Scientific Session 22 — Vascular InterventionsThursday, May 4, 2017
2553. Management of Vascular and Urinary Complications After Partial Nephrectomy.
Alhumayed M*, Alsaikhan N, Narsinh K, Minocha J, Aryafar H. University of California San Diego Medical Center , San Diego , United States
Address correspondence to M. Alhumayed (email@example.com)
Objective: The purpose of this study was to assess the efficacy of interventional radiologic management of vascular and urinary complications occurring after partial nephrectomy.
Materials and Methods: Between 2010 and 2016, 317 patients underwent contrast-enhanced abdominal CT or MRI after partial nephrectomy at our institution. Imaging reports for all 317 patients were reviewed for the incidence of vascular and urinary complications related to partial nephrectomy, including pseudoaneurysm, arteriovenous fistula, or urine leak. Patients who underwent interventional management of vascular and urinary complications, such as renal angiography or percutaneous nephrostomy, were assessed for clinical success using the clinical and imaging data available in the electronic medical record. Failure of interventional management leading to completion nephrectomy, as well as complications of intervention, such as blood transfusion or readmission, were assessed over a mean follow-up period ± SD of 21 ± 20 months.
Results: Of 13 patients with vascular complications after partial nephrectomy, 12 had pseudoaneurysms and five had arteriovenous fistulas. Most patients with vascular complications (92%) underwent angioembolization. Technical success was achieved in all cases. Clinical success was achieved in all but two patients. One patient suffered persistent hematuria and underwent repeat angiography, and one patient underwent completion nephrectomy despite embolization. Of 23 patients (7.2%) with urinary complications, 35% underwent temporary urinary diversion (percutaneous nephrostomy or ureteric stenting), and 35% underwent perinephric drain placement. Two patients (8.7%) underwent completion nephrectomy despite temporary urinary diversion. Of 36 patients with urinary and vascular complications of partial nephrectomy, 33 were successfully managed nonoperatively. Interventional management failed in only three patients (8.3%), who then underwent completion nephrectomy.
Conclusion: Minimally invasive interventional techniques can be used to effectively manage vascular and urinary complications of partial nephrectomy and avoid completion nephrectomy.