Korean Journal of Radiology

The Korean Society of Radiology (대한영상의학회)
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Safety and Efficacy of Transarterial Nephrectomy as an Alternative to Surgical Nephrectomy

  • Choe, Jooae (Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Shin, Ji Hoon (Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Yoon, Hyun-Ki (Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Ko, Gi-Young (Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Gwon, Dong Il (Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Ko, Heung Kyu (Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Kim, Jin Hyoung (Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Sung, Kyu-Bo (Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine)
  • Received : 2013.12.20
  • Accepted : 2014.04.12
  • Published : 2014.07.01
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Abstract

Objective: To evaluate the safety and efficacy of transarterial nephrectomy, i.e., complete renal artery embolization, as an alternative to surgical nephrectomy. Materials and Methods: This retrospective study included 11 patients who underwent transarterial nephrectomy due to a high risk of surgical nephrectomy or their refusal to undergo surgery during the period from April 2002 to February 2013. Medical records and radiographic images were reviewed retrospectively to collect information regarding underlying etiologies, clinical presentations and embolization outcomes. Results: The underlying etiologies for transarterial nephrectomy included recurrent hematuria (chronic transplant rejection [n = 3], arteriovenous malformation or fistula [n = 3], angiomyolipoma [n = 1], or end-stage renal disease [n = 1]), inoperable renal or ureteral injury (n = 2), and ectopic kidney with urinary incontinence (n = 1). The technical success rate was 100%, while clinical success was achieved in eight patients (72.7%). Subsequent surgical nephrectomy was required for three patients due to an incomplete nephrectomy effect (n = 2) or necrotic pyelonephritis (n = 1). Procedure-related complications were post-infarction syndrome in one patient and necrotic pyelonephritis in another patient. Of four patients with follow-up CT, four showed renal atrophy and two showed partial renal enhancement. No patient developed a procedure-related hypertension. Conclusion: Transarterial nephrectomy may be a safe and effective alternative to surgical nephrectomy in patients with high operative risks.

Keywords

References

  1. Ginat DT, Saad WE, Turba UC. Transcatheter renal artery embolization: clinical applications and techniques. Tech Vasc Interv Radiol 2009;12:224-239 https://doi.org/10.1053/j.tvir.2009.09.007
  2. Rassweiler J, Prager P, Haferkamp A, Alken P, Kauffmann GW, Richter G. Transarterial nephrectomy: the current status of experimental and clinical studies. J Endourol 2008;22:767-782 https://doi.org/10.1089/end.2007.9826
  3. Millard FC, Hemingway AP, Cumberland DC, Brown CB. Renal embolization for ablation of function in renal failure and hypertension. Postgrad Med J 1989;65:729-734 https://doi.org/10.1136/pgmj.65.768.729
  4. Delgado P, Diaz F, Gonzalez A, Sanchez E, Gutierrez P, Hernandez D, et al. Intolerance syndrome in failed renal allografts: incidence and efficacy of percutaneous embolization. Am J Kidney Dis 2005;46:339-344 https://doi.org/10.1053/j.ajkd.2005.04.024
  5. Hom D, Eiley D, Lumerman JH, Siegel DN, Goldfischer ER, Smith AD. Complete renal embolization as an alternative to nephrectomy. J Urol 1999;161:24-27 https://doi.org/10.1016/S0022-5347(01)62049-4
  6. Mitra K, Prabhudesai V, James RL, Jones RW, French ME, Cowling M, et al. Renal artery embolization: a first line treatment option for end-stage hydronephrosis. Cardiovasc Intervent Radiol 2004;27:204-207
  7. Keller FS, Coyle M, Rosch J, Dotter CT. Percutaneous renal ablation in patients with end-stage renal disease: alternative to surgical nephrectomy. Radiology 1986;159:447-451 https://doi.org/10.1148/radiology.159.2.3515422
  8. Gonzalez-Satue C, Riera L, Franco E, Escalante E, Dominguez J, Serrallach N. Percutaneous embolization of the failed renal allograft in patients with graft intolerance syndrome. BJU Int 2000;86:610-612
  9. Maeda A, Takeda K, Kondou H, Kimura H, Miura S, Nakashita S, et al. Percutaneous renal artery embolization in a patient with severe nephrotic syndrome which continued after the introduction of hemodialysis. Intern Med 2011;50:2899-2904 https://doi.org/10.2169/internalmedicine.50.5880
  10. Sauk S, Zuckerman DA. Renal artery embolization. Semin Intervent Radiol 2011;28:396-406 https://doi.org/10.1055/s-0031-1296082
  11. Maxwell NJ, Saleem Amer N, Rogers E, Kiely D, Sweeney P, Brady AP. Renal artery embolisation in the palliative treatment of renal carcinoma. Br J Radiol 2007;80:96-102 https://doi.org/10.1259/bjr/31311739
  12. Ubara Y, Tagami T, Higa Y, Suwabe T, Nomura K, Hoshino J, et al. Successful renal transcatheter arterial embolization in three patients with symptomatic hydronephrosis due to ureteral obstruction. Intern Med 2006;45:769-774 https://doi.org/10.2169/internalmedicine.45.1659
  13. Sam K, Gahide G, Soulez G, Giroux MF, Oliva VL, Perreault P, et al. Percutaneous embolization of iatrogenic arterial kidney injuries: safety, efficacy, and impact on blood pressure and renal function. J Vasc Interv Radiol 2011;22:1563-1568 https://doi.org/10.1016/j.jvir.2011.06.020
  14. Schwartz MJ, Smith EB, Trost DW, Vaughan ED Jr. Renal artery embolization: clinical indications and experience from over 100 cases. BJU Int 2007;99:881-886 https://doi.org/10.1111/j.1464-410X.2006.06653.x
  15. Sacks D, McClenny TE, Cardella JF, Lewis CA. Society of Interventional Radiology clinical practice guidelines. J Vasc Interv Radiol 2003;14(9 Pt 2):S199-S202 https://doi.org/10.1097/01.RVI.0000094584.83406.3e
  16. Atar E, Belenky A, Neuman-Levin M, Yussim A, Bar-Nathan N, Bachar GN. Nonfunctioning renal allograft embolization as an alternative to graft nephrectomy: report on seven years' experience. Cardiovasc Intervent Radiol 2003;26:37-39 https://doi.org/10.1007/s00270-002-1976-z
  17. De Groote B, Van Laer P, Maurus K, Van Biervliet JP, Meeus L. Embolization of ectopic kidney to control incontinence. Pediatrics 1990;85:217-219
  18. Buckley JC, McAninch JW. Revision of current American Association for the Surgery of Trauma Renal Injury grading system. J Trauma 2011;70:35-37 https://doi.org/10.1097/TA.0b013e318207ad5a
  19. Weckermann D, Schlotmann R, Tietze W, Hackel T. Gas formation after renal artery embolisation: genesis and clinical relevance. Urol Int 1992;49:211-214 https://doi.org/10.1159/000282428
  20. Probert CS, Osborn DE, Watkin EM. Malignant hypertension due to embolisation of a clear cell renal carcinoma. Br J Urol 1992;70:95-96
  21. Loffroy R, Rao P, Kwak BK, Ota S, De Lin M, Liapi E, et al. Transcatheter arterial embolization in patients with kidney diseases: an overview of the technical aspects and clinical indications. Korean J Radiol 2010;11:257-268 https://doi.org/10.3348/kjr.2010.11.3.257
  22. Polikarpov AA, Tarazov PG, Suvorova IuV, Shumskii˘ IA, Karelin MI. [The angiographic evaluation of the collateral circulation in an inoperable kidney tumor after embolization]. Urol Nefrol (Mosk) 1996;(3):15-17
  23. Abrams HL, Cornell SH. Patterns of collateral flow in renal ischemia. Radiology 1965;84:1001-1012 https://doi.org/10.1148/84.6.1001
  24. Ambos MA, Bosniak MA, Lefleur RS. Blood flow to the kidney via the gonadal-renal capsular artery. Urol Radiol 1979;1:11-16
  25. Cofan F, Vilardell J, Gutierrez R, Real M, Montanya X, Oppenheimer F, et al. Efficacy of renal vascular embolization versus surgical nephrectomy in the treatment of nonfunctioning renal allografts. Transplant Proc 1999;31:2244-2245 https://doi.org/10.1016/S0041-1345(99)00321-8
  26. Perez Rodriguez MT, Sopena B, Lueiro F, Martinez-Vazquez C. Late infection of an embolized renal graft presented as buttock cellulitis. Transpl Infect Dis 2010;12:161-163 https://doi.org/10.1111/j.1399-3062.2009.00467.x
  27. Venkatesan AM, Kundu S, Sacks D, Wallace MJ, Wojak JC, Rose SC, et al. Practice guidelines for adult antibiotic prophylaxis during vascular and interventional radiology procedures. Written by the Standards of Practice Committee for the Society of Interventional Radiology and Endorsed by the Cardiovascular Interventional Radiological Society of Europe and Canadian Interventional Radiology Association [corrected]. J Vasc Interv Radiol 2010;21:1611-1630; quiz 1631 https://doi.org/10.1016/j.jvir.2010.07.018
  28. Hemingway AP, Allison DJ. Complications of embolization: analysis of 410 procedures. Radiology 1988;166:669-672 https://doi.org/10.1148/radiology.166.3.3340761
  29. Cox GG, Lee KR, Price HI, Gunter K, Noble MJ, Mebust WK. Colonic infarction following ethanol embolization of renal-cell carcinoma. Radiology 1982;145:343-345 https://doi.org/10.1148/radiology.145.2.7134432
  30. Galet A, Smith-Morel P, Goudemand J. [Worsening of chronic disseminated intravascular coagulation after embolization of the renal artery]. Ann Fr Anesth Reanim 1990;9:87-89 https://doi.org/10.1016/S0750-7658(05)80041-3

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