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Blunt renal trauma: minimally invasive management with microcatheter embolization experience in nine patients.

Dinkel HP, Danuser H,Triller J.
Department of Diagnostic Radiology, University of Bern, Inselspital, Freiburgstrasse 20, CH 3010 Bern, Switzerland. hans-peter.dinkel@insel.ch

PURPOSE: To evaluate superselective embolization therapy for the management of arterial damage in patients with severe renal trauma. MATERIALS AND METHODS: Nine consecutive patients with renovascular injuries after blunt trauma underwent superselective embolization. Six patients had pseudoaneurysms or traumatic arteriovenous fistulas. Three patients had frank, uncontained extravasation (two shattered kidneys, one complete pedicle avulsion) and were treated immediately after admission. Two patients were hemodynamically unstable. All patients underwent embolization with 3-F coaxial microcatheters and polyvinyl alcohol particles (n = 2) or 0.018-inch platinum microcoils (n = 7). Procedural and medical success and complications (eg, postembolization syndrome, abscess, permanent serum creatinine elevation, hypertension) were retrospectively assessed from the patients' records. Mean clinical follow-up was 11.9 months (range, 1-50 months). RESULTS: In all cases bleeding was effectively controlled with superselective embolization in a single session. There was no procedure-related loss of renal tissue in eight cases; in one patient, a lower pole remnant of 20% of viable ipsilateral parenchyma was lost due to the procedure. In one patient, a coil migrated into a lumbar artery without causing clinical consequences. None of the patients developed abscess, hypertension, or procedure-related impairment of renal function. CONCLUSION: Superselective embolization may be used for effective, minimally invasive control of active renovascular bleeding.

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