Direct Percutaneous Embolization of Renal Pseudoaneurysm

Abstract

PURPOSE: To describe and evaluate a novel method of direct ultrasonography (US)-guided percutaneous embolization of renal pseudoaneurysm. PATIENTS AND METHODS: Fourteen patients with severe hematuria were included in this study from February 2005 to February 2006. They included five patients with penetrating renal trauma, two patients after renal biopsy, and seven patients after percutaneous nephrolithotripsy. Diagnostic duplex US of the pseudoaneurysm was performed. The size of the pseudoaneurysm and its neck were determined. A solution of Gelfoam particles was prepared in sterile saline and under US guidance, the tip of the needle was inserted into the aneurysm, and the solution with Gelfoam particles was injected slowly. During injection of Gelfoam, the pseudoaneurysm initially filled with an echogenic thrombus, thereby decreasing the color flow detected by US. The needle was removed when no flow in the pseudoaneurysm was detectable. The patient was kept for 30 minutes in the department and then discharged home. Follow-up by color Doppler US was performed every 2 weeks for 3 months and then every 3 months for 1 year. RESULTS: In 13 patients, bleeding was effectively controlled with direct embolization in a single session and did not need any further intervention, while one patient needed endovascular embolization because of recurrent severe hematuria after 24 hours. The amount of the injected Gelfoam particles (1-2 mm diameter) was 1 to 3 mL, according to the size of the pseudoaneurysm. No complication was observed secondary to the embolization procedure. Rebleeding did not occur in any patient during the follow-up period that ranged from 3 to 12 months. CONCLUSION: Direct US-guided percutaneous embolization is a new method for managing renal pseudoaneurysm. It avoids the side effects of contrast media, hazards of irradiation, and complications of angiographic catheterization. Moreover, it saves the risk of surgical interference to control bleeding either by partial or total nephrectomy, especially in patients with a solitary kidney. It is rapid, effective, feasible, and tissue preserving, and likely to reduce morbidity and mortality. Therefore, it is recommended as a first-line treatment of actively bleeding renal pseudoaneurysms.