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      Superselective transcatheter renal artery embolization for the treatment of hemorrhage from non-iatrogenic blunt renal trauma: report of 16 clinical cases

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          Abstract

          Objective

          To explore the therapeutic efficacy and outcome of superselective transcatheter renal artery embolization for the treatment of hemorrhage from non-iatrogenic blunt renal trauma (BRT).

          Methods

          Sixteen patients who received superselective transcatheter renal artery embolization for non-iatrogenic BRT hemorrhage between January 2003 and December 2012 were reviewed retrospectively. Spring steel coils with gelatin sponge particles were used to embolize branches of the renal artery in 15 patients with injuries to the segmental or distal renal arteries; super-selective internal iliac artery branch embolization was used to occlude hemorrhage from the branch of the renal artery in two patients with pelvic fracture complicated with internal iliac artery branch laceration; and balloon catheter occlusion was used to embolize the branch of the renal artery in one patient with renal artery trunk laceration.

          Results

          Embolization was achieved successfully in a one-stop procedure in all cases. The patient who received balloon catheter occlusion for renal artery trunk laceration was transferred immediately to surgery for emergency nephrectomy. Another patient died of intracranial trauma 1 day after surgery, although macroscopic hematuria disappeared at the time. Macroscopic hematuria disappeared within 1 day after surgery in the other 14 patients. Follow-up visits at times ranging from 6 months to 9 years after the procedure showed normal renal function without evidence of complications in all surviving patients.

          Conclusion

          Superselective transcatheter renal artery embolization is an effective minimally invasive therapy for the treatment of BRT hemorrhage.

          Most cited references12

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          American Association for the Surgery of Trauma Organ Injury Scale I: spleen, liver, and kidney, validation based on the National Trauma Data Bank.

          This study attempts to validate the American Association for the Surgery of Trauma (AAST) Organ Injury Scale (OIS) for spleen, liver, and kidney injuries using the National Trauma Data Bank (NTDB). All NTDB entries with Abbreviated Injury Scale codes for spleen, liver, and kidney were classified by OIS grade. Injuries were stratified either as an isolated intraabdominal organ injury or in combination with other abdominal injuries. Isolated abdominal solid organ injuries were additionally stratified by presence of severe head injury and survival past 24 hours. The patients in each grading category were analyzed for mortality, operative rate, hospital length of stay, ICU length of stay, and charges incurred. There were 54,148 NTDB entries (2.7%) with Abbreviated Injury Scale-coded injuries to the spleen, liver, or kidney. In 35,897, this was an isolated abdominal solid organ injury. For patients in which the solid organ in question was not the sole abdominal injury, a statistically significant increase (p < or = 0.05) in mortality, organ-specific operative rate, and hospital charges was associated with increasing OIS grade; the exception was grade VI hepatic injuries. Hospital and ICU lengths of stay did not show substantial increase with increasing OIS grade. When isolated organ injuries were examined, there were statistically significant increases (p < or = 0.05) in all outcomes variables corresponding with increasing OIS grade. Severe head injury appears to influence mortality, but none of the other outcomes variables. Patients with other intraabdominal injuries had comparable quantitative outcomes results with the isolated abdominal organ injury groups for all OIS grades. This study validates and quantifies outcomes reflective of increasing injury severity associated with increasing OIS grades for specific solid organ injuries alone, and in combination with other abdominal injuries.
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            Evaluation and management of renal injuries: consensus statement of the renal trauma subcommittee.

            To determine the optimal evaluation and management of renal injuries by review of the world's English-language literature on the subject. A consensus conference convened by the World Health Organization and the Societé Internationale d'Urologie met to critically review reports of the diagnosis and treatment of renal trauma. The English-language literature about renal trauma was identified using Medline, and additional cited works not detected in the initial search obtained. Evidence-based recommendations for the diagnosis and management of renal trauma were made with reference to a five-point scale. There were many Level 3 and 4 citations, few Level 2, and one Level 1 which supported clinical practice patterns. Findings of nearly 200 reviewed citations are summarized. Published reports on renal trauma still rely heavily on expert opinion and single-institution retrospective case series. Prospective trials of the most significant issues, when possible, might improve the quality of evidence that dictates the behaviour of practitioners.
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              Minimally invasive endovascular techniques to treat acute renal hemorrhage.

              We evaluated the effectiveness of endovascular therapy for severe renal hemorrhage.
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                Author and article information

                Journal
                Ther Clin Risk Manag
                Ther Clin Risk Manag
                Therapeutics and Clinical Risk Management
                Therapeutics and Clinical Risk Management
                Dove Medical Press
                1176-6336
                1178-203X
                2014
                16 June 2014
                : 10
                : 455-458
                Affiliations
                [1 ]Department of Urology, First Affiliated Hospital, Medical College, Zhejiang University, Hangzhou, People’s Republic of China
                [2 ]Department of Urology, Second Affiliated Hospital of Wenzhou Medical College, Wenzhou, People’s Republic of China
                [3 ]Zhejiang University Medical College, Hangzhou, People’s Republic of China
                Author notes
                Correspondence: Liping Xie, Department of Urology, First Affiliated Hospital, Medical College, Zhejiang University, Hangzhou 310003, People’s Republic of China, Email xieliping_pd@ 123456163.com
                Article
                tcrm-10-455
                10.2147/TCRM.S59671
                4064954
                24966683
                ec22722f-28de-4797-8434-fc53fd70e53b
                © 2014 Rao et al. This work is published by Dove Medical Press Limited, and licensed under Creative Commons Attribution – Non Commercial (unported, v3.0) License

                The full terms of the License are available at http://creativecommons.org/licenses/by-nc/3.0/. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed.

                History
                Categories
                Original Research

                Medicine
                blunt renal trauma,superselective cannulation,renal artery embolization
                Medicine
                blunt renal trauma, superselective cannulation, renal artery embolization

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