2008 Annual Meeting Abstracts
Angiography and Embolization for Traumatic Renal Injuries
John Mai, David Kunkle, Brett Lebed, Jack Mydlo
Temple University Hospital, Philadelphia, PA
Introduction: Excellent rates of renal salvage have been reported for nonoperative management of severe traumatic renal injuries. Small series have reported the use of angiography in the evaluation of renal trauma; however no guidelines exist to direct its use. We now report our use of angiography for acute traumatic renal injuries and review the world literature.
Methods: We analyzed the world literature and our urologic trauma database for blunt/penetrating renal injuries evaluated by renal angiography from 1995-2005.
Results: 17 patients underwent angiography for CT findings of traumatic renal laceration associated with vascular extravasation(8),segmental infarct(6),or lack of ipsilateral contrast enhancement(3). 7 patients underwent successful embolization of a main renal artery(3) or segmental branch(4). Literature review revealed 225 instances of renal vascular embolization after iatrogenic (26%) or traumatic (74%) injuries. Technical success was achieved in 86% and only 6% required surgical exploration. Only 55(24%) of these were performed for acute injuries rather than delayed manifestations of renal trauma.
Table1. Patients with renal vascular trauma undergoing angiography | All patients | Angiography only | Angiography + renal embolization | P value |
| No. patients(%) | 17 (100%) | 10 (59%) | 7 (41%) | - |
| Mean age, years | 35.1 | 31.2 | 41.7 | 0.22 |
| Mechanism: blunt / penetrating | 14 / 3 | 8 / 2 | 6 / 1 | 1.0 |
| No. hematuria (%) | 16 (94%) | 9 (90%) | 7 (100%) | 1.0 |
| No. urine extravasation (%) | 1 (6%) | 0 (0%) | 1 (14%) | 0.41 |
| Mean time to angio, minutes | 195 | 199 | 188 | 1.0 |
| Transfusion rate (%) | 8 (47%) | 3 (30%) | 5 (71%) | 0.15 |
| Post-angio transfusion rate (%) | 4 (24%) | 2 (20%) | 2 (29%) | 1.0 |
| Mean discharge creatinine | 0.9 | 1.0 | 0.8 | 0.22 |
Conclusions: Angiography is important in the management of suspected renal vascular injuries. While published series of renal embolization describe excellent outcomes, few published cases involve renal trauma. We have performed angiography safely and effectively for renal lacerations with CT evidence of acute infarct, vascular contrast extravasation, or lack of ipsilateral renal contrast enhancement. Nonoperative management utilizing renal angiography should be considered in hemodynamically stable patients with renal vascular injuries.
