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Published on: February 2, 2021
[Renal artery computed tomography angiography for the application of severe bleeding after PCNL]
Yilei Zhao1, Baihua Shen, Baishu Zhong
1Department of Radiology, First Affiliated Hospital, Medical College, Zhejiang University, Hangzhou 310003, China.
Insights
Computed tomography angiography (CTA) is effective for detecting severe bleeding after percutaneous nephrolithotomy (PCNL). Digital subtraction angiography (DSA) may be directly used for arterial hemorrhage cases.
Area of Science:
- Urology
- Radiology
- Vascular Surgery
Background:
- Percutaneous nephrolithotomy (PCNL) is a common procedure for kidney stone removal.
- Severe hemorrhage is a potential complication following PCNL.
- Accurate and timely diagnosis of bleeding sources is crucial for effective management.
Purpose of the Study:
- To assess the clinical utility of computed tomography angiography (CTA) in identifying the causes of severe bleeding after PCNL.
- To determine the role of CTA as a primary diagnostic tool for post-PCNL hemorrhage.
Main Methods:
- A cohort of 50 patients experiencing severe bleeding post-PCNL was retrospectively analyzed.
- All patients underwent renal artery CTA for hemorrhage evaluation.
- Severe bleeding was defined by significant blood loss (>400 ml) or hemoglobin drop (≥20 g/L).
Main Results:
- CTA identified pseudoaneurysms in 24 patients, arteriovenous fistulas in 6, and suspicious bleeding spots in 4.
- 16 patients showed no obvious bleeding source on CTA.
- Digital subtraction angiography (DSA) confirmed and enabled successful coil embolization for pseudoaneurysms and arteriovenous fistulas; conservative management was effective for one rebleeding case.
Conclusions:
- Renal artery CTA serves as a valuable first-line screening tool for severe bleeding after PCNL.
- In cases of arterial hemorrhage, direct DSA examination may be considered for immediate intervention.
Objective:
To evaluate the clinical values of computed tomography angiography (CTA) for severe hemorrhage after percutaneous nephrolithotomy (PCNL).
Methods:
A total of 50 patients with bleeding after PCNL were enrolled. All patients underwent renal artery CTA. There were 34 males and 16 females with an average age of 45.7 years. Left (n = 31) and right (n = 19) sides were affected. The criteria of severe bleeding included a one-off amount of bleeding over 400 ml after PCNL or/and hemoglobin decreased 20 g/L after PCNL.
Results:
Among them, CTA showed pseudoaneurysm (n = 24), arteriovenous fistula (n = 6), suspicious bleeding spot (n = 4) and no obvious bleeding spot (n = 16). And 24 pseudoaneurysm and 6 arterovenous fistula patients underwent digital subtraction angiography (DSA) immediately. The bleeding spots were successfully intervened and coil embolization treatment was performed. Three of 4 suspicious bleeding cases had rebleeding mini-pseudoaneurysms. The remaining one case of rebleeding was successfully controlled by conservative measures.
Conclusion:
Renal artery CTA is the first-line screening technique for severe bleeding after PCNL. But for arterial hemorrhage patients, DSA examination may be directly conducted.
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