Renal artery embolisation: indications and utilisation at Tygerberg Hospital

Abstract

Background: To evaluate the indications, efficacy and outcomes of endovascular renal artery embolisation (RAE) in the management of renal  haemorrhage, specifically in cases of non-iatrogenic origin.

Methods: This is a retrospective case note review of 92 patients who underwent RAE in the period from August 1999 to August 2014 at Tygerberg  Hospital.

Results: Renal artery embolisation was performed in a total of 92 patients. The indication was traumatic renal injury in 60 patients (65.2%), with mean  age 28.2 years. The mechanism of injury was stabbing (55.4%), blunt trauma (7.6%) and gunshot (2.2%). Digital subtraction angiography (DSA) showed  pseudo-aneurysm in 32.6%, arteriovenous fistula in 19.6% and segmental artery injury in 13%. Embolisation success: 85% after one, 88.9% after a second  attempt, with an overall success rate of 98.3% after two attempts. In 20 of the 92 patients (mean age 50.2 years) the indication was malignancy (21.7%).  Other cases included iatrogenic haematuria (4.3%) and angiomyolipoma (3.3%). Embolisation was repeated in 16.3%, with eventual success rate of 93.8%.  Post-embolisation syndrome was the most common complication, seen in 9.8% of all cases. Of the 9 patients who returned for follow-up with  renogram imaging, 4 had a differential function of > 20% of the embolised kidney.

Conclusion: Renal artery embolisation remains a very successful method of managing renal haemorrhage at this hospital, whether this results from  trauma, malignancy, iatrogenic or other causes.