Percutaneous Super-Selective Embolization Of Iatrogenic Lesions Of Renal Vasculature Following Percutaneous Nephrolithotomy

During the last decades, percutaneous nephrolithotomy (PCNL) has become one of the methods of choice for the treatment of renal stones. One specfic complication of PCNL is hemorrhage, which varies from self-limiting (in most cases) to life-threatening which necessitates urgent measures. Percutaneous angiographic approach including renal angiography and selective embolization of renal vessels is the method of choice in cases of massive hemorrhage or persisting hematuria following PCNL.Our objective was to evaluate the effectiveness of percutaneous transarterial embolization for the treatment of renal arterial post-PCNL bleeding.This retrospective study was performed between March 2014 and April 2017 and included 568 patients treated with PCNL in our institution. In 12 of those patients (2.1%) percutaneous angiographic approach with renal selective angioembolization was needed, due to significant post-PCNL renal artery bleeding. The site, number, and type of bleeding lesions, and the result of the embolization procedure were recorded. We report on the incidence, treatment, radiological and clinical results of these serious vascular injuries at our institution.From 568 patients included in the study, 12 (2.1%) had massive hemorrhage, necessitating angiographic embolization. Of those 12 patients 7 were male and 5 female. In our group of patients angiographic success has been observed in 91.6% of the cases (11 of 12 patients).Percutaneous transarterial embolization of the injured vessel is an effective, minimally invasive and relatively easy procedure in experienced centres, with high rate of success and immediate benefits, thus saving the patient from the morbidity that results from severe renal bleeding.