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Totally bloodless percutaneous renal surgery
Michael C Ost1, Zeph Okeke, Brian A VanderBrink
1Department of Urology, The University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
Journal of Endourology
|October 22, 2008
Summary
Intraoperative renal artery balloon occlusion is a feasible and safe technique to reduce blood loss during complex percutaneous renal surgery (PRS). While it improves visibility, patients remain at risk for delayed hemorrhage.
Area of Science:
- Urology
- Interventional Radiology
- Nephrology
Background:
- Complex percutaneous renal surgery (PRS) carries a high risk of blood loss.
- Novel techniques are needed to improve surgical outcomes and patient safety.
Purpose of the Study:
- To evaluate the feasibility and safety of intraoperative transarterial balloon occlusion of the renal artery.
- To assess its efficacy in reducing blood loss during complex PRS.
Main Methods:
- Four high-risk patients underwent transfemoral arteriography and renal artery balloon occlusion prior to PRS.
- The renal artery was intermittently reperfused.
- Percutaneous renal access was obtained under fluoroscopic guidance.
Main Results:
- Intraoperative visualization improved due to decreased bleeding, with blood loss under 500 cc.
- Immediate post-PRS angiography showed no active bleeding.
- Two patients experienced delayed renal hemorrhage requiring embolization.
Conclusions:
- Intraoperative renal artery balloon occlusion is feasible and safe for complex PRS.
- It effectively reduces intraoperative blood loss and improves endoscopic visibility.
- Patients require monitoring for potential delayed hemorrhage due to delayed vascular abnormalities.
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