To describe the role of imaging techniques and Renal Artery Embolization (RAE) in the management of Renal Vascular Injuries (RVI) after Nephron-Sparing Surgery (NSS),
with a particular focus on the imaging features of RVI and both embolization technique and materials,
in order to provide elements for procedural optimization,
minimizing parenchymal loss and increasing procedure safety.
NSS is a well-established treatment tool for patients with renal masses and it is growing up as treatment of choice for patients with small lesions and poor functional residual parenchyma.
Active bleeding (AB),
arteriovenous fistulas (AVF),
and arterio-caliceal fistulas (ACF) have been described as rare but potentially life-threatening RVI associated to NSS.
In this scenario,
rapid clinical evaluation and diagnosis of the underlying RVI are essential to obtain a good treatment outcome,
avoiding fatal events in this subgroup of patients.
Ultrasonography (US) and...
Findings and procedure details
RVI and their imaging features
RVI after NSS include a variety of lesions that are generally isolated but which,
in some cases,
can be associated,
resulting in complex vascular lesions.
·Active arterial bleeding is the consequence of a direct vascular injury determining blood extravasation in the peri-renal space.
US usually shows an echoic collection close to the kidney but the direct demonstration of the vascular lesion is rare.
CT shows an area of contrast medium extravasation with irregular and variable morphology that is evident in...
Endovascular treatment provides good alternative to surgery in diverse RVI with shorter hospitalization and preserving the effect of a NSS on the residual renal parenchyma reducing morbidity.
The safety and effectiveness of these procedures depend on many variables such as the correct selection of patients and the proper pre-procedural imaging and clinical evaluation; nevertheless the experience of vascular interventional radiologist in the selection of embolic agents play a central role in achieving best results.
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