Selective arterial embolization for pseudoaneurysms and arteriovenous fistula of renal artery branches following partial nephrectomy Journal Article

  

Authors:	Ghoneim, T. P.; Thornton, R. H.; Solomon, S. B.; Adamy, A.; Favaretto, R. L.; Russo, P.
Article Title:	Selective arterial embolization for pseudoaneurysms and arteriovenous fistula of renal artery branches following partial nephrectomy
Abstract:	Purpose: We describe the presentation, endovascular management and functional outcomes of 15 patients with renal arterial pseudoaneurysm following open and laparoscopic partial nephrectomy. Materials and Methods: An institutional review board approved, Health Insurance Portability and Accountability Act compliant retrospective review of a prospectively maintained database revealed that 7 of 1,160 patients who underwent open partial nephrectomy and 8 of 301 treated with laparoscopic partial nephrectomy were diagnosed with a pseudoaneurysm of a renal artery branch between 2003 and 2010. Some cases were associated with arteriovenous fistula. Results: Diagnosis of pseudoaneurysm was made a median of 14 days after surgery. Gross hematuria was the most frequent symptom. Median estimated glomerular filtration rate measurements at the preoperative evaluation, postoperatively, on the day the vascular lesion was diagnosed, after embolization and at the last followup were 62, 55, 55, 56 and 58 ml/minute/1.73 m2, respectively. Median followup was 7.8 months. All patients underwent angiography and superselective coil embolization of 1 or more pseudoaneurysms with or without arteriovenous fistula. Eleven patients had immediate cessation of symptoms while 4 had persistent gross hematuria after the procedure. Of these 4 patients 2 were treated with bedside care, 1 required repeat embolization with thrombin, which was successful, and the remaining patient had coagulopathy and underwent radical nephrectomy for persistent bleeding. Conclusions: Pseudoaneurysms and arteriovenous fistulas of the renal artery are rare complications of partial nephrectomy. Presentation is often delayed. Superselective coil embolization is a safe, minimally invasive treatment option that usually solves the clinical problem and preserves renal function. © 2011 American Urological Association Education and Research, Inc.
Keywords:	artificial embolism; postoperative care; follow up; laparoscopic surgery; preoperative evaluation; disease association; data base; retrospective study; hematuria; nephrectomy; patient care; partial nephrectomy; glomerulus filtration rate; blood clotting disorder; angiography; thrombin; false; renal artery; institutional review; aneurysm; renal neoplasms; arteriovenous fistula; coil embolization; false aneurysm; renal artery aneurysm
Journal Title:	Journal of Urology
Volume:	185
Issue:	6
ISSN:	0022-5347
Publisher:	Elsevier Science, Inc.
Date Published:	2011-06-01
Start Page:	2061
End Page:	2065
Language:	English
DOI:	10.1016/j.juro.2011.02.049
PROVIDER:	scopus
PUBMED:	21496835
DOI/URL:	http://www.scopus.com/inward/record.url?eid=2-s2.0-79955804717&partnerID=40&md5=14594a6ed749a33580dbf432d4bde85b
Notes:	--- - "Export Date: 23 June 2011" - "CODEN: JOURA" - "Source: Scopus"

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