Percutaneous embolization for the management of grade 5 renal trauma in hemodynamically unstable patients: initial experience

• Published in: The Journal of urology Vol. 181; no. 4; p. 1737
• Main Authors: Brewer, Jr, M Eric, Strnad, Bradley T, Daley, Brian J, Currier, Ryan P, Klein, Frederick A, Mobley, Joe D, Kim, Edward D
• Format: Journal Article
• Language: English
• Published: United States 01-04-2009
• Subjects: Adolescent; Adult; Child, Preschool; Embolization, Therapeutic - methods; Female; Hemodynamics; Humans; Injury Severity Score; Kidney - injuries; Male; Middle Aged; Retrospective Studies; Wounds, Nonpenetrating - therapy; Young Adult
• ISSN: 1527-3792
• DOI: 10.1016/j.juro.2008.11.100

We evaluated the efficacy and safety of percutaneous embolization for the treatment of grade 5 renal injuries secondary to blunt trauma in patients who are hemodynamically unstable.
This study was a retrospective analysis of grade 5 blunt renal trauma managed with percutaneous embolization between October 2004 and December 2007. Technical success was defined as complete occlusion of all renovascular bleeding at the end of the procedure. Clinical success was defined as the stabilization of vital signs and absence of need for further surgical or radiological intervention.
Nine patients (6 male and 3 female) with grade 5 renal injury secondary to blunt trauma were treated with percutaneous embolization. These patients did not require surgery for other intra-abdominal injuries. Mean patient age was 30 years (median 34, range 5 to 56, SD 15). Mean hospital length of stay was 18 days (median 13, range 5 to 46, SD 14). Mean units of packed red blood cells transfused for each patient was 6 (median 5, range 0 to 17, SD 5) with 2 receiving none. Technical success was achieved in all patients (100%) and all showed complete resolution of active extravasation on angiography. Clinical success was achieved in all patients (100%) with none requiring further intervention.
Percutaneous embolization for the management of grade 5 renal injuries is safe and effective with an excellent success rate in our series. The overall complication rate is minimal. Larger studies with long-term followup are needed to assure durability and efficacy.