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Renal artery embolisation: indications and utilisation at Tygerberg Hospital

2019; Academy of Science of South Africa; Volume: 57; Issue: 4 Linguagem: Inglês

10.17159/2078-5151/2019/v57n4a2819

2078-5151

Ruan Pretorius, Sucari S.C. Vlok, André van der Merwe, A. Zarrabi, Kenneth Du Toit,

Abdominal vascular conditions and treatments

Background: To evaluate the indications, efficacy and outcomes of endovascular renal artery embolisation (RAE) in the management of renal haemorrhage, specifically in cases of non-iatrogenic origin.Methods: This is a retrospective case note review of 92 patients who underwent RAE in the period from August 1999 to August 2014 at Tygerberg Hospital.Results: Renal artery embolisation was performed in a total of 92 patients.The indication was traumatic renal injury in 60 patients (65.2%), with mean age 28.2 years.The mechanism of injury was stabbing (55.4%), blunt trauma (7.6%) and gunshot (2.2%).Digital subtraction angiography (DSA) showed pseudo-aneurysm in 32.6%, arteriovenous fistula in 19.6% and segmental artery injury in 13%.Embolisation success: 85% after one, 88.9% after a second attempt, with an overall success rate of 98.3% after two attempts.In 20 of the 92 patients (mean age 50.2 years) the indication was malignancy (21.7%).Other cases included iatrogenic haematuria (4.3%) and angiomyolipoma (3.3%).Embolisation was repeated in 16.3%, with eventual success rate of 93.8%.Post-embolisation syndrome was the most common complication, seen in 9.8% of all cases.Of the 9 patients who returned for follow-up with renogram imaging, 4 had a differential function of > 20% of the embolised kidney.Conclusion: Renal artery embolisation remains a very successful method of managing renal haemorrhage at this hospital, whether this results from trauma, malignancy, iatrogenic or other causes.