Endovascular Interventional Radiology of the Urogenital Tract

Effect of transarterial embolization of iatrogenic renal artery pseudoaneurysms without or with arteriovenous fistula on renal function at 6-month follow-up

INTRODUCTION

Transarterial embolization (TAE) is the gold standard treatment for iatrogenic renal artery pseudoaneurysms (PSA) and pseudoaneurysms with arteriovenous fistula (PSA + AVF), but its impact on renal function has not been sufficiently investigated. The aim of the study is to assess the impact on of TAE on renal function and its technical and clinical effectiveness.

MATERIALS AND METHODS

Sixty-seven embolization procedures in 61 consecutive patients from December 2006 to October 2020 in two centers were retrospectively reviewed for the following parameters: technical and clinical success and failure, embolization materials, type and dimensions of vascular injuries, percentage of post-procedural ischemic renal parenchyma and estimated glomerular filtration rate (eGFR) values before and 1 day after the surgical, percutaneous or endoscopic (SPE) procedure and before, 1 day after and 6 months after TAE.

RESULTS

We identified 44 PSA and 23 PSA + AVF. Technical success was 95.5%, primary clinical success was 90.2% and secondary clinical success was 96.7%. Different embolization materials were used. A significant decrease of the eGFR was found after the SPE procedure. No significant difference was found between eGFR before and after TAE. A minimal significant improvement of the eGFR was found 6 months after TAE. Embolization of larger lesions resulted in larger post-procedural ischemic areas. PSA + AVF were significantly larger (p = 0.0142) and determined a larger post-procedural ischemic area. No correlation was found between dimensions, kind of vascular injury or post-procedural ischemic area and eGFR.

CONCLUSION

TAE has high technical and clinical success rates and does not affect renal function negatively, regardless of dimensions or kind of vascular injuries or post-procedural ischemic area.

Advancements in Understanding and Managing Radiation Cystitis: A Comprehensive Review

PURPOSE OF REVIEW

This manuscript aims to provide a comprehensive overview of the pathophysiology, risk factors, prevention strategies, and management options for radiation cystitis.

RECENT FINDINGS

Recent studies have shed light on the pathophysiology of radiation cystitis, highlighting the role of inflammation, fibrosis, and vascular damage. Emerging preventive measures like stem cell therapy offer promise, alongside novel treatments such as amniotic bladder therapy and hyperbaric oxygen therapy. This review outlines the latest research on radiation cystitis, covering its pathophysiology, risk factors, prevention, and management. Major findings include insights into the mechanisms of RC development, promising preventive and therapeutic approaches, and the importance of standardized treatment pathways. Future research should focus on identifying genetic risk factors, improving treatment efficacy, and enhancing patient outcomes. This review offers valuable insights for clinicians and researchers, guiding future investigations into radiation cystitis management.

Technical aspect in renal artery embolization in renal tumors: A case series

Introduction

Renal artery embolization aims to reduce blood loss during surgery. Various embolizing agents are available, each of which has its own indications appropriate for various vascular anatomy and renal pathology.

Presentation of case

We report three cases of renal artery embolization prior to surgical nephrectomy using vascular plug and other embolizing agents. In two cases, complete blood flow occlusion was achieved with minimal blood loss during the subsequent surgery. One case only achieved reduced blood flow, but subsequent nephrectomy and patient recovery was successful.

Discussion

Renal artery embolization prior to malignant mass resection is a well-known, potentially beneficial procedure. The rationale that supports this procedure is clear, but its reported outcome in the literature is still inconclusive. It is important to understand its benefits, complications, and pitfalls to achieve better outcome.

Conclusion

In our cases, renal artery embolization provided satisfactory reduction in bleeding during nephrectomy, and therefore has the potential to be employed as a standard procedure for future surgeries.

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Arterial embolization in renal pathology currently has no clinical guidelines

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The use of vascular plug in renal vascular pathology is feasible

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Careful consideration is needed regarding the choice of renal arterial embolization

Post-Traumatic Intraparenchymal Renal Hemorrhages: Correlation between CT and DSA Vascular Findings for Superselective Embolization Procedures

BACKGROUND

This study aims to investigate the correlation between computed tomography (CT) and digital subtraction angiography (DSA) findings in patients affected by acute post-traumatic intraparenchymal renal hemorrhages and evaluate their conservative management with superselective embolization.

METHODS

This retrospective multicenter analysis focuses on patients affected by renal bleedings detected by contrast-enhanced CT and treated with superselective endovascular embolization. CT findings were compared to DSA. Embolization procedural data were analyzed and renal function was evaluated before and after the intervention.

RESULTS

Twenty-seven patients were retrospectively evaluated in one year. Compared to DSA, CT showed 96.3% diagnostic accuracy in terms of hemorrhage recognition; concerning the type of vascular lesion, there was discrepancy between CT and DSA in five cases. The technical success rate of embolization was 100%, while primary clinical success was 88.9%. The inferior parenchymal third was the most frequent site of renal injury. Microcoils were the most adopted embolics. Renal function did not change significantly before and after embolization.

CONCLUSIONS

CT has elevated diagnostic accuracy in detecting post-traumatic intraparenchymal renal hemorrhages; in a small percentage, the type of vascular lesion may differ from the findings observed at DSA. In this scenario, superselective embolization presents high clinical success with a low complication rate.