Direct percutaneous embolization of renal pseudoaneurysm

Area of Science:

• Interventional Radiology
• Nephrology
• Vascular Surgery

Background:

• Renal pseudoaneurysms can cause severe hematuria, often requiring invasive treatments.
• Traditional management includes angiography-guided embolization or surgery, carrying risks of contrast media, radiation, and complications.

Purpose of the Study:

• To describe and evaluate a novel method of direct ultrasonography (US)-guided percutaneous embolization for renal pseudoaneurysms.
• To assess the efficacy and safety of this minimally invasive technique.

Main Methods:

• Fourteen patients with severe hematuria due to renal pseudoaneurysms underwent direct US-guided embolization using Gelfoam particles.
• The procedure involved US visualization, needle insertion into the pseudoaneurysm, and slow injection of Gelfoam until flow cessation.
• Follow-up included color Doppler US every 2 weeks for 3 months, then every 3 months for 1 year.

Main Results:

• Successful bleeding control in a single session for 13 out of 14 patients.
• One patient required secondary endovascular embolization for recurrent hematuria.
• No complications were observed, and no rebleeding occurred during the 3-12 month follow-up period.

Conclusions:

• Direct US-guided percutaneous embolization is a novel, effective, and feasible treatment for renal pseudoaneurysms.
• This technique avoids contrast media, radiation, and surgical complications, preserving kidney tissue.
• It is recommended as a first-line treatment for actively bleeding renal pseudoaneurysms, potentially reducing morbidity and mortality.