Selective embolization in the treatment of severe blunt renal injury

About 10-15 percent of all blunt abdominal trauma is associated with blunt renal injury; 85 percent of these renal injuries are minor contusions and can successfully be treated conservatively. Injuries of the pedicle account for 5 percent and require surgical intervention. Serious lacerations and disruptions of renal parenchyma associated with bleeding, account for the remaining 10 percent. The treatment of these major injuries is more difficult and controversial. Surgical treatment is associated with few complications, but nephrectomies are indicated in 15 to 60 percent of cases. A conservative approach is associated with many early and late complications (up to 60 percent) and in 13 to 68 percent surgery is still necessary. Selective embolization of one or more bleeding segmental renal arteries is an attractive alternative. The advantages are evident. The chance that the bleeding can be successfully stopped is high (more than 90 percent). The treatment is relatively easy and can be repeated, as much as possible renal parenchyma can be saved and arteriovenous fistula can also be treated. Early complications are minor and rare and late complications e.g. hypertension, are also very rare. Two patients are presented who were successfully treated with selective embolization for severe renal bleeding after blunt trauma.