Renal vascular injuries following nephron-sparing surgery and their endovascular management

Introduction: This study aims to describe renal vascular injuries following nephron-sparing surgery and the efficacy of transcatheter embolisation in management of these complications. Methods: A retrospective review was performed on 96 patients who underwent nephron-sparing surgery from 2001 to 2005. Selective angiography was performed on all patients referred for significant postoperative haematuria and internal bleeding, followed by embolisation where indicated. Patient presentation, type of vascular injury, embolisation technique and treatment outcome were reviewed in each case. Efficacy of embolisation in preservation of renal function was assessed. Results: Seven arterial lesions were identified in four patients (three male and one female; age range 47-70 years). Three patients developed pseudoaneurysms (mean size 2.1 cm, range 1.5-3 cm). One patient revealed four separate areas of active contrast extravasations. All patients were successfully treated with coil embolisation with complete symptomatic relief within one to three days. Renal function was preserved in all patients over a follow-up period of 90 days. Conclusion: Renal arterial injuries, especially pseudoaneurysms, are an important though uncommon cause of haematuria following nephron-sparing surgery. Coil embolisation is an effective treatment for management of these iatrogenic injuries.