Superselective embolization of renal vessels – the treatment of choice in kidney injuries with bleeding into the urinary system
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Wojskowy Instytut Medyczny – Państwowy Instytut Badawczy, Klinika Urologii Ogólnej, Czynnościowej i Onkologicznej, Polska
Wojskowy Instytut Medyczny – Państwowy Instytut Badawczy, Pracownia Radiologii Zabiegowej, Zakład Radiologii Lekarskiej, Polska
Submission date: 2022-08-18
Final revision date: 2022-08-26
Acceptance date: 2022-09-21
Publication date: 2022-12-30
Corresponding author
Adam Waldemar Majchrzak   

Wojskowy Instytut Medyczny – Państwowy Instytut Badawczy, Klinika Urologii Ogólnej, Czynnościowej i Onkologicznej, Polska
LW 2022;100(4):253-258
Introduction and purpose: Kidney injuries account for 5% of all injuries of patients admitted to hospital and requiring specialist treatment – most often they affect young men. Kidney injuries can be treated conservatively with organ sparing in the majority of cases. The severity of injury is assessed with the 5-grade American Association for the Surgery of Trauma (AAST) scale. High-risk (grade V) injuries should be treated surgically with organ-sparing surgery. If such treatment is not possible, surgeons may be forced to perform nephrectomy. In grade I-IV injuries with active bleeding, transarterial selective embolization is an alternative allowing for organ sparing. This study aims at selecting a group of patients eligible for transarterial selective embolization, based on the AAST score. Material and methods: Between 2018 and 2022, a total of 27 patients (external + iatrogenic injuries) was hospitalized at the Department of Urology of the Military Institute of Medicine-National Research Institute. Their injuries were characterised by health- and life-threatening bleeding from the renal parenchyma or renal vessels. The medical intervention applied within the research was transarterial selective embolization (TSE) with tissue adhesives, i.e. Glubran, Histoacryl, Lipidol, and embolization spiral coils or spongostan. Results: Between 2018 and 2022, 27 endovascular interventions were performed in patients with renal injuries at Military Institute of Medicine. None of the patients after transarterial selective embolization required urological intervention in the form of nephrectomy. In one case, due to multisite severe bleeding not allowing for organ-sparing treatment, renal artery embolization was required. In the remaining patients, bleeding was successfully stopped. Conclusions: Transarterial selective embolization is an effective, minimally invasive treatment for high-risk renal injuries.
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