From the Guidelines
Kidney embolization is a recommended treatment for patients with traumatic renal injuries, arteriovenous fistula, pseudoaneurysm, and non-self-limiting gross hematuria, as it has been shown to be effective in controlling hemorrhage and preserving renal function 1.
Indications for Kidney Embolization
The indications for kidney embolization include:
- Arterial contrast extravasation on CT-scan in hemodynamically stable or transient responder patients
- Gross non-self-limiting hematuria
- Arteriovenous fistula
- Pseudoaneurysm (PSA)
- Extended perirenal hematoma
- Progressive decrease in hemoglobin concentration during non-operative management (NOM)
Guidelines for Kidney Embolization
The guidelines for kidney embolization recommend that the procedure be performed as selectively as possible to limit the associated parenchymal infarction 1. The choice of embolic agents depends on the type of vascular injury, but coils with or without gelfoam are commonly used.
Contraindications for Kidney Embolization
The contraindications for kidney embolization include renal venous pedicle avulsion, which requires immediate surgery 1. Other relative contraindications include uncorrectable coagulopathy, severe renal insufficiency, pregnancy, and contrast allergies.
Outcomes of Kidney Embolization
The outcomes of kidney embolization have been shown to be favorable, with a success rate ranging from 63% to 100% in blunt renal trauma 1. The procedure has also been shown to have lower complication rates compared to surgery, and can preserve renal function in the long term 1.
From the Research
Indications for Kidney Embolization
- Prenephrectomy and preradiofrequency ablation infarction of renal tumors 2
- Management of renal angiomyolipomas 2, 3, 4
- Palliation of unresectable renal malignancy 2, 5
- Renal hemorrhage (life-threatening or chronic debilitating hematuria) 2, 5
- Arteriovenous fistulas 2
- Vascular malformations 2, 4
- Renal artery aneurysms and pseudoaneurysms 2, 4
- Severe hydronephrosis and hypertension 2
- Renal trauma 6
- Complications following biopsy 6
Guidelines for Kidney Embolization
- A multidisciplinary approach between urology and interventional radiology should be pursued for all patients undergoing renal embolization regardless of indication 6
- Preprocedural planning and careful monitoring of complications should be performed to optimize clinical outcomes 6
- Selection of the appropriate embolic agent depends on the clinical application, technical and clinical endpoints, as well as the pathology lesion(s) targeted 2
- Renal artery embolization can be performed alone or in combination with remodeling techniques, stent-grafting, and balloon- or stent-assisted coiling in more complicated cases 2