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Hoegger MJ, Middleton WD. Ultrasound-Guided Thrombin Injection for the Treatment of Bleeding Following Kidney and Liver Biopsies. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2022; 41:247-253. [PMID: 33780029 DOI: 10.1002/jum.15699] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 03/03/2021] [Accepted: 03/07/2021] [Indexed: 06/12/2023]
Abstract
The purpose of this study was to describe the technique and outcomes of percutaneous thrombin injection into the superficial aspect of actively bleeding liver and kidney biopsy tracks identified with color Doppler ultrasound with the aim of hemorrhage termination. After percutaneous thrombin injection, 15/16 (94%) patients did not require further intervention. Ultrasound-guided thrombin injection into the superficial site of active bleeding is an effective technique for terminating bleeding in the immediate post-procedure period following kidney and liver biopsies and should be considered if active bleeding persists on color Doppler after ≥30 minutes of compression and observation.
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Affiliation(s)
- Mark J Hoegger
- Mallinckrodt Institute of Radiology, Washington University, St Louis, Missouri, USA
| | - William D Middleton
- Mallinckrodt Institute of Radiology, Washington University, St Louis, Missouri, USA
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Lim CC, Tan HZ, Tan CS, Healy H, Choo J, Franca Gois PH. Desmopressin acetate to prevent bleeding in percutaneous kidney biopsy: a systematic review. Intern Med J 2021; 51:571-579. [PMID: 32040251 DOI: 10.1111/imj.14774] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Revised: 01/05/2020] [Accepted: 02/05/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Kidney biopsy is the gold standard for diagnosing kidney disease but may result in bleeding, especially in uraemia. DDAVP (1-deamino-8-d-arginine vasopressin) may reduce uraemic bleeding but guidelines on its use are lacking. AIM To evaluate whether DDAVP reduced bleeding complications after percutaneous kidney biopsies. METHODS We searched CENTRAL, PubMed, Embase, LILACS, WHO Trials Registry and ClinicalTrials.gov until May 2019 for randomised controlled trials (RCT), quasi-RCT and prospective cohort studies that compared DDAVP with placebo or no intervention, prior to native or allograft kidney biopsy. The primary outcome was post-biopsy bleeding. Secondary outcome was adverse events related to DDAVP. RESULTS Abstracts of 270 identified papers were examined and 24 selected for evaluation. Two studies, one RCT and one prospective cohort that collectively evaluated 738 native kidney biopsies, met the inclusion criteria. One enrolled individuals with serum creatinine ≤1.5 mg/dL (132 μmol/L) and/or estimated glomerular filtration rate ≥60 mL/min/1.73 m2 while the other evaluated biopsies with serum creatinine >150 μmol/L. DDAVP was administered as a single subcutaneous dose of 0.3 μg/kg in both studies. Data were not pooled for meta-analysis due to clinical heterogeneity. GRADE quality of evidence from these two studies was low for DDAVP preventing any bleeding complication after native kidney biopsy. Low quality evidence suggested that adverse effects were not increased in DDAVP therapy. No prospective studies evaluated DDAVP in transplant kidney biopsies. CONCLUSION Currently available prospective data are insufficient to support the routine use of DDAVP prior to percutaneous kidney biopsies hence high quality trials are required.
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Affiliation(s)
- Cynthia C Lim
- Department of Renal Medicine, Singapore General Hospital, Singapore
| | - Hui Zhuan Tan
- Department of Renal Medicine, Singapore General Hospital, Singapore
| | - Chieh Suai Tan
- Department of Renal Medicine, Singapore General Hospital, Singapore
| | - Helen Healy
- Kidney Health Service, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.,Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Jason Choo
- Department of Renal Medicine, Singapore General Hospital, Singapore
| | - Pedro Henrique Franca Gois
- Kidney Health Service, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.,Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
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Escudero-Fernandez JM, Bolufer Cardona M, Perez Lafuente M, Montealegre C, Uriarte I, Serres-Créixams X. Active bleeding after kidney biopsy: Successful ultrasound-guided direct thrombin embolization into the cortical fistula. JOURNAL OF CLINICAL ULTRASOUND : JCU 2021; 49:390-394. [PMID: 33098132 DOI: 10.1002/jcu.22939] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 09/30/2020] [Accepted: 10/09/2020] [Indexed: 06/11/2023]
Abstract
A 27-year-old man, previously diagnosed with IgA nephropathy, was referred for native kidney biopsy. After the procedure, the patient presented active bleeding revealed by Doppler and contrast-enhanced ultrasonography at the biopsy site. Successful embolization of the cortical fistula, the focus of bleeding, was achieved using ultrasound-guided thrombin injection and confirmed by Doppler ultrasonography, contrast-enhanced ultrasonography, and CT angiography. This case report shows that contrast-enhanced ultrasonography is useful for detecting active bleeding after a solid organ biopsy. Moreover, ultrasound-guided thrombin embolization is a safe and minimally invasive treatment and an alternative to angiography-guided embolization.
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Affiliation(s)
| | | | | | | | - Iciar Uriarte
- Grup de Recerca en Imatge Mèdica Molecular, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Hospital Universitari, Barcelona, Spain
| | - Xavier Serres-Créixams
- Servei de Radiologia, Vall d'Hebron Hospital Universitari, Barcelona, Spain
- Grup de Recerca en Imatge Mèdica Molecular, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Hospital Universitari, Barcelona, Spain
- Universitat Autònoma de Barcelona, Bellaterra, Spain
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Lim CC, Tan RY, Choo JCJ, Tan HZ, Mok I, Chin YM, Tan CS. Estimation of risk for major bleeding in native kidney biopsies in patients with multiple risk factors. Int Urol Nephrol 2021; 54:343-348. [PMID: 33913059 DOI: 10.1007/s11255-021-02874-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Accepted: 04/20/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND AIMS Individuals undergoing kidney biopsy are increasingly older and may have concurrent illnesses that cause deranged hematological and renal parameters that are associated with post-biopsy bleeding. We aimed to develop a clinical risk model to quantify bleeding risks in high-risk individuals with multiple risk factors. METHODS Single-center retrospective cohort study of consecutive adults with serum creatinine ≥ 2 mg/dL (176 µmol/L) and had ultrasound-guided percutaneous native kidney biopsies between June 2011 and July 2015 in our tertiary referral center. The primary outcome was major bleeding, defined as need for red cell transfusion, radiological or surgical intervention, or if bleeding led to death within 7 days after kidney biopsy. RESULTS Among 184 native kidney biopsies with serum creatinine ≥ 2 mg/dL, median age was 54.1 years and eGFR was 18.8 ml/min/1.73 m2. Major bleeding occurred in 19 biopsies (10.3%). Multivariate analysis accounting for age, weight, hemoglobin, platelet, prothrombin time and urea found that higher hemoglobin (adjusted OR 0.51, 95% CI 0.33-0.79, p = 0.003) and platelet (adjusted OR 0.99, 95% CI 0.98-0.99, p = 0.01) were independently associated with reduced major bleeding. A risk model that included (1) age ≥ 62 years old, (2) hemoglobin < 10 g/dL and (3) platelets ≤ 216 × 109/L as categorical variables predicted major bleeding post-biopsy. CONCLUSION We developed a risk model that included multiple risk factors to quantify bleeding risks in native kidney biopsies with renal impairment.
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Affiliation(s)
- Cynthia C Lim
- Department of Renal Medicine, Singapore General Hospital, Academia Level 3, 20 College Road, Singapore, 169856, Singapore.
| | - Ru Yu Tan
- Department of Renal Medicine, Singapore General Hospital, Academia Level 3, 20 College Road, Singapore, 169856, Singapore
| | - Jason C J Choo
- Department of Renal Medicine, Singapore General Hospital, Academia Level 3, 20 College Road, Singapore, 169856, Singapore
| | - Hui Zhuan Tan
- Department of Renal Medicine, Singapore General Hospital, Academia Level 3, 20 College Road, Singapore, 169856, Singapore
| | - Irene Mok
- Department of Renal Medicine, Singapore General Hospital, Academia Level 3, 20 College Road, Singapore, 169856, Singapore
| | - Yok Mooi Chin
- Department of Renal Medicine, Singapore General Hospital, Academia Level 3, 20 College Road, Singapore, 169856, Singapore
| | - Chieh Suai Tan
- Department of Renal Medicine, Singapore General Hospital, Academia Level 3, 20 College Road, Singapore, 169856, Singapore
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Prud'homme C, Deschamps F, Allorant A, Massard C, Hollebecque A, Yevich S, Ngo-Camus M, Gravel G, Nicotra C, Michiels S, Scoazec JY, Lacroix L, Solary E, Soria JC, De Baere T, Tselikas L. Image-guided tumour biopsies in a prospective molecular triage study (MOSCATO-01): What are the real risks? Eur J Cancer 2018; 103:108-119. [PMID: 30223224 DOI: 10.1016/j.ejca.2018.08.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Revised: 07/29/2018] [Accepted: 08/02/2018] [Indexed: 12/17/2022]
Abstract
PURPOSE To evaluate efficacy, complications and preprocedural risk factors for percutaneous image-guided core needle biopsy of malignant tumours for genomic tumour analysis. MATERIALS AND METHODS Procedural data for core biopsies performed at a single centre for the MOSCATO-01 clinical trial were prospectively recorded between December 2011 and March 2016. Data assessed included patient demographics, tumour characteristics, procedural outcomes and complications. RESULTS A total of 877 biopsies were performed under computed tomography (38.4%) or ultrasound guidance (61.6%) for tumours in the liver (n = 363), lungs (n = 229), lymph nodes (n = 138), bones (n = 15) and other miscellaneous sites (n = 124). Each biopsy harvested a mean 4.4 samples [1-15], with adequate tumour yield for genomic analysis in 95.3% of cases. Procedural complications occurred in 89 cases (10.1%), with minor grade I complications in 59 (66.3%); grade II in 16 (18%) and grade III in 14 (15.7%). No grade IV complications and no procedure-related death occurred. The most common complications were pneumothorax (51/89, 57.3%), haemorrhage (24/89, 27%) and pain (8/89, 8.9%). Predictive factors for complications by univariate analysis included biopsied organ (lung vs other), sample number, prone position, lesion size, lesion depth and biopsy approach. By multivariate analysis, only pulmonary biopsy was a significant risk factor (odds ratio = 27.23 [4.93-242.76], p < 0.01). CONCLUSION Percutaneous image-guided core needle biopsy in cancer patients provides an effective method to obtain molecular screening samples, with an overall low complication rate. Lung mass biopsies present a higher risk of complication, although complications are manageable by minimally invasive techniques without prolonged sequelae.
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Affiliation(s)
- Clara Prud'homme
- Department of Interventional Radiology, Gustave Roussy, Villejuif, France.
| | - Fréderic Deschamps
- Department of Interventional Radiology, Gustave Roussy, Villejuif, France.
| | - Adrien Allorant
- Biostatistics and Epidemiology Unit, Gustave Roussy, Université Paris-Saclay University, CESP, INSERM, Villejuif, F-94805, France.
| | | | | | - Steve Yevich
- Department of Interventional Radiology, Gustave Roussy, Villejuif, France.
| | - Maud Ngo-Camus
- Drug Development Department (DITEP), Gustave Roussy, Villejuif, France.
| | - Guillaume Gravel
- Department of Interventional Radiology, Gustave Roussy, Villejuif, France.
| | - Claudio Nicotra
- Drug Development Department (DITEP), Gustave Roussy, Villejuif, France.
| | - Stefan Michiels
- Biostatistics and Epidemiology Unit, Gustave Roussy, Université Paris-Saclay University, CESP, INSERM, Villejuif, F-94805, France.
| | - Jean-Yves Scoazec
- Department of Pathology and Laboratory Medicine, Gustave Roussy, Villejuif, France; Faculté de Médecine, Kremlin-Bicêtre, Université Paris Sud, France; Laboratory of Translational Research and Biological Resource Center - AMMICA, INSERM US23/CNRS UMS3655, France.
| | - Ludovic Lacroix
- Department of Pathology and Laboratory Medicine, Gustave Roussy, Villejuif, France; Laboratory of Translational Research and Biological Resource Center - AMMICA, INSERM US23/CNRS UMS3655, France.
| | - Eric Solary
- Drug Development Department (DITEP), Gustave Roussy, Villejuif, France; Faculté de Médecine, Kremlin-Bicêtre, Université Paris Sud, France.
| | - Jean-Charles Soria
- Drug Development Department (DITEP), Gustave Roussy, Villejuif, France; Faculté de Médecine, Kremlin-Bicêtre, Université Paris Sud, France.
| | - Thierry De Baere
- Department of Interventional Radiology, Gustave Roussy, Villejuif, France; Faculté de Médecine, Kremlin-Bicêtre, Université Paris Sud, France.
| | - Lambros Tselikas
- Department of Interventional Radiology, Gustave Roussy, Villejuif, France; Faculté de Médecine, Kremlin-Bicêtre, Université Paris Sud, France; Laboratory of Translational Research in Immunology - LRTI, INSERM U1015, Gustave Roussy, France.
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