Efficacy And Safety Evaluation Of Selective Renal Artery Embolization For Renal Hemorrhage

Objective:To investigate the clinical application value of selective renal artery embolization in acute renal hemorrhage,summarize the treatment methods and special cases,and evaluate the efficacy of embolization,postoperative complications and surgical safety.Methods:The clinical data of 106 patients with acute renal hemorrhage treated with selective renal artery embolization from December 2014 to August 2017 in the Second Affiliated Hospital of Kunming Medical University were retrospectively analyzed.To summarize the causes,locations,types,and clinical symptoms of these patients,analyze the indications and contraindications for superselective renal artery embolization,and discuss the methods of embolization,embolization and hemostasis,postoperative renal function changes,blood pressure conditions,and correlations.Complications were evaluated.RESULTS:Of 106 patients with acute renal hemorrhage;80 males and 26 females.The patients aged 10 to 80 years old,with an average age of(48.92±13.67)years,87 cases of iatrogenic injury,9 cases of trauma,6 cases of tumor rupture,and 4 cases of vascular malformation.There were 54 cases of left kidney injury and 52 cases of right kidney injury.After renal artery angiography,4 patients with paraneovascular arterial blood supply were found and 93 cases of hemorrhage were found.Among them,2 cases were paraneoary arterial hemorrhage;11 cases of suprarenal pole,29 cases of renal epithelium,and middle and upper kidney.In 7 cases of the pole,23 cases of the middle and lower poles of the kidney,22 cases of the infrarenal pole,and 1 case of the suprarenal,middle and inferior poles;the contrast hemorrhage showed 63 cases of pseudoaneurysm,6 cases of arteriovenous fistula,and pseudoaneurysm.There were 15 cases of arteriovenous fistula,7 cases of direct contrast agent spillage,2 cases of contrast agent spillage and pseudoaneurysm.No 13 cases of obvious bleeding were found.Ninety-three patients underwent superselective renal artery embolization using 31 cases of conventional coils,40 cases of microcoil,5 cases of gelatin sponge particles/bar,8 cases of ordinary coils/gelfoam particles/strips,micro coils + Gelatin sponge particles/strips were used in 9 cases,and 13 cases showed no signs of hemorrhage.Hemostatic perfusion was performed with thrombin.Eighty-three cases of 93 embolization patients received successful embolization and hemostasis was successful.81 cases of hemorrhoid fistulas and catheters stopped bleeding from 1 to 7 days after embolization,and gross hematuria disappeared.In 2 cases,hemorrhagic shock and multiple organ failure occurred despite hemorrhage.24h and 7h death;10 cases of rebleeding 2～6d again embolization,8 cases of 1～3d bleeding stopped,2 cases received a third embolization after 3d bleeding stopped;13 cases of infusion of thrombin drugs to treat patients with hemostasis The bleeding stopped at 3 to 11 days after treatment with clinically relevant treatment.After follow-up,93 cases of embolism were followed up in 21 cases with different degrees of postembolization syndrome,10 cases of mild fever,body temperature at 37～38,10 cases of lumbar discomfort,soreness,mild pain symptoms,1 case of nausea Vomiting performance,the above symptoms relieved or disappeared 2 to 5 days after symptomatic treatment.Observed that the postoperative hemoglobin increased steadily,there was no abnormal change in renal function indicators such as creatinine and urea,and there was no significant increase or decrease in blood pressure.Preoperative and postoperative imaging data(CT,KUB+IVP,B ultrasound)contrast,no significant changes in renal pelvis and renal pelvis morphology,no renal parenchymaConclusions:Selective renal artery embolization is mainly used in iatrogenic injury.Different combinations of embolization materials are selected according to the signs of contrast bleeding to achieve good hemostasis.The incidence of postoperative complications of superselective renal artery embolization is low,and renal function can be protected to the greatest extent.For all types of patients with acute renal hemorrhage,it is a minimally invasive,safe,reliable and effective treatment.