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The etiology and treatment of delayed bleeding following percutaneous lithotripsy
Insights
Percutaneous stone manipulation can cause vascular injuries in 0.9% of cases. Transcatheter embolization effectively treats these injuries, offering a minimally invasive alternative to surgery.
Area of Science:
- Urology
- Vascular Surgery
- Interventional Radiology
Background:
- Percutaneous stone manipulation is a common urological procedure.
- Vascular complications, though rare, can occur during these interventions.
Observation:
- A study of 1,032 percutaneous stone manipulations identified a 0.9% incidence of significant vascular injuries.
- These injuries included pseudoaneurysms, arteriovenous fistulas, and vascular lacerations, diagnosed via angiography.
Findings:
- Seven patients with vascular injuries were successfully treated using transcatheter embolization.
- Two additional patients experienced delayed bleeding, resolving with conservative management, highlighting the need for arteriography in such cases.
Implications:
- Transcatheter embolization is an effective treatment for vascular injuries post-percutaneous stone manipulation.
- Angiography is crucial for diagnosing postoperative bleeding, and peripheral vessel embolization is preferred over flank exploration.
Abstract:
In 1,032 percutaneous stone manipulations the incidence of significant, documented or presumed vascular injuries was 0.9 per cent. Seven cases of pseudoaneurysm, arteriovenous fistula or vascular lacerations were found, all of which were diagnosed angiographically. The patients were treated successfully with transcatheter embolization techniques. Two additional patients experienced delayed bleeding, presumably from vascular injuries, which resolved spontaneously with conservative therapy. Arteriography should be performed in these patients with serious postoperative bleeding. Embolization of the peripheral vessel is preferable to flank exploration.