• Journal of Trauma and Injury
• /
• v.34 no.3
• /
• pp.198-202
• /
• 2021

Super-selective renal artery embolization is an increasingly popular technique for the management of traumatic, low-grade renal trauma. When performed in distal arterial branches, this intervention enables tissue preservation and arrest of hemorrhage, but it may not be practical in cases of multifocal, high-grade renal injuries. In such cases, surgical nephrectomy remains the more common treatment modality to ensure hemodynamic control. We present the unique case of a patient who presented in hemorrhagic shock following a major trauma that resulted in a grade 5 renal injury treated with complete renal artery embolization using Gelfoam, resulting in hemodynamic stabilization. Interestingly, imaging 1 month after embolization revealed residual enhancement of the inferior pole of the kidney, suggesting reconstitution of flow and partial renal salvage. Ultimately, transcatheter "nephrectomy" with careful selection of a temporary embolic agent may serve as a safe and efficient alternative to surgical nephrectomy with the added possibility of preserving partial renal perfusion and function in the emergent setting.

• Korean Journal of Veterinary Research
• /
• v.41 no.3
• /
• pp.429-436
• /
• 2001

The present study was performed to investigate the effect of iohexol-ethanol mixture and barium-ethanol mixture on the induction of transcatheter renal artery embolization in healthy 18 dogs, which were divided into two groups of 9 dogs and the 9 dogs were divided into 3 subgroups of 3 dogs. The renal artery embolization was undertaken unilaterally with the dose of 1.5, 2.0, and 3.0 ml/kg iohexol-ehtanol mixture and with the dose of 0.2, 0.4, and 0.8 ml/kg barium-ethanol mixture. And serum chemistry on 0, 1,3, 7, and 14 days, intravenous pyelography on 7days, angiography on 14 days, and histopathology on 14 days were evaluated. Serum BUN and creatinine concentration of two groups with iohexol-ethanol mixture and barium-ethanol mixture administration were mildly increased a t 1 day after injection of embolic materials and then returned to baseline. No significant changes in BUN and creatinine levels occurred in any of dogs. In all dogs with the dose of 1.5 ml/kg iohexol-ethanol mixture, the renal arteries were not embolized. All dogs with the dose of 3.0 ml/kg died. In all dogs with the dose of 2.10 ml/kg, the treated arteries were completely occluded. In barium-ethanol mixture administered group, the renal artery in one dog with the dose of 0.2 ml/kg was not embolized. In all dogs with the dose of 0.8 ml/kg, the renal arteries were completely embolized, but loac overembolization occured in two dogs. All animals with the dose of 0.4 ml/kg had effective embolization and no evidence of radiopaque barium opacity in systemic arteries distal to the renal-artery was found. All embolized kidneys were shrunk and decreased in size in gross examination and were shown diffuse necrosis in histopathologic examination. In the present study, renal arteries were embolized with the dose of 2.0 ml/kg iohexol-ethanol mixture or 0.4 ml/kg barium-ethanol mixture. And it is considered that the dose had a satisfactory embolic effect.

• Journal of Trauma and Injury
• /
• v.28 no.4
• /
• pp.262-265
• /
• 2015

An arteriovenous fistula (AVF) from the renal artery following a penetrating abdominal trauma is not common. We report the case of a 19-year-old male who presented with a knife stab wound in the right upper quadrant. Due to unstable vital signs and to the protrusion of the mesentery through the stab wound, providing definite evidence of peritoneal violation, an emergent exploratory laparotomy was carried out. There were injuries at the proximal transverse mesocolon and the second portion of the duodenum, with bile leakage. There was also a mild amount of retroperitoneal hematoma near the right kidney, without signs of expansion or pulsation. The mesocolon and the duodenum were repaired. After the operation, abdominal computerized tomography (CT) was performed, which revealed contrast from the right renal artery shunting directly into the vena cava. Transcatheter arterial embolization with a coil and vascular plug was performed, and the fistula was repaired. The patient recovered completely and was discharged without complication. For further and thorough evaluation of an abdominal trauma, especially one involving the retroperitoneum, a CT scan is recommended, when possible, either prior to surgery or after surgery when the patient is stabile. Furthermore, a lateral retroperitoneal hematoma and an AVF after a penetrating trauma may not always require exploration. Sometimes, it may be safely treated non-operatively or with embolization.