Risk Evaluation of Selective Renal Arterial Embolization in the Treatment of Delayed Hemorrhage from Renal Artery Pseudoaneurysm After Partial Nephrectomy

摘要

Renal-artery pseudoaneurysm (RAP) is a well-described complication of partial nephrectomy. We aimed to evaluate the occurrence rate of delayed hemorrhage from RAP after partial nephrectomy, and to investigate the efficacy and safety of selective renal arterial embolization. Between January 2000 and December 2010, 426 partial nephrectomies were performed at our institution for treatment of small renal mass (SRMs). A retrospective review of these cases revealed that 14 patients developed a postoperative RAP (3.29 % incidence). We compared the clinical characteristics between the 14 patients with delayed renal hemorrhage and other 412 patients. RAP was diagnosed by renal angiography in 12 patients with delayed renal hemorrhage. Of the 12 patients, 10 patients were successfully treated with selective renal arterial embolization after presenting with symptoms postoperatively, 1 patient was treated with open surgery, and 1 patient was treated with nephrectomy. The other two patients showed no abnormalities in renal angiography, and the symptoms relieved by transfusion and hemostasis treatment. We found that tumor type, tumor size, tumor location, and surgical approach were significantly different between the 14 patients and other 412 patients. RAP showed a low incidence. The risk factors of RAP included renal cell carcinoma, tumor with large size, and tumor location. Most patients with delayed renal hemorrhage from RAP were successfully cured by selective renal arterial embolization. Therefore, selective renal arterial embolization can be used as the preferential therapy for RAP.