Department of Urology, School of Medicine, Seattle, Washington, USA.
J Urol. 2011 Apr;185(4):1316-20. doi: 10.1016/j.juro.2010.12.003. Epub 2011 Feb 22.
To our knowledge data on diagnostic angiography and angioembolization after renal trauma have been limited to single institution series with small numbers. We used the National Trauma Data Bank® to investigate national patterns of diagnostic angiography and angioembolization after blunt and penetrating renal trauma.
All renal injuries treated between 2002 and 2007 were identified in the National Trauma Data Bank by Abbreviated Injury Scale codes and converted to American Association for the Surgery of Trauma renal injury grades. Diagnostic angiography and angioembolization were identified by ICD-9 codes and examined. Initial angioembolization was considered a failure if subsequent therapy was needed. Repeat diagnostic angiography was not considered a failure.
A total of 9,002 renal injuries were available for analysis. A total of 165 patients (2%) underwent diagnostic angiography after renal injury, including 77 (47%) who underwent concomitant angioembolization. Of the patients 78% sustained grade III-V renal injuries. Of the 77 patients with initial angioembolization 68 required successive therapy. Repeat angioembolization was the most common management choice (29% of patients). Secondary angioembolization was durable during the index hospitalization with success in 35 of 36 cases. Successive therapy was required after initial angioembolization for all grade IV and V renal injuries in 48 patients. The overall renal salvage rate was 92%, including 88% for grade IV and V injuries.
Successive therapy is common after initial management of renal injury by angioembolization. Close observation is highly recommended after initial angioembolization for grade IV-V renal injuries. National agreement on the use of diagnostic angiography and angioembolization is needed since these procedures may be overused after grade I-III renal injuries.
据我们所知，关于肾外伤后的诊断性血管造影和血管栓塞的数据仅限于少数单机构系列。我们使用国家创伤数据库®来研究钝性和穿透性肾外伤后诊断性血管造影和血管栓塞的全国模式。
通过损伤严重度评分代码在国家创伤数据库中确定 2002 年至 2007 年期间治疗的所有肾损伤，并转换为美国创伤外科学会肾损伤分级。通过 ICD-9 代码识别诊断性血管造影和血管栓塞，并进行检查。如果需要后续治疗，则认为初始血管栓塞失败。重复诊断性血管造影不被认为是失败。
共有 9002 例肾损伤可用于分析。共有 165 例患者（2%）在肾损伤后接受了诊断性血管造影，其中 77 例（47%）同时进行了血管栓塞。患者中有 78%的人患有 III-V 级肾损伤。在初始血管栓塞的 77 例患者中，有 68 例需要连续治疗。重复血管栓塞是最常见的治疗选择（29%的患者）。在指数住院期间，二次血管栓塞是持久的，36 例中有 35 例成功。在 48 例所有 IV 和 V 级肾损伤患者中，初始血管栓塞后需要连续治疗。整体肾存活率为 92%，包括 IV 和 V 级损伤的 88%。
在血管栓塞初始治疗肾损伤后，连续治疗很常见。对于 IV-V 级肾损伤，在初始血管栓塞后强烈建议密切观察。由于这些程序在 I-III 级肾损伤后可能被过度使用，因此需要就诊断性血管造影和血管栓塞的使用达成国家共识。
