The role of angioembolization in the management of hemorrhagic urovascular emergencies: Retrospective Cohort Study

Introduction: Transarterial embolization is an effective method in the management of hemorrhagic vascular emergencies irrespective of its etiology. The aim of this study is to evaluate the role of angioembolization in the management of urovascular bleed and to evaluate the morphological and functional impact in the embolized organ in the medium-term follow-up. Materials and Methods: The hospital records of 11 patients with 12 renal units and two patients with hematuria of bladder origin who underwent angioembolization from the period of October 2012 to October 2015 were retrospectively reviewed. Data on clinical indication, technique, site, and type of bleeding were recorded. The outcome measures such as success rate, preprocedural requirement of blood transfusion, and periprocedural complications were analyzed. Results: Indications for angioembolization included blunt renal trauma (2), metastatic renal cell carcinoma (1), postpercutaneous nephrolithotomy (3), postpercutaneous nephrostomy (1), angiomyolipoma (2), renal biopsy (2), postpartial nephrectomy (1), cervical cancer with intractable radiation cystitis (1), and postradical cystectomy with internal iliac artery pseudoaneurysm (1). Out of these, two patients had secondary bleed and required a second session of angioembolization. The meantime between the first presentation and embolization was 34.46 h (4–96 h). Mean preprocedural blood transfusion requirement was 4.9 units (3–8 units). None of these patients required postprocedural blood transfusion. There was no serious postprocedural complication. There was no incidence of hypertension or renal impairment in the medium-term follow-up. Conclusion: The procedure carries low morbidity and a high rate of preservation of organ function. Hence, it should always be considered in the management of postoperative bleeding before embarking on surgical exploration.