Indications for transcatheter angiographic embolization in the treatment of delayed hemorrhage after percutaneous nephrolithotomy: a multicenter retrospective study
Purpose: Ddelayed hemorrhage after percutaneous nephrolithotomy (PCNL) has not been well defined in the literature.The clinical presentation has not been well described and treatment algorithms are lacking..The purpose of this study is to determine the timing and indications of transcatheter angiographic embolization (TAE) for delayed post-PCNL hemorrhage.Matherials and Methods: The medical records of 137 patients who underwent TAE for delayed post-PCNL hemorrhage (defimed as gross hematuria occurring ≥ 24 hours after surgery) at five university hospitals between January 2005 and December 2012 were reviewed retrospectively.Results: The mean time to the onset of post-PCNL hemorrhage was 10.5 days (2-30 days).Clinical presentation included sudden-onset bleeding in 41 patients (29.9%), intermittent bleeding in 81 patients (59.1%), and continuous-slow bleeding in 19 patients (10.9%).Hemodynamic instability occurred in 32 patients (23.4%).The mean hemoglobin decrease from the first post-PCNL day to the day of transcatheter angiographic embolization was 49.5 g/L (31.0-79.0 g/L).Renal angiography showed a pseudoaneurysm in 68 (49.6%) patients, arteriovenous fistula (AVF) in 28 (20.4%) patients, and both lesions in 17 (12.4%) patients.An arterial laceration was seen in 24 (17.5%) patients.A second embolization was required in 7 (5.1%) patients within 3 days of the first TAE.TAE was successful in stopping bleeding in all cases.There were no major complications associated with TAE.Conclusion: TAE is the recommended treatment for delayed post-PCNL hemorrhage in patients with hemodynamic instability and/or corrected hemoglobin decrease > 30 g/L following conservative management.
Long LI
Department of Radiology, Guangdong Provincial Corps Hospital of Chinese People”s Armed Police Force,Guangzhou 510507, China
国内会议
济南
英文
22-28
2014-05-24（万方平台首次上网日期，不代表论文的发表时间）