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Objective To investigate the causes of bleeding due to arterial injury after minimally invasive percutaneous nephrolithotomy (mPCNL).Methods We retrospectively analyzed the clinical data of 2 980 patients who underwent ultrasound-guided mPCNL between January 2012,and January 2017,in our hospital.Among them,1 853 were male and 1 127 were female.Age from17 to 76 years old,average age was (45.7 ± 24.1) years.The calculi size was from 1.5 to 4.2 cm,average of (2.62 ± 1.08) cm.There were 2 478 kidney stones and 502 cases of ureteral calculi.Besides,727 cases with mild hydronephrosis,1 971 cases with moderate hydronephrosis,282 cases with severe hydronephrosis;480 patients with urinary tract infection;103 patients with renal empyema or acute renal failure;63 patients with cardiovascular and cerebrovascular stent implantation;214 patients with diabetes mellitus.Results In this study,all of the patients were established percutaneous renal tract successfully,indwelling drainage tube (6 ± 2)d,and postoperative hemorrhage in 117 cases,of which 29 patients suffered from bleeding due to arterial injury and DSA showed 20 cases with acute arterial injury,5 cases with pseudo-aneurysm,and 4 cases with arteriovenous fistula.However,all these cases were rehabilitated after the treatment of super-selective renal artery embolization.The rates of arterial injury of renal calyx access and pelvic access were 0.39％ (10/2 535) and 4.27％ (19/445),respectively.The rate of arterial injury in renal pelvic access was significantly higher than renal calyx access of PCNL (P ＜ 0.05).The rates of arterial injury in lower,middle,upper calyx access were 0.38％ (1/267),0.40％ (6/1 516),0.40％ (3/752),respectively.There was no significant effect of different renal calyx on postoperative arterial injury rate of mPCNL(P ＞0.05).All the percutaneous renal accesses were dilated with Amplatz sheaths,and the arterial injury rate of F16-18 and F20-22 tracts in the calyx access were 0.35％ (5/1 446),0.46％ (5/1 089),respectively,with no significant difference in size of calyx access associated with rate of arterial injury after mPCNL(P ＞0.05).The arterial injury rates of F16-18 and F20-22 tracts in the pelvic access were 1.98％ (5/253) and 7.29％ (14/192),respectively.There was significant difference in the size of the pelvic access in the rate of arterial injury after mPCNL(P ＜ 0.05).In addition,the arterial injury rate of single tract PCNL was 0.94％ (25/2 653) as compared to 1.22％ (4/327) in multi-tracts PCNL.There was no significant difference in the rate of arterial injury between single and multi-tracts PCNL(P ＞ 0.05).Conclusions The puncture of the renal pelvis and size of renal pelvis tract significantly increased the probability of postoperative bleeding due to arterial injury.
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Objective To evaluate the impact of preoperative renal artery embolization in renal cell carcinoma patients with venous tumor thrombus.Methods A total of 249 RCC patients with venous tumor thrombus underwent radical nephrectomy and thrombectormy in our hospital.Seventy-four patients received preoperative renal artery embolization while other 175 patients did not.The related items were analyzed.The tumor thrombus level was divided into 5 groups with American Mayo clinic classification system.Considering the significant difference in tumor situation and treatment strategies, we took the hepatic vein as a cut-off line, dividing patients into two subgroups, the early and advanced tumor thrombus groups.There were 208 patients in the early tumor thrombus group and 41 patients in the advanced group.The related items were analyzed respectively.Results Patients in the embolization group tended to have larger tumors and higher percentage of advanced tumor thrombus.For all patients, the embolization group had longer operation time [(4.8 ±2.1) h vs.(4.1 ±2.2) h ,P 0.05).Conclusion Preoperative RAE may be more appropriate for patients with advanced tumor thrombus because of its benefits in reducing operation time, intraoperative blood loss and elevating the operative security.
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Objective To investigate the clinical effect of interventional embolization in the treatment of intractable hematuria after percutaneous nephrolithotripsy. Methods A retrospective analysis of the First Affili?ated Hospital of Kunming Medical University from February 2014 to March 2016 after percutaneous nephrolithot?omy appears intractable hematuria patients in 36 cases was conducted. All patients were treated with conservative treatment but invalid,then lesion was confirmed by renal artery angiography,after that,line embosphere micro?spheres or polyvinyl alcohol particles combined with spring ring interventional the treatment was conduc?ted. Postoperative urine color changes, postoperative complications and follow?up were observed whether have bleeding again. Results ( 1) The success rate:36 cases patients all with successful embolization,the symptoms of hematuria in 1?3 days gradually disappeared,and the effective rate was 100%. ( 2) Complications:the compli?cations after operation in 10 patients appeared different degree of embolism syndrome,given analgesic and antie?metic,the symptoms gradually ease after treatment. One case patient with a transient increase of creatinine after operation,renal function returned to normal 7 days after the treatment. ( 3) Follow up:there was no recurrence of hemorrhage after 3?6 months of follow?up. Conclusion Transcatheter embolization in the treatment of intracta?ble hematuria has definite curative effect,less trauma,high safety,less complications and faster postoperative re?covery.
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Objective To evaluate the clinical application of high quality for super-selective renal artery embolization (SRAE) in treating bleeding after percutaneous nephrolithotomy (PCNL).Methods 134 patients received percutaneous nephrolithotomy were divided into control group (67 patients) and observation group (67 patients).All of patients with serious bleeding after PCNL were given SRAE in the Second Affiliated Hospital of Kunming Medical College from June 2010 to June 2015.At the same time,we gave high quality nursing to observation group.The patients in control group received routine nursing.The effect of nursing was observed.Results The degree of hematuria disappear of the patients in observation group was higher than that in control group (P＜ 0.05).There were fewer complications in observation group.In the sixth month after discharge,none of them had obvious renal impairment.No recurrence of hematuria,pus kidney and urinary cyst was tested.All cases were satisfied with the treatment.Conclusion It's the key to prevent serious complications and cure successfully with effective and timely supervision and high quality nursing care during the perioperation of SRAE in treating bleeding after PCNL.
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Objective To evaluate the clinical effect of percutaneous transcatheter renal artery thrombolysis in treating acute renal artery embolism. Methods A total of 23 patients with acute renal artery embolism underwent DSA-guided percutaneous transcatheter renal artery thrombolysis. Continuous urokinase thrombolytic therapy with micro pump was carried out in all patients; renal artery angiography was performed 3 days later; the therapeutic effect was evaluated with imaging manifestations and laboratory tests. Results Postoperative DSA showed that the renal artery was completely open in 21 patients and partially open in 2 patients; the effective rate was 91.3%. After thrombolysis treatment, complete remission of pain, oliguria, hematuria, fever and other symptoms was obtained in 21 cases, and relief of symptoms in 2 cases. Postoperative urine protein, aspartate aminotransferase (AST), lactate dehydrogenase (LDH), creatine kinase isoenzyme MB (CK-MB) and serum creatinine (SCr) levels were obviously decreased. Conclusion For the treatment of acute renal artery embolism, DSA-guided percutaneous transcatheter renal artery thrombolysis is very effective, minimally-invasive and highly-safe.
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Background: Kidney transplantation is the treatment of choice for the vast majority of patients with end stage renal disease. Many of the current challenges with the donor grafts are the results of anatomic variants, such as multiple renal arteries, multiple. The previous studies have shown that use of vessel grafts is associated with a higher incidence of vascular and urologic complications. With this back ground the knowledge of variations in vascular pattern is very helpful for renal transplantation and renal surgeries. Materials and Methods: 100 kidneys (Fifty pairs) intact with abdominal aorta were collected from department of Forensic department, JSS Medical College and Mysore Medical College. For study of segmental variation Corrosion cast technique method was used. The variations of posterior division were observed and recorded. Results: In present study type I posterior division of renal artery were found in - 27% cases, type II in - 42% cases, type III in - 25% cases. Conclusion: In present studywe found three types of posterior division of renal artery this knowledge helpful in treatment of renal trauma, renal transplantation, renovascular hypertension, renal artery embolization, vascular reconstruction.
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Renovascular hypertension is caused by narrowing of the arteries supplying the kidneys. There are several methods to treat renal artery stenosis, such as medications, percutaneous transluminal renal angioplasty, and atherosclerosis. A boy presented to our hospital with severe hypertension. Computed tomography angiogram revealed severe narrowing of the left renal artery and hypoplastic left kidney. Total renal artery embolizaton was performed to make a complete occlusion of the left renal artery. Follow-up renin and aldosterone levels were gradually decreased. The main advantage of renal artery embolization is that it is minimally invasive compared with extensive surgical procedures. Therefore, renal artery embolization should be considered as an alternative to surgical nephrectomy in pediatric patients with renovascular hypertension.
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Child , Humans , Male , Embolization, Therapeutic/methods , Hypertension, Renovascular/therapy , Renal ArteryABSTRACT
Autosomal polycystic kidney disease is responsible for about 10% of the cases of end stage renal disease. The increase in kidney size is usually proportional to the degree of deterioration in renal function. At the time of transplantation, these nonfunctional kidneys can be massively enlarged and nephrectomy is required before renal transplantation. However, pretransplantation nephrectomy of polycystic kidneys has the potential risk of surgical complications, including ileus, hernias, infection, excessive bleeding and/or intestinal injury. We report here on two cases successful renal transplantation in patients with polycystic kidneys after renal contraction by renal artery embolization and without nephrectomy. The volume reduction was evaluated by CT before and 3 months after renal artery embolization and the reduction in volume was 48% and 44% in each case, respectively. The embolization was well tolerated in both cases without immediate or delayed complications except for fever and lumbar flank pain. Four months after renal artery embolization, both of the patients successfully received a transplant from living donors.
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Humans , Contracts , Fever , Flank Pain , Hemorrhage , Hernia , Ileus , Kidney , Kidney Failure, Chronic , Kidney Transplantation , Living Donors , Nephrectomy , Polycystic Kidney Diseases , Polycystic Kidney, Autosomal Dominant , Renal Artery , TransplantsABSTRACT
Objective To evaluate super-selective renal arterial embolization(SRAE)in treating severe renal hemorrhage when conservative treatment had failed. Methods SRAE was performed in 111 patients with severe renal hemorrhage who had failed to respond the conservative management.The clinical data,the way of embolization,the medication and the follow-up findings were retrospectively analyzed.Results Excellent results were obtained in all patients after SRAE and no serious complications occurred.The technical successful rate with single session was 95.5%(106/111).Gross hematuria disappeared within 1-4 days after the treatment.Two patients developed shock after renal embolization and had to receive surgery after the shock was controlled.Three patients had a recurrence of hematuria,the blood urine subsided after SRAE was employed again.A follow-up with a mean period of 37.4 months was carried out in 92 patients,and the follow-up checkups showed that the renal function was well preserved in all patients.Conclusion Super-selective renal artery catheterization and embolization is a safe and effective treatment for severe renal hemorrhage,it can maximally preserve the healthy renal parenchyma as well as the renal function.Therefore,this technique should be regarded as the treatment of first choice for patients with severe renal hemorrhage.
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In patients with renal transplant failure's the graft can be left in situ when there are no additional complications. Graft intolerance occurs in some failed renal grafts when the immunological treatment is completely withdrawn. We experienced a case of graft intolerance syndrome in a patient with renal graft failure treated by percutaneous renal artery embolization. A 31 year -old man was admitted at nephrology department because of fever and hematuria without other infection focus. He was diagnosed as graft intolerance syndrome and treated by percutaneous embolization of the failed renal allograft. The embolization was successful. He suffered from post-emboization syndrome and treated by sulindac. We report this case with a review of relevant literatures and conclud that percutaneous renal artery embolizaion is a simple, safe and effective technique for the treatment of nonfunctioning renal allograft with clinical intolerance. Surgical nephrectomy should be reserved as a second level of treatment when allograft embolization has been ineffective owing to reappearance of manifestations of clinical intolerance.
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Humans , Allografts , Fever , Hematuria , Nephrectomy , Nephrology , Renal Artery , Sulindac , TransplantsABSTRACT
Objective:It is difficult to separate intermediate-and advanced-stage renal carcinoma,and in some cases even harder to totally remove it.This study aimed to assess the effect of the renal artery infusion chemoembolization on intermediate-and advanced-stage renal carcinoma before surgery.Methods: Twenty-seven patients with intermediate-or advanced-stage renal carcinoma accepted the Sandwich mode of selective bronchial renal artery embolization 3-7 days before surgery.Then we analyzed both the methods of embolization and surgery after intervention therapy.Results: All the patients were successfully treated by transarterial embolization.During the operation,renal artery pulsatility significantly decreased or even disappeared,with obvious swelling of the surrounding renal tissues but very little bleeding.Conclusion: Preoperative chemoembolization for intermediate-and advanced-stage renal carcinoma can improve surgical conditions,shorten the operation time,decrease bleeding and elevate the success rate.
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Objective To assess the value of transcatheter superselective arterial embolization in treatment of renal traumatic hemorrhage. Methods 20 patients underwent digital subtraction angiography with definite diagnosis before embolization. Embolization materials used in the study were gelfoam sponge chips and steel coils including 14 cases of segmental arteries with their branches through superselective renal arterial embolization. 6 cases were treated by selective renal arterial embolization. Results After renal artery embolization, macroscopic hematurin disappeared on 3th to 5th day after the procedure. With an average of 29 months of follow-up, there was no recurrent hemorrhage associated with normal renal function and blood pressure. Conclusions Superselective renal arterial embolization has advantages of less aggression, less complications, and good hemostatic efficacy, with maximal preservation of renal tissue and function for treatment of mild and moderate renal injuries.
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Objective To evaluate the clinical application of superselective renal artery embolization for the treatment of traumatic renal hemorrhage. Methods Thirty eight patients with traumatic renal hemorrhage were first demonstrated by renal arterigraphy under seldinger technique to ensure the rupture site and degree of renal artery and then followed by percutaneous cathetherized superselective renal arterial embolization through guidance of super slippery guide wire with gelfoam particles or steel coil. Results All 38 patients revealed occlusive abruption of bleeding arteries and disappearance of vextravasation staining after the superselective catheterized renal arterial embolization with gelfoam particles and steel spring coil under DSA. Clinically, all patients urine turned clear without macroscopic hematuria during 1 - 3 days after the procedure. Conclusions Superseclective renal arterial embolization is less aggressive and simultaneously with less complications, good hemostatic efficacy, maximal preservation of renal tissue and function for renal traumatic hemorrhage, which is worthy to be recommended.
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Preparations of polyacrylonitrile (PAN) are now being considered as possible new therapeutic embolization agents. This study evaluated two different liquid PAN formulations and a solid particle form (particle diameters, 100-400?m). Eighteen rabbits underwent unilateral renal embolization with one of the three different preparations (n=6 in each group). PAN was effective in causing infarcts in all embolized kidneys, which were documented with both angiograms and pathologic findings. These preliminary results show that PAN may have promise as an effective agent for clinical renal embolizations.
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Prenephrectomy therapeutic renal artery embolization by injecting gelfoam into therenal artery was done in a 47 year-old female patient with hypernephroma. This technique facilitated nephrectomy and decreased blood loss. A post-infarction syndrome characterized by flank pain, fever and nausea also occurred in this patient. We report our experience herein with review of literature.