Nakul Gupta1, Anish Patel2, Joe Ensor3, Kamran Ahrar4, Judy Ahrar4, Alda Tam4, Bruno Odisio4, Stephen Huang4, Ravi Murthy4, Armeen Mahvash4, Rony Avritscher4, Stephen McRae4, Sharjeel Sabir4, Michael Wallace4, Surena Matin5, Sanjay Gupta6. 1. Houston Methodist Hospital, Houston, TX, USA. 2. The University of Texas Southwestern Medical Center, Dallas, TX, USA. 3. The Houston Methodist Cancer Center, Houston Methodist Research Institute, Houston, TX, USA. 4. Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Unit 1471, PO Box 301402, Houston, TX, 77230-1402, USA. 5. Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA. 6. Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Unit 1471, PO Box 301402, Houston, TX, 77230-1402, USA. sgupta@mdanderson.org.
Abstract
PURPOSE: To describe the incidence of multiple renal artery pseudoaneurysms (PSA) in patients referred for renal artery embolization following partial nephrectomy and to study its relationship to RENAL nephrometry scores. MATERIALS AND METHODS: The medical records of 25 patients referred for renal artery embolization after partial nephrectomy were retrospectively reviewed for the following parameters: size and number of tumors, RENAL nephrometry scores, angiographic abnormalities, technical and clinical outcomes, and estimated glomerular filtration rates (eGFRs) after embolization. RESULTS: Twenty-four patients had primary renal tumors, while 1 patient had a pancreatic tumor invading the kidney. Multiple tumors were resected in 4 patients. Most patients (92 %) were symptomatic, presenting with gross hematuria, flank pain, or both. Angiography revealed PSA with (n = 5) or without (n = 20) AV fistulae. Sixteen patients (64 %) had multiple PSA involving multiple renal vessels. Higher RENAL nephrometry scores were associated with an increasing likelihood of multiple PSA. Multiple vessels were embolized in 14 patients (56 %). Clinical success was achieved after one (n = 22) or two (n = 3) embolization sessions in all patients. Post-embolization eGFR values at different time points after embolization were not significantly different from the post-operative eGFR. CONCLUSION: A majority of patients requiring renal artery embolization following partial nephrectomy have multiple pseudoaneurysms, often requiring selective embolization of multiple vessels. Higher RENAL nephrometry score is associated with an increasing likelihood of multiple pseudoaneurysms. We found transarterial embolization to be a safe and effective treatment option with no long-term adverse effect on renal function in all but one patient with a solitary kidney.
PURPOSE: To describe the incidence of multiple renal artery pseudoaneurysms (PSA) in patients referred for renal artery embolization following partial nephrectomy and to study its relationship to RENAL nephrometry scores. MATERIALS AND METHODS: The medical records of 25 patients referred for renal artery embolization after partial nephrectomy were retrospectively reviewed for the following parameters: size and number of tumors, RENAL nephrometry scores, angiographic abnormalities, technical and clinical outcomes, and estimated glomerular filtration rates (eGFRs) after embolization. RESULTS: Twenty-four patients had primary renal tumors, while 1 patient had a pancreatic tumor invading the kidney. Multiple tumors were resected in 4 patients. Most patients (92 %) were symptomatic, presenting with gross hematuria, flank pain, or both. Angiography revealed PSA with (n = 5) or without (n = 20) AV fistulae. Sixteen patients (64 %) had multiple PSA involving multiple renal vessels. Higher RENAL nephrometry scores were associated with an increasing likelihood of multiple PSA. Multiple vessels were embolized in 14 patients (56 %). Clinical success was achieved after one (n = 22) or two (n = 3) embolization sessions in all patients. Post-embolization eGFR values at different time points after embolization were not significantly different from the post-operative eGFR. CONCLUSION: A majority of patients requiring renal artery embolization following partial nephrectomy have multiple pseudoaneurysms, often requiring selective embolization of multiple vessels. Higher RENAL nephrometry score is associated with an increasing likelihood of multiple pseudoaneurysms. We found transarterial embolization to be a safe and effective treatment option with no long-term adverse effect on renal function in all but one patient with a solitary kidney.
Authors: Inès Dominique; Charles Dariane; Cyril Fourniol; Thomas Le Guilchet; Sophie Hurel; Eric Fontaine; Eric Mandron; Francois Audenet; Arnaud Mejean; Marc Olivier Timsit Journal: Ther Adv Urol Date: 2019-02-15