Imaging Evalution of Iatrogenic Renal Vascular Injuries In a Teritiary Care Hospital and Their Endovascular management.

Abstract

OBJECTIVE: To study the role of USG Doppler, CT renal angiography in evaluation of iatrogenic renal vascular injuries  and to assess the effectiveness & safety of endovascular interventional of IRVIs

MATERIALS and METHODS:  In our study a total of 23 patients with IRVIs were included and patients were initially evaluated with USG Doppler followed by CT ang iography and DSA was performed in 20 patients. Four of the patients shows spontaneous resolution as confirmed by preprocedure USG Doppler and embolization of IRVIs was perforned using microcoil in 19 patients. Technical success was confirmed at the end of the procedure by a renal angiogram. The patients were followed up for a period of 6 months to assess the clinical success.

RESULTS: The most common cause of IRVI in our study was PCNL seen in 16(70%) patients followed by Partial Nephrectomy and PCN. All patients presented to us within 10-14 days of the etiological event with hematuria or flank pain or drop in haemotocrit. USG was able to detect IRVIs in the form of RAPs in 17 (74%) and perirenal/intrarenal haematoma  in 2(7%) cases. CT angiography was able to detect IRVIs in all the patients, however additional aneurysms in two patients were not detected which were  later seen on DSA renal angiography. Embolization  was performed for 21 aneurysms in 19 patients using micro coils and showed 100 % technical and  clinical success.

CONCLUSION:. USG Doppler and CT angiography plays a very important role in diagnosis of iatrogenic renal vascular injuries. Endovascular embolization is an effective and safe method for management of iatrogenic renal vascular injuries in our setting.

IMPLICATIONS: Percutaneous Nephrolithotomy is the commonest cause of renal artery pseudo aneurysms in our setting. The incidence of asymptomatic RAP’s post renal intervention may be more and a sizeable number among them may undergo spontaneous resolution. CT angiographic flow dynamics ( delayed peak enhancement) may be helpful in identification of RAP’s with high probability of spontaneous resolution. Although angioembolization of RAP is an effective and safe method for the treatment of post intervention or post trauma RAPs, the procurement of hardware (micro catheters, coils) in a resource constrained environment like ours can be a limiting factor adding to the morbidity.