Severe bleeding following laparoscopic partial nephrectomy treated by selective renal artery embolization - initial experience and review of the literature

Kaloyan Davidoff, Elenko Popov, Adrian Popov, Dimitar Zlatanov, N. Stoyanov, Assen Alexandrov, V. Ivanov, K. Ibrahimov

Abstract


Purpose: Partial nephrectomy (PN) is an accepted alternative to radical nephrectomy for nephron sparing surgery to treat renal tumors. Although complications are relatively rare after PN, they may include renal hemorrhage that can be massive and life threatening. Artery embolization can have a major role in the management of these cases and to avoid radical nephrectomy.
Materials and methods: We report three consecutive patients with massive hemorrhage after LAPN, treated by arterial embolization and review the literature to discuss the clinical presentation, imaging evaluation and clinical outcome.
Results: After selective catheterization and identification of the bleeding site, micro-coils were used as embolization material. Immediate technical and clinical success was achieved in all cases.
Conclusion: Superselective artery embolization of renal hemorrhage is a simple, safe and efficient procedure. It has a high clinical success and should be considered as an alternative to nephrectomy, minimizing the morbidity and preserving renal tissue.


Keywords


embolization; nephrectomy; postoperative hemorrhage

Full Text:

PDF

References


/Delakas D, Karyotis I, Daskalopoulos G, et al. Nephronsparing surgery for localized renal cell carcinoma with a normal contralateral kidney: a European three-center experience. Urology 2002;60:998-1002.

Lee CT, Katz J, Shi W, et al. Surgical management of renal tumors 4 cm. or less in a contemporary cohort. J Urol 2000;163:730-736.

Uzzo RG, Novick AC. Nephron sparing surgery for renal tumors: indications, techniques and outcomes. J Urol 2001;166:6-18.

Benway BM, Bhayani SB, Rogers CG, et al. Robotassisted partial nephrectomy: an international experience. Eur Urol 2010;57:815-820.

Uberoi J, Badwan KH, Wang DS. Renal-artery pseudoaneurysm after laparoscopic partial nephrectomy. J Endourol 2007;21:330-333.

Albani JM, Novick AC. Renal artery pseudoaneurysm after partial nephrectomy: three case reports and a literature review. Urology 2003;62:227-231.

Cohenpour M, Strauss S, Gottlieb P, et al. Pseudoaneurysm of the renal artery following partial nephrectomy: imaging findings and coil embolization. Clin Radiol 2007;62:1104-1109.

Moore CJ, Rozen SM, Fishman EK. Two cases of pseudoaneurysm of the renal artery following laparoscopic partial nephrectomy for renal cell carcinoma: CT angiographic evaluation. Emerg Radiol 2004;10:193-196.

Parsons JK, Schoenberg MP. Renal artery pseudoaneurysm occurring after partial nephrectomy. Urology 2001; 58:105.

Singh D, Gill IS. Renal artery pseudoaneurysm following laparoscopic partial nephrectomy. J Urol 2005;174: 2256-2259.

Wright JL, Porter JR. Renal artery pseudoaneurysm after laparoscopic partial nephrectomy. Urology 2005; 66:1109.e17-1109.e19.

Zorn KC, Starks CL, Gofrit ON, et al. Embolization of renal-artery pseudoaneurysm after laparoscopic partial nephrectomy for angiomyolipoma: case report and literature review. J Endourol 2007;21:763-768.

Netsch C, Bruning R, Bach T, et al. Management of renal artery pseudoaneurysm after partial nephrectomy. World J Urol 2010;28:519-524.

Zelenˇ a´k K, Sopilko I, Sˇ vihra J, et al. Successful embolization of a renal artery pseudoaneurysm with arteriovenous fistula and extravasations using Onyx after partial nephrectomy for renal cell carcinoma. Cardiovasc Intervent Radiol 2009;32:163-165.

Seldinger SI. Catheter replacement of the needle in percutaneous arteriography: a new technique. Acta Radiol 1953;39:368-376.

Sacks D, McClenny TE, Cardella JF, et al. Society of Interventional Radiology clinical practice guidelines. J Vasc Interv Radiol 2003;14:S199-S202.

Zabkowski T, Piasecki P, Zielin´ ski H, et al. Superselective renal artery embolization in the treatment of iatrogenic bleeding into the urinary tract. Med Sci Monit 2015;21: 333-337.

Morita S, Tajima T, Yamazaki H, et al. Early postoperative screening by contrast-enhanced CT and prophylactic embolization of detected pseudoaneurysms prevents delayed hemorrhage after partial nephrectomy. J Vasc Interv Radiol 2015;26:950-957.

Richstone L, Reggio E, Ost MC, et al. First Prize (tie): Hemorrhage following percutaneous renal surgery: characterization of angiographic findings. J Endourol 2008; 22:1129-1136.

Tinto H, Di Primio M, Tselikas L, et al. Selective arterial embolization of life-threatening renal hemorrhage in four patients after partial nephrectomy. Diagn Interv Imaging 2014;95:601-609.

Baumann C, Westphalen K, Fuchs H, et al. Interventional management of renal bleeding after partial nephrectomy. Cardiovasc Intervent Radiol 2007;30: 828-832.

Inci K, Cil B, Yazici S, et al. Renal artery pseudoaneurysm: complication of minimally invasive kidney surgery. J Endourol 2010;24:149-154.

Lazarov R, de Kort G, van Moorselaar R. Persistent renal bleeding treated with selective vascular embolisation with preservation of renal function. Nederl Tijdschr Geneesk 2002;146:994-999.

Nadu A, Kleinmann N, Laufer M, et al. Laparoscopic partial nephrectomy for central tumors: analysis of perioperative outcomes and complications. J Urol 2009;181: 42-47.

Spana G, Haber G-P, Dulabon LM, et al. Complications after robotic partial nephrectomy at centers of excellence: multi-institutional analysis of 450 cases. J Urol 2011;186: 417-422.

Shapiro EY, Hakimi AA, Hyams ES, et al. Renal artery pseudoaneurysm following laparoscopic partial nephrectomy. Urology 2009;74:819-823.




DOI: http://dx.doi.org/10.19264/hj.v30i2.232