Renal Pseudoaneurysms and Arteriovenous Fistulas as a Complication of Nephron-Sparing Partial Nephrectomy: Technical and Functional Outcomes of Patients Treated With Selective Microcoil Embolization During a Ten-Year Period

Abstract

Purpose: The aim of this study was to evaluate the clinical and functional outcomes in patients who underwent selective interventional embolization of renal pseudoaneurysms or arteriovenous fistulas at our center.

Materials and Methods: Our retrospective analysis included all consecutive patients who received selective transcatheter embolization of renal pseudoaneurysms or arteriovenous fistulas after partial nephrectomy in our department from January, 2003 to September, 2013. The technical and clinical success rate and functional outcome of every procedure was collected and analyzed. Furthermore, the change in renal parenchymal volume before and after embolization was determined in a subgroup.

Results: A total of 1425 patients underwent partial nephrectomy at our hospital. Of these, 39 (2.7 %) were identified with a pseudoaneurysm or an arteriovenous fistula after partial nephrectomy. The diagnosis of the vascular lesions was made by means of biphasic CT or CEUS. Technical success by means of selective microcoil embolization was achieved in all 39 patients (100 %). Clinical success, defined as no need for further operation or nephrectomy during follow-up, was achieved in 35 of 39 patients (85.7 %). Renal function, as measured by eGFR before and after the intervention, did not change significantly. However, a mean loss of parenchymal volume of 25.2 % was observed in a subgroup. No major or minor complications were attributable to the embolization procedure.

Conclusion: Transcatheter embolization is a promising method for treating vascular complications which may occur after partial nephrectomy. We confirm the high success rate of this technique while discussing renal functional outcomes and potential safety aspects.

Key points:

• Arterial pseudoaneurysms and arteriovenous fistulas are rare but severe complications after partial nephrectomy

• Selective microcoil embolization is a safe and effective kidney-preserving procedure for treating these complications

• Embolization leads to a significant loss of renal parenchymal volume but not to a loss of renal function

Citation Format:

• Strobl FF, D'Anastasi M, Hinzpeter R et al. Renal Pseudoaneurysms and Arteriovenous Fistulas as a Complication of Nephron-Sparing Partial Nephrectomy: Technical and Functional Outcomes of Patients Treated With Selective Microcoil Embolization During a Ten-Year Period. Fortschr Röntgenstr 2016; 188: 188 – 194

Zusammenfassung

Ziel: Das Ziel dieser Studie war das klinische und funktionelle Ergebnis der Patienten zu untersuchen, die mit einer interventionellen, selektiven Embolisation von renalen Pseudoaneurysmen oder AV-Fisteln an unserer Klinik behandelt wurden.

Material und Methoden: Diese retrospektive Studie schloss alle konsekutiven Patienten ein, die zwischen 2003 und 2013 an unserer Klinik eine selektive Katheter-gestützte Embolisation eines renalen Pseudoaneurysmas oder einer AV-Fistel nach partieller Nephrektomie erhielten. Es wurde die technische und klinische Erfolgsrate sowie das funktionelle Ergebnis von allen Interventionen analysiert. Zusätzlich wurde in einer Subgruppe der Einfluss der Intervention auf das Parenchymvolumen der behandelten Niere untersucht.

Ergebnisse: Insgesamt wurde zwischen 2003 und 2013 in unserer Klinik bei 1425 Patienten eine partielle Nephrektomie durchgeführt. Von diesen wurden 39 Patienten (2,7 %) zur interventionellen Behandlung eines renalen Pseudoaneurysmas oder einer AV-Fistel überwiesen. Bei allen Patienten wurde diese Diagnose durch eine biphasische CT Untersuchung oder eine kontrastverstärkte Ultraschalluntersuchung (CEUS) bestätigt. Insgesamt konnte ein primärer technischer Erfolg bei 39 Patienten (100 %) durch eine selektive Embolisation mit Microcoils erreicht werden. Ein klinischer Erfolg, definiert durch eine fehlende Notwendigkeit zur weiteren Operation oder Nephrektomie wurde in 35 von 39 Patienten erreicht (85,7 %). Die prä- und postinterventionelle GFR zeigte keine signifikante Änderung (p > 0,05). Jedoch wurde ein Verlust des renalen Parenchymvolumens von 25,2 % in einer Subgruppe festgestellt. Bezogen auf die interventionelle Prozedur zeigten sich keine major oder minor Komplikationen.

Schlussfolgerung: Eine kathetergesteuerte Embolisation ist eine erfolgsversprechende organerhaltende Methode zur Behandlung vaskulärer Komplikationen, die nach partieller Nephrektomie auftreten können. Wir bestätigen die hohe Erfolgsrate dieser Technik und analysieren funktionelle renale Endpunkte sowie Sicherheitsaspekte.

Kernaussagen:

• Arterielle Pseudoaneurysmen oder arteriovenöse Fisteln sind seltene, jedoch schwerwiegende Komplikationen nach partieller Nephrektomie

• Die selektive Mikrocoil Embolisation ist ein sicheres nierenerhaltendes Verfahren zur Behandlung dieser Komplikationen

• Die Embolisation führt zu einem signifikanten Verlust des Nierenparenchymvolumens aber zu keinem renalen Funktionsverlust

Key words

embolization - renal arteries - angiography - interventional procedures

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