Vascular injuries after percutaneous renal procedures: treatment by transcatheter embolization

Percutaneous renal procedures have become the standard technique for diagnosis and treatment of a number of renal pathologies. Hemorrhage and vascular lesions are the most serious complications. We report our experience with 15 patients treated by hyperselective vascular embolization. Fifteen patients (10 men and 5 women; mean age 55 years) had severe perioperative hemorrhage after percutaneous renal procedures, due to arterial renal major injury. All patients underwent duplex US, CT, and renal arteriography demonstrating the presence of arteriovenous fistulas (n=2), renal hematoma (n=3), pseudoaneurysms (n=3), and hematoma with pseudoaneurysm (n=7). Four patients showed transient renal dysfunction, with an increase in serum creatinine levels. One patient had a solitary transplanted kidney. Hyperselective arterial embolization was performed successfully by means of coils (n=14), associated with gelfoam in 4 cases; homologous blood clot was used in 1 patient. No major complications occurred, and renal function rapidly normalized in the 4 patients with transient renal failure. Imaging follow-up confirmed the successful devascularization of the lesion. Renal arterial hemorrhage following percutaneous procedures is a rare but severe complication. Hyperselective renal artery embolization, with particles and/or coils, represents the first-choice treatment option, being safe and effective in stopping the bleeding.