Tinto H R, Di Primio M, Tselikas L, Rico A Palomera, Pellerin O, Pagny J-Y, Sapoval M
Radiology Department, Hospital de São José, Rua José António Serrano, 1150 Lisboa, Portugal; Radiology Department, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisboa, Portugal.
Interventional Radiology Department, Hôpital Européen Georges-Pompidou, 75015 Paris, France.
Diagn Interv Imaging. 2014 Jun;95(6):601-9. doi: 10.1016/j.diii.2014.02.005. Epub 2014 Mar 15.
Partial nephrectomy (PN) is an accepted alternative to radical nephrectomy for nephron sparing surgery to treat renal tumors. Although complications are relatively rare after PN, they may include renal hemorrhage that can be massive and life threatening. Artery embolization can have a major role in the management of these cases and to avoid radical nephrectomy.
We report four consecutive patients with massive hemorrhage after PN, treated by arterial embolization and review the literature to discuss the clinical presentation, imaging evaluation and clinical outcome. All patients developed arteriovenous fistula and one a pseudoaneurysm.
After selective catheterization and identification of the bleeding site, we used microcoils as embolization material. Immediate technical and clinical success was achieved in all cases.
Superselective artery embolization of renal hemorrhage is a simple, safe and efficient procedure. It has a high clinical success and should be considered as an alternative to nephrectomy, minimizing the morbidity and preserving renal tissue.
对于保留肾单位手术治疗肾肿瘤，部分肾切除术（PN）是根治性肾切除术可接受的替代方法。尽管PN术后并发症相对少见，但可能包括严重且危及生命的肾出血。动脉栓塞在这些病例的处理及避免根治性肾切除术方面可发挥重要作用。
我们报告连续4例PN术后发生大出血并接受动脉栓塞治疗的患者，并复习文献以讨论临床表现、影像学评估及临床结果。所有患者均发生动静脉瘘，1例发生假性动脉瘤。
经选择性插管并确定出血部位后，我们使用微线圈作为栓塞材料。所有病例均即刻取得技术和临床成功。
肾出血的超选择性动脉栓塞是一种简单、安全且有效的方法。其临床成功率高，应被视为肾切除术的替代方法，可将发病率降至最低并保留肾组织。
