OBJECTIVE
To evaluate the renal function outcomes after selective trans-arterial embolization
(SAE) of iatrogenic vascular lesions (IVL), including pseudoaneurysm and arteriovenous
fistula, following partial nephrectomy (PN).
MATERIALS AND METHODS
A multi-institutional study was conducted including consecutive patients who underwent
PN between January 2009 and March 2019. Two surgical approaches were used: open and
robot-assisted PN. Patients with SAE were identified and matched (1:2) with patients
without IVL. The matching criteria were age, gender, Charlson score, creatinine clearance,
RENAL score, and tumor size. The primary outcome was the evolution of global renal
function at 6-months postoperatively.
RESULTS
A total of 493 consecutive PN (360 open PN and 133 robot-assisted PN) were included.
IVL occurred in 17 cases (3.4%) without statistical difference according to the surgical
approach (P = .78). Patients from embolization group were matched to 34 cases without postoperative
IVL. Groups were comparable concerning clinical, tumor and surgical characteristics.
The clinical success of SAE, defined as the absence of recourse to a second embolization
or a total nephrectomy, was obtained in 16 (94.1%) cases. No minor or major complications
were reported after SAE. The preoperative estimated glomerular filtration rate (eGFR)
was similar between control group (93 [85-102] ml/min) and embolization group (95
[83-102] ml/min) (P = .99). Median (IQR) eGFR between control group (87 [72-95] ml/min) and embolization
group (83 [76-93] ml/min) at a follow-up of 6 months showed no significant difference
(P = .73).
CONCLUSION
IVL are rare complications of PN. SAE is an effective and minimally invasive management
tool, with no deleterious effect on global renal function.
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Article info
Publication history
Published online: April 10, 2020
Accepted:
March 26,
2020
Received:
February 25,
2020
Identification
Copyright
© 2020 Elsevier Inc. All rights reserved.
