Endovascular Management of Iatrogenic Renal Vascular Injury: Experience in 28 Cases

Aim of the Work: To evaluate the feasibility and efficacy of endovascular techniques in the management of gross hematuria caused by iatrogenic renal vascular injury. Specifically, we aimed to assess different embolic agents, different methods of embolization and their impact on the renal parenchymal loss and renal function. Patients and Methods: This is a single institutional study carried out between May 2004 to January 2011 and included 28 patients. Records of all patients who underwent postprocedural renal angioembolisation were reviewed. Data on embolization technique and embolic agents, success rate, periprocedural complications, and the long-term morphological and functional outcomes of embolised organs was recorded. Results: Twenty eight patients underwent angiography for diagnosis and treatment of gross hematuria caused by iatrogenic injury of renal vessels after surgical or percutaneous nephrolithotomy or renal biopsy. 96% were angiographically positive and underwent superselective embolization; of them pseudoaneurysm was noted 82%, AVF in 11%, and distorted renal branches in 7%. None of the 27 patients with successful embolisation developed recurrent bleeding or required postprocedural blood transfusion. There were no major procedure related post-embolisation complications. Conclusion: The high success rate and low incidence of complications make endovascular management the first-choice treatment option in cases of severe postprocedural renal hemorrhage. Superselective embolization of the injured vessel minimizes the extent of renal parenchymal infarction and allows sparing of the renal parenchyma.