Matsumoto Monica M, Reddy Shilpa N, Nadolski Gregory J, Shamimi-Noori Susan, Trerotola Scott O, Stavropoulos S William
Department of Radiology, University of Pennsylvania Health System, Philadelphia, Pennsylvania.
Department of Radiology, University of Pennsylvania Health System, Philadelphia, Pennsylvania.
J Vasc Interv Radiol. 2023 Mar;34(3):436-444. doi: 10.1016/j.jvir.2022.11.016. Epub 2022 Nov 19.
To evaluate differences in arteriographic findings and outcomes after embolization among patients with a suspected iatrogenic renal arterial injury (IRAI).
Patients at the authors' institution who underwent renal arteriography for suspected IRAIs after partial nephrectomy, biopsy, or percutaneous access over a 20-year period were included. Records, imaging, and outcomes were reviewed. Data analysis was performed using the Fisher exact or Kruskal-Wallis test.
Ninety arteriograms were performed on 83 patients after partial nephrectomy (n = 32), biopsy (n = 27), or percutaneous access (n = 24), including for nephrostomy/ureterostomy and stone removal. The median number of days between the index procedure and arteriogram was highest (15 days) after partial nephrectomy and lowest (5 days) after biopsy (P = .0001). Embolization was performed during 76% of arteriograms. If prearteriographic imaging showed positive results for IRAIs, embolization was performed in 67% versus 33% if imaging showed negative results (P = .005). The transfusion rate was higher after biopsy than after partial nephrectomy or percutaneous access (P = .002). Acute kidney injury after arteriogram occurred in 7% of patients; however, all returned to baseline by 1 week.
Despite the different mechanism of IRAIs in partial nephrectomy, biopsy, and percutaneous access, arteriographic findings and outcomes were overall similar among groups. Prearteriographic imaging can help identify IRAIs but cannot supersede the clinical judgment regarding indication for embolization. IRAIs can present acutely or after a long interim, although patients who underwent biopsy presented earlier and more frequently required a blood transfusion. IRAIs can be treated with embolization without permanent deleterious effects on renal function.
评估疑似医源性肾动脉损伤（IRAI）患者栓塞术后血管造影结果及预后的差异。
纳入作者所在机构20年间因部分肾切除、活检或经皮穿刺后疑似IRAI而接受肾动脉造影的患者。回顾记录、影像学资料及预后情况。采用Fisher精确检验或Kruskal-Wallis检验进行数据分析。
83例患者共进行了90次血管造影，其中部分肾切除术后32例，活检术后27例，经皮穿刺术后24例（包括肾造瘘/输尿管造口术及结石清除术）。部分肾切除术后至血管造影的中位天数最高（15天），活检术后最低（5天）（P = 0.0001）。76%的血管造影术中进行了栓塞。如果血管造影术前影像学检查显示IRAI阳性结果，则67%的患者进行了栓塞；如果影像学检查显示阴性结果，则为33%（P = 0.005）。活检后的输血率高于部分肾切除术后或经皮穿刺术后（P = 0.002）。血管造影术后7%的患者发生急性肾损伤；然而，所有患者在1周内均恢复至基线水平。
尽管部分肾切除、活检及经皮穿刺导致IRAI的机制不同，但各组间血管造影结果及预后总体相似。血管造影术前影像学检查有助于识别IRAI，但不能取代关于栓塞指征的临床判断。IRAI可急性出现或在较长间歇期后出现，尽管活检患者出现较早且更频繁需要输血。IRAI可通过栓塞治疗，且对肾功能无永久性有害影响。
