Interventional Radiology Management of Renal Pseudoaneurysms: Experience at a Tertiary Care Hospital
Objectives Renal pseudoaneurysms are multifactorial in origin, and angioembolization remains the mainstay of treatment. Few case reports have also described percutaneous embolization using glue or thrombin. Our study aimed to evaluate the predictors of active bleed by analyzing their etiology, morph...
Saved in:
| Main Authors: | , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Thieme Medical and Scientific Publishers Pvt. Ltd.
2020-08-01
|
| Series: | Journal of Clinical Interventional Radiology ISVIR |
| Subjects: | |
| Online Access: | http://www.thieme-connect.de/DOI/DOI?10.1055/s-0040-1715026 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1850240925063708672 |
|---|---|
| author | Ujjwal Gorsi Raghuraman Soundararajan Tejeshwar Singh Jugpal Anupam Lal Sreedhara B Shetty Naveen Kalra Mandeep Kang Manavjit Singh Sandhu |
| author_facet | Ujjwal Gorsi Raghuraman Soundararajan Tejeshwar Singh Jugpal Anupam Lal Sreedhara B Shetty Naveen Kalra Mandeep Kang Manavjit Singh Sandhu |
| author_sort | Ujjwal Gorsi |
| collection | DOAJ |
| description | Objectives Renal pseudoaneurysms are multifactorial in origin, and angioembolization remains the mainstay of treatment. Few case reports have also described percutaneous embolization using glue or thrombin. Our study aimed to evaluate the predictors of active bleed by analyzing their etiology, morphology, imaging features, and treatment adopted. To the best of our knowledge, this is the largest such study done in India.
Methods This was a retrospective study of patients treated for renal pseudoaneurysms between 2014 and 2019. We reviewed their clinical data, treatment modalities used, and clinical outcomes. We also assessed computed tomography angiography (CTA) and conventional angiography images.
Results A total of 79 patients (54 males and 25 females) were included in the study. The mean age was 39.5 years (range 15–83 years). The most common cause was renal biopsy, followed by surgery. Of these, three patients (3.9%) had more than one lesion and 57% of pseudoaneurysms were seen in lower polar arteries. Active contrast extravasation was seen in 15.2% (n = 12) of the patients and 21.5% (n = 17) showed lobulations in CT and digital substraction angiography. The mean size of the pseudoaneurysms was 1.17 cm (SD 0.7); 22.8% of pseudoaneurysms were wide necked. The embolization was approached by endovascular (89.9%), percutaneous (10.1%), or both (1.3%) routes. Embolization was performed using microcoils (78.5%), gel foam (12.7%), N-butyl cyanoacrylate glue (8.9%), polyvinyl alcohol (8.9%), and thrombin (5.1%) either as a single agent or in combination. The technical success was achieved in all cases after the first procedure. Pseudoaneurysms with a wide neck (p = 0.03) and lobulations (p = 0.002) were associated with active contrast extravasation. Episodes of rebleeding were seen at a younger age (p-value = 0.02).
Conclusion Minimally invasive methods remain the cornerstone in the management of renal pseudoaneurysms with high success rates. The morphology of pseudoaneurysms can help predict the risk of active bleeding and decide the type of intervention. Direct percutaneous injection into the aneurysm sac is an alternate technique and should be considered when an endovascular approach is challenging. |
| format | Article |
| id | doaj-art-9f3261fe190d4585abc291b33f69900b |
| institution | OA Journals |
| issn | 2456-4869 |
| language | English |
| publishDate | 2020-08-01 |
| publisher | Thieme Medical and Scientific Publishers Pvt. Ltd. |
| record_format | Article |
| series | Journal of Clinical Interventional Radiology ISVIR |
| spelling | doaj-art-9f3261fe190d4585abc291b33f69900b2025-08-20T02:00:43ZengThieme Medical and Scientific Publishers Pvt. Ltd.Journal of Clinical Interventional Radiology ISVIR2456-48692020-08-0140208308710.1055/s-0040-1715026Interventional Radiology Management of Renal Pseudoaneurysms: Experience at a Tertiary Care HospitalUjjwal Gorsi0Raghuraman Soundararajan1Tejeshwar Singh Jugpal2Anupam Lal3Sreedhara B Shetty4Naveen Kalra5Mandeep Kang6Manavjit Singh Sandhu7Department of Radiodiagnosis, Post Graduate Institute of Medical Education and Research, Chandigarh, IndiaDepartment of Radiodiagnosis, Post Graduate Institute of Medical Education and Research, Chandigarh, IndiaDepartment of Radiodiagnosis, Post Graduate Institute of Medical Education and Research, Chandigarh, IndiaDepartment of Radiodiagnosis, Post Graduate Institute of Medical Education and Research, Chandigarh, IndiaDepartment of Radiodiagnosis, Post Graduate Institute of Medical Education and Research, Chandigarh, IndiaDepartment of Radiodiagnosis, Post Graduate Institute of Medical Education and Research, Chandigarh, IndiaDepartment of Radiodiagnosis, Post Graduate Institute of Medical Education and Research, Chandigarh, IndiaDepartment of Radiodiagnosis, Post Graduate Institute of Medical Education and Research, Chandigarh, IndiaObjectives Renal pseudoaneurysms are multifactorial in origin, and angioembolization remains the mainstay of treatment. Few case reports have also described percutaneous embolization using glue or thrombin. Our study aimed to evaluate the predictors of active bleed by analyzing their etiology, morphology, imaging features, and treatment adopted. To the best of our knowledge, this is the largest such study done in India. Methods This was a retrospective study of patients treated for renal pseudoaneurysms between 2014 and 2019. We reviewed their clinical data, treatment modalities used, and clinical outcomes. We also assessed computed tomography angiography (CTA) and conventional angiography images. Results A total of 79 patients (54 males and 25 females) were included in the study. The mean age was 39.5 years (range 15–83 years). The most common cause was renal biopsy, followed by surgery. Of these, three patients (3.9%) had more than one lesion and 57% of pseudoaneurysms were seen in lower polar arteries. Active contrast extravasation was seen in 15.2% (n = 12) of the patients and 21.5% (n = 17) showed lobulations in CT and digital substraction angiography. The mean size of the pseudoaneurysms was 1.17 cm (SD 0.7); 22.8% of pseudoaneurysms were wide necked. The embolization was approached by endovascular (89.9%), percutaneous (10.1%), or both (1.3%) routes. Embolization was performed using microcoils (78.5%), gel foam (12.7%), N-butyl cyanoacrylate glue (8.9%), polyvinyl alcohol (8.9%), and thrombin (5.1%) either as a single agent or in combination. The technical success was achieved in all cases after the first procedure. Pseudoaneurysms with a wide neck (p = 0.03) and lobulations (p = 0.002) were associated with active contrast extravasation. Episodes of rebleeding were seen at a younger age (p-value = 0.02). Conclusion Minimally invasive methods remain the cornerstone in the management of renal pseudoaneurysms with high success rates. The morphology of pseudoaneurysms can help predict the risk of active bleeding and decide the type of intervention. Direct percutaneous injection into the aneurysm sac is an alternate technique and should be considered when an endovascular approach is challenging.http://www.thieme-connect.de/DOI/DOI?10.1055/s-0040-1715026renal pseudoaneurysmangioembolizationcoilsthrombincyanoacrylate glue |
| spellingShingle | Ujjwal Gorsi Raghuraman Soundararajan Tejeshwar Singh Jugpal Anupam Lal Sreedhara B Shetty Naveen Kalra Mandeep Kang Manavjit Singh Sandhu Interventional Radiology Management of Renal Pseudoaneurysms: Experience at a Tertiary Care Hospital Journal of Clinical Interventional Radiology ISVIR renal pseudoaneurysm angioembolization coils thrombin cyanoacrylate glue |
| title | Interventional Radiology Management of Renal Pseudoaneurysms: Experience at a Tertiary Care Hospital |
| title_full | Interventional Radiology Management of Renal Pseudoaneurysms: Experience at a Tertiary Care Hospital |
| title_fullStr | Interventional Radiology Management of Renal Pseudoaneurysms: Experience at a Tertiary Care Hospital |
| title_full_unstemmed | Interventional Radiology Management of Renal Pseudoaneurysms: Experience at a Tertiary Care Hospital |
| title_short | Interventional Radiology Management of Renal Pseudoaneurysms: Experience at a Tertiary Care Hospital |
| title_sort | interventional radiology management of renal pseudoaneurysms experience at a tertiary care hospital |
| topic | renal pseudoaneurysm angioembolization coils thrombin cyanoacrylate glue |
| url | http://www.thieme-connect.de/DOI/DOI?10.1055/s-0040-1715026 |
| work_keys_str_mv | AT ujjwalgorsi interventionalradiologymanagementofrenalpseudoaneurysmsexperienceatatertiarycarehospital AT raghuramansoundararajan interventionalradiologymanagementofrenalpseudoaneurysmsexperienceatatertiarycarehospital AT tejeshwarsinghjugpal interventionalradiologymanagementofrenalpseudoaneurysmsexperienceatatertiarycarehospital AT anupamlal interventionalradiologymanagementofrenalpseudoaneurysmsexperienceatatertiarycarehospital AT sreedharabshetty interventionalradiologymanagementofrenalpseudoaneurysmsexperienceatatertiarycarehospital AT naveenkalra interventionalradiologymanagementofrenalpseudoaneurysmsexperienceatatertiarycarehospital AT mandeepkang interventionalradiologymanagementofrenalpseudoaneurysmsexperienceatatertiarycarehospital AT manavjitsinghsandhu interventionalradiologymanagementofrenalpseudoaneurysmsexperienceatatertiarycarehospital |