School of Medicine, University of California-San Francisco, San Francisco, CA; Department of Urology, Emory University, Atlanta, GA.
Division of Urology, Department of Surgery, University of Utah, Salt Lake City, UT.
Urology. 2021 Feb;148:287-291. doi: 10.1016/j.urology.2020.10.027. Epub 2020 Oct 28.
To find clinical or radiographic factors that are associated with angioembolization failure after high-grade renal trauma.
Patients were selected from the Multi-institutional Genito-Urinary Trauma Study. Included were patients who initially received renal angioembolization after high-grade renal trauma (AAST grades III-V). This cohort was dichotomized into successful or failed angioembolization. Angioembolization was considered a failure if angioembolization was followed by repeat angiography and/or an exploratory laparotomy.
A total of 67 patients underwent management initially with angioembolization, with failure in 18 (27%) patients. Those with failed angioembolization had a larger proportion ofgrade IV (72% vs 53%) and grade V (22% vs 12%) renal injuries. A total of 53 patients underwent renal angioembolization and had initial radiographic data for review, with failure in 13 cases. The failed renal angioembolization group had larger perirenal hematoma sizes on the initial trauma scan.
Angioembolization after high-grade renal trauma failed in 27% of patients. Failed angioembolization was associated with higher injury grade and a larger perirenal hematoma. Likely these characteristics are associated with high-grade renal trauma that may be less amenable to successful treatment after a single renal angioembolization.
寻找与高级别肾外伤后血管栓塞治疗失败相关的临床或影像学因素。
本研究从多机构泌尿生殖系统创伤研究中选择患者。纳入标准为：初诊为高级别肾外伤（AAST 分级 III-V 级）并接受肾动脉栓塞治疗的患者。根据血管栓塞治疗是否成功，将该队列分为成功组和失败组。如果血管栓塞治疗后需要再次行血管造影和/或剖腹探查，即视为治疗失败。
共有 67 例患者接受了初始血管栓塞治疗，其中 18 例（27%）治疗失败。治疗失败组中，IV 级（72%比 53%）和 V 级（22%比 12%）肾损伤的比例更高。共有 53 例患者接受了肾动脉栓塞治疗，并对初始创伤扫描的影像学数据进行了回顾，其中 13 例治疗失败。与成功组相比，治疗失败组的初始肾周血肿更大。
27%的高级别肾外伤患者血管栓塞治疗失败。治疗失败与更高的损伤分级和更大的肾周血肿有关。这些特征可能与高级别肾外伤有关，单次肾动脉栓塞治疗后可能不太容易成功。
