Failure of initial superselective renal arterial embolization in the treatment of renal hemorrhage after percutaneous nephrolithotomy: a respective analysis of risk factors
首发时间:2015-11-23
Abstract: Background: Superselective renal arterial embolization (SRAE) is a well-established method for the treatment of severe hemorrhage after percutaneous nephrolithotomy (PCNL). However, there remains a significant rate of failures requiring repeat SRAE or nephrectomy. The aim of the present study is to identify risk factors for initial treatment failure of SRAE in patients with renal hemorrhage after PCNL. Methods: We retrospectively analyzed the data of patients who had undergone SRAE for severe bleeding due to PCNL. Data on patients who experienced initial treatment failure requiring repeat embolization or open surgery were compared with those on patients those who did not using univariate and multivariate analyses. Patient age, sex, kidney side, hypertention, diabetes, tract size, tract dilation methods, number of bleeding sites, arteriovenous fistula and renal vascular aberration/tortuosity were studied as potential predictors. Results: A total of 98 patients required SRAE for bleeding control after PCNL. Renal arteriography revealed pseudoaneurysm in 65, arteriovenous fistula in 6, and a combination of both in 11. Eleven patients had free extravasation, with coexisting pseudoaneurysm in 8 of them. Vascular aberration/tortuosity were encountered in ten patients. Seventeen patients (17.3%) experienced initial treatment failure and underwent repeat SRAE. On multivariate analysis, significant predictors of initial treatment failure included percutaneous tract size, number of bleeding sites and vascular aberration/tortuosity. Conclusions: In conclusion, repeated SRAE is preferred for patients who have experienced initial treatment failure with recurrent hemorrhage following PCNL. Our findings suggested that large tract size, multiple bleeding sites, and renal vascular aberration/tortuosity were significantly associated with increased risk of initial treatment failure of SRAE. This can assist interventional radiologists in the planning and execution of SRAE in this setting.
keywords: surgery percutaneous nephrolithotomy renal artery embolization hemorrhage
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超选择性肾动脉栓塞术治疗PCNL术后出血失败的危险因素分析
摘要: 背景:超选择性肾动脉栓塞术(SRAE)是一种治疗经皮肾镜取石术(PCNL)后出血有效的治疗方法。该术式有可能会失败需要重复栓塞或再次手术。本研究的目的是确定PCNL术后患者出血行初次栓塞治疗失败的危险因素。 方法:回顾性分析由于PCNL术后严重出血而行SRAE的患者数据。将初次栓塞治疗成功的患者与初始治疗失败而需要重复栓塞或开放手术的患者进行比较。研究的危险因素包括患者年龄,性别,高血压,糖尿病,通道大小,通道扩张方法,出血点数量,动静脉瘘及肾血管畸变/曲折。 结果:共有98例PCNL术后出血需行SRAE。肾动脉造影显示假性动脉瘤65例,动静脉瘘6例,假性动脉瘤合并动静脉瘘11例。11例患者表现为造影剂外渗,其中合并假性动脉瘤8例。10例患者表现为血管畸变/曲折。共17例患者因初始治疗失败而行重复栓塞。在多变量回归分析中,初始治疗失败的危险因素包括经皮通道大小,出血点数目和血管畸变/曲折。 结论:重复栓塞是首次高选择性肾动脉栓塞治疗失败后的首选治疗。大的经皮通道,多个出血点,肾血管畸变/曲折为初次栓塞失败的危险因素。这可以为放射介入医生在SRAE时提供有价值的信息。
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No.4661789106278914****
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超选择性肾动脉栓塞术治疗PCNL术后出血失败的危险因素分析
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