PURPOSE: Selective percutaneous transarterial embolization has proved to be effective, safe treatment for posttraumatic renal hemorrhage but inefficacious procedures often lead to nephrectomy. Thus, the success rate of transarterial embolization should be maximized. MATERIAL AND METHODS: We retrospectively investigated the clinical success rate of transarterial embolization for posttraumatic bleeding. Study inclusion criteria were imaging evidence and clinical signs of hemorrhage or a hemoglobin decrease of more than 2 gm/dl in urological cases. We excluded spontaneous bleeding from analysis. RESULTS: A total of 21 patients with a median age of 66 years (range 12 to 78) met study inclusion criteria. Etiology was blunt trauma in 3 cases (14%), stab wound in 1 (5%) and an iatrogenic cause in 17 (81%). In 2 patients an active bleeding site could not be detected during selective angiography. Transarterial embolization was done in 19 patients and led to primary clinical success in 12 (63%), including 2 with grade V parenchymal injury. In 6 of 7 cases (86%) in which primary treatment failed transarterial embolization was repeated. It resulted in clinical success in 4 of 6 patients (67%) with equal efficiency (p =1). Three patients (16%) who could not be sufficiently treated with transarterial embolization underwent nephrectomy. CONCLUSIONS: When conservative measures fail and clinical symptoms or a relevant hemoglobin decrease occur, transarterial embolization should be considered. Since the success rate is equally high for initial and repeat interventions, re-intervention is justified when the clinical course allows.
PURPOSE: Selective percutaneous transarterial embolization has proved to be effective, safe treatment for posttraumatic renal hemorrhage but inefficacious procedures often lead to nephrectomy. Thus, the success rate of transarterial embolization should be maximized. MATERIAL AND METHODS: We retrospectively investigated the clinical success rate of transarterial embolization for posttraumatic bleeding. Study inclusion criteria were imaging evidence and clinical signs of hemorrhage or a hemoglobin decrease of more than 2 gm/dl in urological cases. We excluded spontaneous bleeding from analysis. RESULTS: A total of 21 patients with a median age of 66 years (range 12 to 78) met study inclusion criteria. Etiology was blunt trauma in 3 cases (14%), stab wound in 1 (5%) and an iatrogenic cause in 17 (81%). In 2 patients an active bleeding site could not be detected during selective angiography. Transarterial embolization was done in 19 patients and led to primary clinical success in 12 (63%), including 2 with grade V parenchymal injury. In 6 of 7 cases (86%) in which primary treatment failed transarterial embolization was repeated. It resulted in clinical success in 4 of 6 patients (67%) with equal efficiency (p =1). Three patients (16%) who could not be sufficiently treated with transarterial embolization underwent nephrectomy. CONCLUSIONS: When conservative measures fail and clinical symptoms or a relevant hemoglobin decrease occur, transarterial embolization should be considered. Since the success rate is equally high for initial and repeat interventions, re-intervention is justified when the clinical course allows.
Authors: M H Okur; S Arslan; B Aydogdu; M S Arslan; C Goya; H Zeytun; E Basuguy; I Uygun; M K Çigdem; A Önen; S Otcu Journal: Eur J Trauma Emerg Surg Date: 2016-02-01 Impact factor: 3.693
Authors: Federico Coccolini; Ernest E Moore; Yoram Kluger; Walter Biffl; Ari Leppaniemi; Yosuke Matsumura; Fernando Kim; Andrew B Peitzman; Gustavo P Fraga; Massimo Sartelli; Luca Ansaloni; Goran Augustin; Andrew Kirkpatrick; Fikri Abu-Zidan; Imitiaz Wani; Dieter Weber; Emmanouil Pikoulis; Martha Larrea; Catherine Arvieux; Vassil Manchev; Viktor Reva; Raul Coimbra; Vladimir Khokha; Alain Chichom Mefire; Carlos Ordonez; Massimo Chiarugi; Fernando Machado; Boris Sakakushev; Junichi Matsumoto; Ron Maier; Isidoro di Carlo; Fausto Catena Journal: World J Emerg Surg Date: 2019-12-02 Impact factor: 5.469