Interventional Radiology Management of Renal Pseudoaneurysms: Experience at a Tertiary Care HospitalFunding None.
Objectives Renal pseudoaneurysms are multifactorial in origin, and angioembolization remains the mainstay of treatment. Few case reports have also described percutaneous embolization using glue or thrombin. Our study aimed to evaluate the predictors of active bleed by analyzing their etiology, morphology, imaging features, and treatment adopted. To the best of our knowledge, this is the largest such study done in India.
Methods This was a retrospective study of patients treated for renal pseudoaneurysms between 2014 and 2019. We reviewed their clinical data, treatment modalities used, and clinical outcomes. We also assessed computed tomography angiography (CTA) and conventional angiography images.
Results A total of 79 patients (54 males and 25 females) were included in the study. The mean age was 39.5 years (range 15–83 years). The most common cause was renal biopsy, followed by surgery. Of these, three patients (3.9%) had more than one lesion and 57% of pseudoaneurysms were seen in lower polar arteries. Active contrast extravasation was seen in 15.2% (n = 12) of the patients and 21.5% (n = 17) showed lobulations in CT and digital substraction angiography. The mean size of the pseudoaneurysms was 1.17 cm (SD 0.7); 22.8% of pseudoaneurysms were wide necked. The embolization was approached by endovascular (89.9%), percutaneous (10.1%), or both (1.3%) routes. Embolization was performed using microcoils (78.5%), gel foam (12.7%), N-butyl cyanoacrylate glue (8.9%), polyvinyl alcohol (8.9%), and thrombin (5.1%) either as a single agent or in combination. The technical success was achieved in all cases after the first procedure. Pseudoaneurysms with a wide neck (p = 0.03) and lobulations (p = 0.002) were associated with active contrast extravasation. Episodes of rebleeding were seen at a younger age (p-value = 0.02).
Conclusion Minimally invasive methods remain the cornerstone in the management of renal pseudoaneurysms with high success rates. The morphology of pseudoaneurysms can help predict the risk of active bleeding and decide the type of intervention. Direct percutaneous injection into the aneurysm sac is an alternate technique and should be considered when an endovascular approach is challenging.
14 August 2020 (online)
Thieme Medical and Scientific Publishers Private Ltd.
A-12, Second Floor, Sector -2, NOIDA -201301, India
- 1 Ngo TC, Lee JJ, Gonzalgo ML. Renal pseudoaneurysm: an overview. Nat Rev Urol 2010; 7 (11) 619-625
- 2 Cura M, Elmerhi F, Bugnogne A, Palacios R, Suri R, Dalsaso T. Renal aneurysms and pseudoaneurysms. Clin Imaging 2011; 35 (01) 29-41
- 3 Whittier WL, Korbet SM. Timing of complications in percutaneous renal biopsy. J Am Soc Nephrol 2004; 15 (01) 142-147
- 4 Mohsen T, El-Assmy A, El-Diasty T. Long-term functional and morphological effects of transcatheter arterial embolization of traumatic renal vascular injury. BJU Int 2008; 101 (04) 473-477
- 5 Pappas P, Constantinides C, Leonardou P. et al. Biopsy-related hemorrhage of renal allografts treated by percutaneous superselective segmental renal artery embolization. Transplant Proc 2006; 38 (05) 1375-1378
- 6 Siu YP, Tong MK, Leung KT. et al. Renal artery pseudoaneurysm following renal transplantation and treatment by percutaneous thrombin injection. Hong Kong Med J 2006; 12 (01) 80-81
- 7 Gupta V, Galwa R, Khandelwal N, Bapuraj JR. Postpyelolithotomy renal artery pseudoaneurysm management with percutaneous thrombin injection: a case report. Cardiovasc Intervent Radiol 2008; 31 (02) 422-426
- 8 Lal A, Singhal M, Ramachandran R, Rathi M, Jha V, Khandelwal N. Percutaneous injection of acrylic glue into renal allograft pseudoaneurysm for control of intractable post-biopsy hematuria. Indian J Nephrol 2014; 24 (02) 124-126
- 9 Jain V, Ganpule A, Vyas J. et al. Management of non-neoplastic renal hemorrhage by transarterial embolization. Urology 2009; 74 (03) 522-526
- 10 Yang HK, Koh ES, Shin SJ, Chung S. Incidental renal artery pseudoaneurysm after percutaneous native renal biopsy. BMJ Case Rep 2013; 2013: bcr2012006537
- 11 Rivera M, Villacorta J, Jiménez-Alvaro S, Quereda C. Asymptomatic large extracapsular renal pseudoaneurysm following kidney transplant biopsy. Am J Kidney Dis 2011; 57 (01) 175-178
- 12 Loffroy R, Guiu B, Lambert A. et al. Management of post-biopsy renal allograft arteriovenous fistulas with selective arterial embolization: immediate and long-term outcomes. Clin Radiol 2008; 63 (06) 657-665
- 13 Krueger K, Zaehringer M, Strohe D, Stuetzer H, Boecker J, Lackner K. Postcatheterization pseudoaneurysm: results of US-guided percutaneous thrombin injection in 240 patients. Radiology 2005; 236 (03) 1104-1110
- 14 Abud DG, Mounayer C, Benndorf G, Piotin M, Spelle L, Moret J. Intratumoral injection of cyanoacrylate glue in head and neck paragangliomas. AJNR Am J Neuroradiol 2004; 25 (09) 1457-1462
- 15 Gorsi U, Chaluvashetty S, Kalra N. et al. Percutaneous glue embolization as a primary treatment for visceral pseudoaneurysms. Minim Invasive Ther Allied Technol 2020; 29 (03) 170-176