Endovascular management of iatrogenic renal arterial lesions and clinical outcomes

Abstract

PURPOSE We aimed to evaluate iatrogenic renal arterial lesions, includ-ing pseudoaneurysm, arteriovenous fistula, and arteriocalice-al fistula, their management by endovascular embolization, and the clinical results.METHODSFifty-five patients (forty males, fifteen females) with a me-dian age of 40 years (range, 8-85 years), who underwent endovascular embolization of iatrogenic renal arterial lesions between March 2003 and December 2013 were included in this retrospective study. Types of iatrogenic lesions and de-tails of embolization procedures were reported. Estimated glomerular filtration rate (eGFR), renal function tests, hemo-globin, and hematocrit levels before and after embolization were recorded and compared. RESULTSMedian follow-up was 24 months. We identified 53 pseudo-aneurysms, 30 arteriovenous fistulas, and 11 arteriocaliceal fistulas in 55 patients, after percutaneous nephrolithotomy (n=26), renal biopsy (n=21), nephrostomy (n=3), renal sur-gery (n=3), and extracorporeal shock wave lithotripsy (n=2). Median number of pseudoaneurysms was 1 (range, 1-4) with a median size of 7 mm (range, 1.5-35 mm). Fifty-one patients underwent coil embolization. Median number of coils was 5 (range, 2-21) and median renal parenchymal loss was 5% (range, 1%-50%). There were no significant differences between pre- and postoperative eGFR and serum parameters. CONCLUSIONIatrogenic renal arterial lesion can be a life threatening con-dition. Superselective coil embolization is a safe, minimally invasive treatment option with minimal renal parenchymal loss and without significant change in renal function.