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- Non-Permanent Transcatheter Proximal Renal Artery Embolization for a Grade 5 Renal Injury with Delayed Recanalization and Preserved Renal Parenchymal Enhancement
- Abhishek Jairam, Bradley King, Zachary Berman, Gerant Rivera-Sanfeliz
- J Trauma Inj. 2021;34(3):198-202. Published online September 30, 2021
- DOI: https://doi.org/10.20408/jti.2020.0075
- 2,812 View
- 66 Download
- 2 Citations
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Abstract
PDF Super-selective renal artery embolization is an increasingly popular technique for the management of traumatic, low-grade renal trauma. When performed in distal arterial branches, this intervention enables tissue preservation and arrest of hemorrhage, but it may not be practical in cases of multifocal, high-grade renal injuries. In such cases, surgical nephrectomy remains the more common treatment modality to ensure hemodynamic control. We present the unique case of a patient who presented in hemorrhagic shock following a major trauma that resulted in a grade 5 renal injury treated with complete renal artery embolization using Gelfoam, resulting in hemodynamic stabilization. Interestingly, imaging 1 month after embolization revealed residual enhancement of the inferior pole of the kidney, suggesting reconstitution of flow and partial renal salvage. Ultimately, transcatheter “nephrectomy” with careful selection of a temporary embolic agent may serve as a safe and efficient alternative to surgical nephrectomy with the added possibility of preserving partial renal perfusion and function in the emergent setting.
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Summary
Citations
Citations to this article as recorded by
- Salvation of a solitary kidney in a patient with grade IV renal trauma: a case report
Hyuntack Shin, Ae Jin Sung, Min A Lee, Jayun Cho, Gil Jae Lee, Byungchul Yu, Kang Kook Choi
Journal of Trauma and Injury.2022; 35(Suppl 1): S18. CrossRef - The Role of Renal Artery Embolisation in the Management of Blunt Renal Injuries: A Review
Rosemary Denning Ho, Vivek Shrivastava, Amir Mokhtari, Raghuram Lakshminarayan
Vascular and Endovascular Review.2022;[Epub] CrossRef
Original Article- Efficiency of Embolization for Kidney Injury
- Young Kee Kwon, Hyuk Soo Chang, Byung Hoon Kim, Choal Hee Park, Chun Il Kim
- J Korean Soc Traumatol. 2010;23(1):16-20.
- 968 View
- 2 Download
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Abstract
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- PURPOSE
High-grade (III, IV, V) renal injury may need interventional management. We investigated whether the selective embolization of the renal artery is effective for the treatment of major renal injury in comparison with emergency renal exploration.
METHODS
We retrospectively reviewed the medical and radiologic records of patients who underwent surgery or embolization for renal injury (Grade III, IV, V) between January 1990 and December 2007. We analyzed the change in treatment method before and after 2000, the blood pressure, the hemoglobin at the time of visit, the hospital days and the complications in patients who received surgery or embolization. Preserved renal functions of the embolized kidneys were identified by using enhanced CT.
RESULTS
Cases of surgery and embolization were 37 and 13, respectively: 5 and 4 in renal injury grade III, 17 and 6 in grade IV and 13 and 3 in grade V. Cases of surgery and embolization were 33 and 1 before 2000 and 2 and 12 after 2000, repectively: embolizations increased after 2000. No significant differences in mean diastolic pressure, hemoglobin, hospital days and complications existed between the surgery and the embolization groups (p>0.05). However, the transfusion volume was significantly smaller in the embolization group (p<0.05). One postoperative complication occurred in the surgery group. We identified the preserved renal functions of the embolized kidney by using enhanced CT.
CONCLUSION
Embolization could be one treatment method for high-grade renal injury. Thus, we might suggest selective embolization a useful method for preserving the renal function in cases of high-grade renal injury. -
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