Complicaciones hemorrágicas de la nefrolitotomía percutánea: valor del tratamiento endovascular precoz / Hemorrhagic complicationes after percutaneous nephrolithotomy: The importance of an early endovascular management

Introducción y objetivos: La hemorragia secundaria a la fístula arteriovenosa (FAV) o al pseudoaneurisma (PA) es una complicación poco frecuente de la nefrolitotomía percutánea (NLPC). El objetivo de este estudio es evaluar las complicaciones hemorrágicas (CH) tras la NLPC y los resultados del tratamiento endovascular.Materiales y métodosEntre mayo de 2009 y diciembre de 2019 se realizaron en nuestro centro 1.335 NLPC por litiasis renal. Analizamos la incidencia de CH tempranas y tardías, el tratamiento administrado, la necesidad de embolización posterior y los datos clínicos y analíticos de los pacientes.ResultadosUn total de 59 (4,4%) pacientes presentaron CH, y todos fueron tratados con arteriografía y embolización selectiva (AES) para controlar el sangrado. Se observó hematoma perirrenal en 38 pacientes (64%).En cuanto a los hallazgos angiográficos, hubo 32 (54%) PA, 8 (14%) FAV, 4 (7%) extravasaciones por laceración vascular y 15 (25%) PA combinadas con FAV. En un caso, fueron necesarios 3 procedimientos para controlar la hemorragia. En 30 pacientes (51%) no se requirió transfusión de sangre, mientras que en 29 (49%) se transfundió una media de 1,3 unidades. La mediana de seguimiento fue de 24±21 meses.El intervalo de tiempo medio entre la NLPC y la AES fue de 7,3±4,9 días. Un total de 24 (41%) pacientes reingresaron tras el alta debido a una CH tardía que requería AES. La demora entre el reingreso y la AES fue de 4,8±4,6horas de media.ConclusiónLas CH tempranas y tardías tras la NLPC pueden ser mayores. El tratamiento con AES tras la detección precoz es un método efectivo y mínimamente invasivo que evita múltiples transfusiones de sangre, en muchos casos insuficientes. (AU)

Introduction and objectives: Hemorrhage due to arteriovenous fistula (AVF) or pseudoaneurysm (PA) is a rare complication after percutaneous nephrolithotomy (PCNL). The objective of this study is to evaluate hemorrhagic complications (HC) after PCNL and the results of their endovascular treatment.Materials and methodsBetween May 2009 and December 2019, 1335 PCNL were performed in our center for kidney stone disease. We analyzed the incidence of early and late HC, their management, the need for subsequent embolization, as well as clinical and analytical data of these patients.ResultsA total of 59 (4.4%) patients presented HC. Bleeding was managed with arteriography and selective embolization (ASE). Perirenal hematoma was seen in 38 patients (64%).Regarding angiographic findings, there were 32 (54%) PA, 8 (14%) AVF, 4 (7%) extravasations due to vascular laceration and 15 (25%) PA combined with AVF. In one case, 3 procedures were required to control the bleeding. In 30 patients (51%) blood transfusions were not necessary, while in 29 (49%), a mean of 1.3 units were transfused. Median follow-up was 24±21 months.Mean time interval between PCNL and ASE was 7.3±4.9 days. A total of 24 (41%) patients were readmitted after discharge due to late HC requiring ASE. Delay between readmission and ASE was 4.8±4.6hours in average.ConclusionEarly and late HC after PCNL can be severe. Rapid identification and treatment with ASE is an effective and minimally invasive and avoids multiple blood transfusions which in many cases constitute an insufficient treatment. (AU)

Hemorrhagic complicationes after percutaneous nephrolithotomy: The importance of an early endovascular management.

INTRODUCTION AND OBJECTIVES: Hemorrhage due to arteriovenous fistula (AVF) or pseudoaneurysm (PA) is a rare complication after percutaneous nephrolithotomy (PCNL). The objective of this study is to evaluate hemorrhagic complications (HC) after PCNL and the results of their endovascular treatment. MATERIALS AND METHODS: Between May 2009 and December 2019, 1335 PCNL were performed in our center for kidney stone disease. We analyzed the incidence of early and late HC, their management, the need for subsequent embolization, as well as clinical and analytical data of these patients. RESULTS: A total of 59 (4.4%) patients presented HC. Bleeding was managed with arteriography and selective embolization (ASE). Perirenal hematoma was seen in 38 patients (64%). Regarding angiographic findings, there were 32 (54%) PA, 8 (14%) AVF, 4 (7%) extravasations due to vascular laceration and 15 (25%) PA combined with AVF. In one case, 3 procedures were required to control the bleeding. In 30 patients (51%) blood transfusions were not necessary, while in 29 (49%), a mean of 1.3 units were transfused. Median follow-up was 24 ±â€¯21 months. Mean time interval between PCNL and ASE was 7.3 ±â€¯4.9 days. A total of 24 (41%) patients were readmitted after discharge due to late HC requiring ASE. Delay between readmission and ASE was 4.8 ±â€¯4.6 h in average. CONCLUSION: Early and late HC after PCNL can be severe. Rapid identification and treatment with ASE is an effective and minimally invasive and avoids multiple blood transfusions which in many cases constitute an insufficient treatment.

Hemorrhagic complicationes after percutaneous nephrolithotomy: The importance of an early endovascular management. / Complicaciones hemorrágicas de la nefrolitotomía percutánea: valor del tratamiento endovascular precoz.

INTRODUCTION AND OBJECTIVES: Hemorrhage due to arteriovenous fistula (AVF) or pseudoaneurysm (PA) is a rare complication after percutaneous nephrolithotomy (PCNL). The objective of this study is to evaluate hemorrhagic complications (HC) after PCNL and the results of their endovascular treatment. MATERIALS AND METHODS: Between May 2009 and December 2019, 1335 PCNL were performed in our center for kidney stone disease. We analyzed the incidence of early and late HC, their management, the need for subsequent embolization, as well as clinical and analytical data of these patients. RESULTS: A total of 59 (4.4%) patients presented HC. Bleeding was managed with arteriography and selective embolization (ASE). Perirenal hematoma was seen in 38 patients (64%). Regarding angiographic findings, there were 32 (54%) PA, 8 (14%) AVF, 4 (7%) extravasations due to vascular laceration and 15 (25%) PA combined with AVF. In one case, 3 procedures were required to control the bleeding. In 30 patients (51%) blood transfusions were not necessary, while in 29 (49%), a mean of 1.3 units were transfused. Median follow-up was 24±21 months. Mean time interval between PCNL and ASE was 7.3±4.9 days. A total of 24 (41%) patients were readmitted after discharge due to late HC requiring ASE. Delay between readmission and ASE was 4.8±4.6hours in average. CONCLUSION: Early and late HC after PCNL can be severe. Rapid identification and treatment with ASE is an effective and minimally invasive and avoids multiple blood transfusions which in many cases constitute an insufficient treatment.