Intrarenal pseudoaneurysm after percutaneous nephrostolithotomy: endovascular treatment with N-butyl-2-cyanoacrylate

N-butyl 2-Cyanoacrylate (NBCA) in Nephron Sparing Superselective Embolization of Iatrogenic Renovascular Injuries: A Single Centre Experience

Purpose To evaluate the safety and efficacy of N-butyl-2-cyano-acrylate (NBCA) for endovascular management of iatrogenic renal-vascular injuries and effects on renal function. Material & Methods Fifteen patients with diagnosed or suspected iatrogenic renal vascular injuries, following percutaneous procedures formed the study group. All the patients were having retroperitoneal hemorrhage or hematuria, with hemodynamic instability at the time of presentation. Pseudoaneurysms, active extravasation of contrast, and the arteriovenous fistula were identified as the cause of bleeding on digital subtraction angiography. Patients underwent trans arterial super-selective embolization. Renal function was monitored using serum creatinine, estimated glomerular filtration rate (eGFR), and mean blood pressure of all the patients at immediate post-procedure and two months intervals. Results Technical and clinical success was achieved in all the cases using NBCA alone. Patients improved hemodynamically. None of the patients required repeat embolization. No derangement in renal function was observed immediately after the procedure and at interval follow-up. Conclusion NBCA can be used as a safe embolizing agent to provide a quick and effective cure for iatrogenic renovascular injuries. Renal parenchymal loss can be minimized by super selective technique.

"Endourological closure of a malformative vascular source of bleeding using the VortX 0.018" coil®"

AIMS

Renal vascular malformations, congenital or acquired, are sometimes challenging for urologists and interventional radiologists to resolve. Arterovenous fistulas and pseudoaneuryms are usually embolized by interventional radiologists, with a low rate of complications. We propose a new endourological/interventional radiology technique to treat a source of arterovenous bleeding coming from a renal calyx in a minimally invasive way.

METHODS

A combined endourological and interventional radiology procedure is described, using a Flexible Fiberoptic Ureteroscopes to undertake a retrograde intrarenal surgery (RIRS) to identify the source of bleeding; subsequently the VortX Coil® is inserted through a microcatheter to stop the bleeding and the correct position of the VortX coil is evaluated. Furthermore, we made a literature research on Pubmed and Medline to look for similar procedures.

RESULTS

In case of a renal bleeding that could not be treated by endovascular way, a combined urological and interventional radiology procedure can be undertaken. We did not find similar endourological and interventional radiology procedure on Pubmed and Medline, so this is the first tecnique of endourological closure of a bleeding point using a coil.

CONCLUSION

From our experience this could be a mininvasive technique to solve renal bleedings coming from a calyx that are not found by endovascular approach. Indeed, in our knowledge, the technique here described is the first that provides the use of an endovascular coil by endourological way in renal vascular malformations.

A Novel Embolization Technique for Renal Hemorrhage Complication by Autologous Fat Tissue

The percutaneous nephrolithotomy method is the most used treatment option for urinary stone disease. Bleeding is the most feared complication of this method. Transcatheter coil or medical glue embolization is currently the used treatment option for this bleeding complication. The aim of this report to show the novel subcutaneous fat tissue embolization technique for percutaneous nephrolithotomy related bleeding complications. In these two cases, we treated the percutaneous nephrolithotomy related bleeding complication with subcutaneous fat tissue. Subcutaneous fat tissue was taken with subcutaneous fascia from the femoral site by 1 cm incision. This tissue to be used for embolization was passed on the 0.014 guidewire from the back end of this guidewire (like shish kebab). The fat tissue passed on the 0.014 wire was sent to the bleeding site through the guiding catheter and guideliner, over the 0.014 guidewire with the monorail balloon (as a pusher) placed behind this fat tissue. The subcutaneous fat tissue with subcutaneous fascia embolization was completely stopped the bleeding and fistula. We have successfully used a novel embolization technique for fat tissue embolization to the bleeding site (Ari technique). Subcutaneous fat tissue embolization with the novel embolization technique for percutaneous nephrolithotomy related bleeding is a safe and reliable treatment option.

Embolization with Onyx® of an arterial pseudoaneurysm with an arteriovenous fistula complicating a percutaneous nephrolithotomy: A case report and review of literature

Percutaneous nephrolithotomy (PCNL) has proven very effective in the management of renal stones. However, complications are not so rare, and bleeding is one of the most worrisome; it has a reported incidence of 1%–3% and may happen during track dilatation. In addition, arterial pseudoaneurysms and/or arteriovenous fistulas (AVF) may occur. We report the case of a patient with an intrarenal pseudoaneurysm associated with an AVF, after PCNL. Superselective endovascular embolization with Onyx^® was successfully performed, achieving exclusion of the pseudoaneurysm and AVF with preservation of the remaining vascularization of the kidney. We review the literature regarding endovascular management of kidney vascular lesions after PCNL. Selective renal embolization is a minimally invasive procedure, highly effective with a low incidence of complications. Currently, it is considered the most appropriate technique in the treatment of arterial iatrogenic complications following percutaneous renal procedures. Onyx^® is an effective, easy to handle, and safe alternative embolic agent for these procedures.

Endovascular embolization in the management of traumatic and postoperative abdominopelvic bleeding: a single-center experience

Background/aim: Endovascular embolization is widely used instead of surgery in the treatment of traumatic and postoperative abdominopelvic bleeding. The objective of this study is to evaluate the efficiency of computed tomography in the determination of active bleeding and the efficiency of endovascular embolization in traumatic and postoperative abdominopelvic bleeding. Materials and methods: Thirty-one patients admitted to our hospital with traumatic and postoperative abdominopelvic bleeding between January 2006 and September 2012 and treated with endovascular embolization were retrospectively enrolled in the study. In 15 hemodynamically stable patients, abdominal computed tomography was performed to detect the presence and/or localization of the hemorrhage. All 31 patients underwent digital subtraction angiography (DSA) and endovascular embolization. Results: Active hemorrhage was detected in all patients evaluated by computed tomography. Thirty-two embolization procedures were performed in 31 patients. Embolization was successful in all procedures. Two patients needed retreatment because of recurrent bleeding. One patient died 2 days after embolization as a result of concomitant multiorgan injury. Conclusion: Computed tomography is able to detect active bleeding, allowing it to take the place of diagnostic DSA. If careful patient selection is carried out, endovascular embolization may be the final treatment, despite high-grade visceral organ injury.

Clinical efficacy and safety of transcatheter embolization for vascular complications after percutaneous nephrolithotomy

Introduction

Percutaneous nephrolithotomy (PNL) is the preferred procedure for safe and effective surgical treatment of kidney stones. Hemorrhage is the most serious complication of PNL, resulting from pseudoaneurysm (PA) or arteriovenous fistula (AVF), and can usually be controlled with conservative treatment.

Aim

To evaluate endovascular treatments and outcomes of vascular complications observed after PNL.

Material and methods

We retrospectively reviewed data on 19 patients who underwent renal embolization due to post-PNL renal artery bleeding between March 2005 and September 2016. Embolization materials included embolization coils and glue. The incidence of post-PNL vascular complications and their endovascular treatments, outcomes, and the follow-up data were analyzed.

Results

Nineteen (1.1%) of 1,609 patients (mean age: 44.9 years, range: 19-75 years) underwent angiography and subsequent transcatheter embolization to control bleeding. The mean time to onset of hemorrhage was 7.2 days after PNL (range: 3-18 days). The PNL entry site was the lower calyx in 15 patients, the middle calyx in 3, and the upper calyx in 1. PA, AVF, and PA plus AVF occurred in 14, 5, and 3 of the 19 renal angiography patients, respectively. Embolization of the affected vessels was successful in all 19 patients. The embolization materials of coil, glue, and coil plus glue were used in 16, 3, and 2 patients, respectively.

Conclusions

Severe hematuria is a rare complication of PNL and can be successfully treated with transcatheter embolization.

Transcatheter embolization of peripheral renal artery for hemorrhagic urological emergencies using FuAiLe medical glue

Our objective was to review the technical success and clinical outcomes of transcatheter embolization of peripheral renal artery with FuAiLe medical glue (FAL). All patients who underwent FAL embolization for peripheral renal artery bleeding were retrospectively analyzed for underlying pathologies, technical success and outcome of embolization procedure. 14 consecutive patients underwent FAL embolization between November 2009 and February 2013. The causes of bleeding were post biopsy (n = 5), blunt trauma (n = 5), percutaneous lithotripsy of kidney stones (n = 3), and complication of cardiac catheterization (n = 1). Bleeding was effectively controlled with a single injection of FAL. Mean volume of FAL mixture (FAL:Lipiodol, 1:1) was 0.5 mL (range, 0.2–0.8 mL). No reflux of the embolic agent was noted. Average cost of FAL for each procedure was $74. Postembolization clinical follow-up showed no evidence of recurrent hematuria, progression of hematoma, hypertension, or elevation of serum creatinine. Doppler ultrasound examinations in 13 patients demonstrated no abscess, renal parenchyma infarction, or renal artery abnormalities. Superselective FAL embolization may be used for the treatment of active bleeding from peripheral renal arteries. It has a high success rate and is quicker and less expensive than embolization with other agents.

Intrarenal pseudoaneurysm after percutaneous nephrolithotomy: angiotomographic assessment and endovascular management

We report a case of intrarenal pseudoaneurysm of the right kidney after percutaneous nephrolithotomy (PCNL) in supine position. Diagnosis was established by angiotomography with a 3-D reconstruction. Treatment was successfully achieved by endovascular occlusion using N-butyl-2-cyanoacrylate.

The Effect of Cyanoacrylic Glue on Rat Testis, Urethra and Spongiosal Tissue: An Experimental Study

PURPOSE

We examined the effect of Glubran2 on the rat urethra and spongiosal tissue as well as the histopathological effect. We also investigated its clinical use.

MATERIALS AND METHODS

Eight control and 12 study group male Wistar rats were used in our study. The corpus spongiosum tissues, including the urethra and the tunica albuginea of the testis, were cut 0.5 and 0.2 cm long, respectively. Incision areas in the control group were sutured. In the study group Glubran2 was dripped on the area. Three weeks later all rats were sacrificed. The penile and testicular tissues were histopathologically investigated. One-way ANOVA and the t test were applied for statistical analysis.

RESULTS

When the study group was compared with the control group, the difference in urethral healing (p = 0.001), urethral lumen irregularity (p = 0.036), spongiosal tissue healing (p = 0.001), inflammation (p = 0.000), hyperemia-bleeding (p = 0.036) and total healing (p = 0.001) were statistically significant. When the study and control groups were compared, the difference in inflammation (p = 0.000), necrotic areas (p = 0.002), tunica albuginea irregularity (p = 0.005), Sertoli's and Leydig cell destruction (p = 0.005), and testicular spermatogenesis (p = 0.005) were statistically significant.

CONCLUSIONS

While perfect healing in the urethral and spongiosal tissues supports the clinical application, damage to the seminiferous tubules, decreased spermatogenesis at the operated site, tunica albuginea irregularity in a fourth of the testes and calcification in 1 testis were observed.

Emergency endovascular embolization of traumatic intrarenal arterial pseudoaneurysms with N-butyl cyanoacrylate

AIM

The aim of this study is to report the effectiveness of selective endovascular embolization with N-butyl cyanoacrylate (NBCA) in the treatment of traumatic intrarenal arterial pseudoaneurysms.

MATERIALS AND METHODS

Five patients (four males and one female) presented with massive haematuria. Five pseudoaneurysms were detected angiographically, and in all of the cases the aetiology was penetrating trauma. The pseudoaneurysms ranged in size between 7 and 30 mm (mean: 13.8 mm). After the superselective catheterization with a microcatheter-microguidewire system, embolization was performed using NBCA and Lipiodol mixture.

RESULTS

All the pseudoaneurysms were successfully embolized and excluded from the circulation without any other major intrarenal arterial branch occlusion. There were no major or minor complications related to the embolization procedures. Haematuria ceased in 1-3 days after the embolization, and during the follow-up period both re-bleeding and deterioration of renal function did not occur.

CONCLUSION

The endovascular management of renal artery branch pseudoaneurysms by embolization with NBCA is a reasonable and an effective therapeutic technique.

Embolization of a renal artery aneurysm using ethylene vinyl alcohol copolymer (Onyx)

PURPOSE

To report the embolization of a renal artery aneurysm using Onyx, a radiopaque nonadhesive liquid embolic agent.

CASE REPORT

A 28-year-old woman with hypertension and fibromuscular dysplasia presented with a 20-mm renal artery aneurysm. In order to avoid any migration of embolic material into the parent vessel, a compliant balloon was inflated to exclude the aneurysm from the blood flow while injecting the liquid embolic agent. Complete aneurysm exclusion was achieved immediately, with no angiographic or duplex evidence of distal embolization or intra-aneurysmal flow. The Doppler ultrasound at 6 months confirmed aneurysm exclusion.

CONCLUSIONS

The ease of use and nature of this material makes Onyx an effective and safe option in the treatment of wide-necked renal aneurysms.