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Long‐term functional and morphological effects of transcatheter arterial embolization of traumatic renal vascular injury
Author(s) -
Mohsen Tarek,
ElAssmy Ahmed,
ElDiasty Tarek
Publication year - 2008
Publication title -
bju international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.773
H-Index - 148
eISSN - 1464-410X
pISSN - 1464-4096
DOI - 10.1111/j.1464-410x.2007.07185.x
Subject(s) - medicine , renal function , creatinine , kidney , embolization , urology , renal injury , dimercaptosuccinic acid , radiology , surgery
OBJECTIVE To assess the long‐term morphological and functional outcome of superselective transarterial embolization (TAE) for treating traumatic renal vascular injury. PATIENTS AND METHODS The surgical records of 124 patients with traumatic renal vascular injury managed by TAE between 1990 and 2004 were reviewed, of whom 81 completed a long‐ term follow‐up and were included in the final analysis. Patients were followed using serum creatinine levels, grey‐scale ultrasonography, intravenous urography (IVU) and radioisotopic renography using 99m Tc‐mercapto‐acetyl triglycine (MAG3) and 99m Tc‐dimercaptosuccinic acid (DMSA). RESULTS Embolization resulted in the cessation of haematuria in all patients but two (97.5%). At 3 months, serum creatinine levels increased in four of nine patients with a solitary kidney, but only one of them required haemodialysis. After a mean follow‐up of 4.6 years, IVU showed a normal calyceal configuration in 70% of renal units, pyelonephritic changes in 26% and no dye excretion in 4%. DMSA scans showed no evidence of photopenic areas in 17 renal units (21%). The mean ( sd ) percentage of DMSA uptake by the corresponding kidney improved from 24 (9)% at the 3‐month scans to 32 (10)% at the last follow‐up scan ( P < 0.001). Using MAG3, the mean ( sd ) glomerular filtration rate improved significantly from 26 (11) mL/min at the 3‐month scan to 32 (9) mL/min at the last follow‐up ( P < 0.05). CONCLUSIONS Superselective TAE is safe and effective for traumatic renal vascular injury. The short‐term deleterious effects were more pronounced in patients with a solitary kidney. The long‐term follow‐up showed functional and morphological improvements in the embolized renal units.