: A rare and important complication of minimally invasive surgery. 2011;4:2.
• 5. Chandradev S, Ateesh S. Endovascular and percutaneous management of the pseudoaneurysms. Open Journal of Radiology. 2014;4(03):241.
• 6. Kervancioglu S, Gelebek Yilmaz F, Erturhan S. Endovascular management of vascular complications after percutaneous nephrolithotomy. Vasa. 2014;43(6):459-464.
• 7. Tan T, Teh H, Pua U, Ho S. Endovascular management of iatrogenic renal vascular injuries complicating percutaneous nephrolithotripsy: Role of renal angiography and superselective coil embolisation. J HK Coll Radiol. 2008;11:103-107.
• 8. Abath C, Andrade G, Cavalcanti D, Brito N, Marques R. Complex renal artery aneurysms: liquids or coils? Techniques in vascular and interventional radiology. 2007;10(4):299-307.
• 9. Hyams ES, Pierorazio P, Proteek O, Sukumar S, Wagner AA, Mechaber JL, et al. Iatrogenic vascular lesions after minimally invasive partial nephrectomy: a multi-institutional study of clinical and renal functional outcomes. Urology. 2011;78(4):820-826.
• 10. Inci K, Cil B, Yazici S, Peynircioglu B, Tan B, Şahin A, et al. Renal artery pseudoaneurysm: complication of minimally invasive kidney surgery. Journal of endourology. 2010;24(1):149-154.
• 11. Singh D, Gill IS. Renal artery pseudoaneurysm following laparoscopic partial nephrectomy. The Journal of urology. 2005;174(6):2256-2259.
• 12. Gahan JC, Gaitonde M, Wadskier L, Cadeddu JA, Trimmer C. Renal function outcomes following selective angioembolization for iatrogenic vascular lesions after partial nephrectomy. Journal of endourology. 2013;27(12):1516-1519.
• 13. Ghoneim TP, Thornton RH, Solomon SB, Adamy A, Favaretto RL, Russo P. Selective arterial embolization for pseudoaneurysms and arteriovenous fistula of renal artery branches following partial nephrectomy. The Journal of urology. 2011;185(6):2061-2065.
• 14. Shapiro EY, Hakimi AA, Hyams ES, Cynamon J, Stifelman M, Ghavamian R. Renal artery pseudoaneurysm following laparoscopic partial nephrectomy. Urology. 2009;74(4):819-823.
• 15. Kobayashi K, Censullo ML, Rossman LL, Kyriakides PN, Kahan BD, Cohen AM. Interventional radiologic management of renal transplant dysfunction: indications, limitations, and technical considerations. Radiographics. 2007;27(4):1109-1130.
• 16. Ramani AP, Desai MM, Steinberg AP, Ng CS, Abreu SC, Kaouk JH, et al. Complications of laparoscopic partial nephrectomy in 200 cases. The Journal of urology. 2005;173(1):42-47.
• 17. Albani JM, Novick AC. Renal artery pseudoaneurysm after partial nephrectomy: three case reports and a literature review. Urology. 2003;62(2):227-231.
• 18. Chatziioannou A, Mourikis D, Awad M, Konstantinedes P, Panourgias E, Vlachos L. Embolization of a segmental renal artery pseudoaneurysm after partial nephrectomy in a solitary kidney. Urologia internationalis. 2000;64(4):223-225.
• 19. Heye S, Maleux G, Van Poppel H, Oyen R, Wilms G. Hemorrhagic complications after nephron-sparing surgery: angiographic diagnosis and management by transcatheter embolization. American Journal of Roentgenology. 2005;184(5):1661-1664.
• 20. Parsons JK, Schoenberg MP. Renal artery pseudoaneurysm occurring after partial nephrectomy. Urology. 2001;58(1):105.
• 21. Richstone L, Fossett LK, Okeke Z, Ost MC, Rastinehad AR, Lobko I, et al. 1688: Hemorrhage Following Percutaneous Renal Surgery: Characterization of Angiographic Findings. The Journal of Urology. 2007;177(4):560.
• 22. Helck A, Hoffmann R, Sommer W, Notohamiprodjo M, Albyaa H, Reiser M, et al. Diagnosis, therapy monitoring and follow up of renal artery pseudoaneurysm with contrast-enhanced ultrasound in three cases. Clinical hemorheology and microcirculation. 2010;46(2-3):127-37.
• 23. Tinto H, Di Primio M, Tselikas L, Rico AP, Pellerin O, Pagny J-Y, et al. Selective arterial embolization of life-threatening renal hemorrhage in four patients after partial nephrectomy. Diagnostic and interventional imaging. 2014;95(6):601-9.
• 24. Netsch C, Brüning R, Bach T, Gross A. Management of renal artery pseudoaneurysm after partial nephrectomy. World journal of urology. 2010;28(4):519-24.
• 25. Ierardi AM, Floridi C, Fontana F, Duka E, Pinto A, Petrillo M, et al. Transcatheter embolisation of iatrogenic renal vascular injuries. La radiologia medica. 2014;119(4):261-8.
• 26. Rennert J, Herold T, Schreyer A, Banas B, Jung E, Feuerbach S, et al., editors. Evaluation of a liquid embolization agent (Onyx) for transcatheter embolization for renal vascular lesions. RöFo-Fortschritte auf dem Gebiet der Röntgenstrahlen und der bildgebenden Verfahren; 2009: © Georg Thieme Verlag KG Stuttgart• New York.