MANAGEMENT OF ACQUIRED RENAL VASCULAR ABNORMALITIES BY TRANSCATHETER ARTERIAL OCCLUSION

Abstract

Transcatheter arterial embolization is now a well established technique with many clinical applications. There have been a number of reports on the use of this technique to control bleeding secondary to trauma, biopsy and nephrostomy. These techniques frequently represent the only form of treatment available, surgery being contraindicated or inappropriate owing to • either the patient's general condition or the nature of the underlying abnormality.

In many centers, pre operative embolization of hypervascular renal cell carcinoma has become a routine practice and in selected cases, may be used as a primary form of therapy in patients with unresectable tumors.

The timing of the embolization procedure must be carefully considered. The choice of an embolizing agents depends on a variety of factors.

The objective of this work was to evaluate the role of the transcatheter arterial occlusion in the management of patients with acquired renal vascular abnormalities taking in consideration preservation of renal parenchyma as mush as possible, to assess the different embolic materials used to follow the •• function and morphological outcome of the interventional angiographic procedures.

Fourty patients (31 male : 9 female) with uncontrollable hematuria were subjected to intra arterial digital subtraction angiography (IA-DSA) for the aorta and renal artery, followed by trial of super-selective catheterization and embolization of the aniographically documented vascular lesion. The embolic material used was platinum-microcoils in 26, alcohol in 8, microcoils with alcohol in 4 and Gelfoam in one patient.

The procedure was successfully performed in 39 patients (97.5%). Of the patients 23 had false arterial aneurysms, 11 had both arterio-venous fistula and aneurysms, 5 had arterio-venous fistula and one had vascular laceration.