First prize (tie) - Hemorrhage following percutaneous renal surgery: Characterization of angiographic findings

Lee Richstone, Ernesto Reggio, Michael C. Ost, Casey Seideman, Lindsey K. Fossett, Zeph Okeke, Ardeshir R. Rastinehad, Igor Lobko, David N. Siegel, Arthur D. Smith

Research output: Contribution to journalReview article

57 Citations (Scopus)

Abstract

Purpose: Percutaneous surgery is an established approach to a spectrum of renal pathology, and hemorrhage is the most concerning complication of this technique. We determined the frequency of postoperative hemorrhage requiring selective angioembolization (SAE), the efficacy of this approach, and characterized the angiographic findings. Methods: We reviewed our database of 4695 patients who underwent percutaneous renal surgery and identified patients requiring SAE for postoperative hemorrhage. Angiographic findings were recorded and efficacy of SAE documented. Results: Patients undergoing percutaneous stone extraction (PSE; 3685), percutaneous antegrade endopyelotomy (PAE; 850), and upper-tract transitional cell carcinoma (UTTCC) resection (160) were reviewed. We identified 57 patients requiring SAE (1.2%) who underwent 44 PSEs (77.2%), 7 PAEs (12.3%), and 6 UTTCC resections (10.5%). This represented 1.2%, 0.8%, and 3.2% of all PSE, PAE, and UTTCC resections, respectively. Angiography revealed treatable lesions in 94.7% of patients. Overall, 64 angiographic findings were encountered including 30 pseudoaneurysms (53% of patients, 47% of findings), 14 arteriovenous fistulas (AVFs) (25% of patients, 22% of findings), and 14 instances of contrast extravasation (25% of patients, 22% of findings). Two arterial dissections and one instance each of a hypervascular area, a vascular "cut-off" sign, and a fistula between an artery and the percutaneous tract were identified. One bleeding vessel identified at the base of a UTTCC resection was not amenable to embolization. Ten patients (17.5%) had ≥1 angiographic finding. Three patients (5.3%) had no angiographic findings to account for hemorrhage. No angioembolization-related complications occurred. Complete resolution of bleeding was observed in 54 patients (95%). Conclusions: Major hemorrhage requiring intervention after percutaneous renal surgery is uncommon. The most common angiographic finding is arterial pseudoaneurysm, followed by arteriovenous fistula, and contrast extravasation. In 95% of cases angiography reveals a demonstrable and treatable etiology. This strongly supports the first-line use of angiography for intractable bleeding in this setting.

Original languageEnglish (US)
Pages (from-to)1129-1135
Number of pages7
JournalJournal of Endourology
Volume22
Issue number6
DOIs
StatePublished - Jun 1 2008
Externally publishedYes

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Hemorrhage
Kidney
Transitional Cell Carcinoma
Postoperative Hemorrhage
Angiography
False Aneurysm
Arteriovenous Fistula
Fistula
Blood Vessels
Dissection
Arteries
Databases
Pathology

ASJC Scopus subject areas

  • Urology

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First prize (tie) - Hemorrhage following percutaneous renal surgery : Characterization of angiographic findings. / Richstone, Lee; Reggio, Ernesto; Ost, Michael C.; Seideman, Casey; Fossett, Lindsey K.; Okeke, Zeph; Rastinehad, Ardeshir R.; Lobko, Igor; Siegel, David N.; Smith, Arthur D.

In: Journal of Endourology, Vol. 22, No. 6, 01.06.2008, p. 1129-1135.

Research output: Contribution to journalReview article

Richstone, L, Reggio, E, Ost, MC, Seideman, C, Fossett, LK, Okeke, Z, Rastinehad, AR, Lobko, I, Siegel, DN & Smith, AD 2008, 'First prize (tie) - Hemorrhage following percutaneous renal surgery: Characterization of angiographic findings', Journal of Endourology, vol. 22, no. 6, pp. 1129-1135. https://doi.org/10.1089/end.2008.0061
Richstone, Lee ; Reggio, Ernesto ; Ost, Michael C. ; Seideman, Casey ; Fossett, Lindsey K. ; Okeke, Zeph ; Rastinehad, Ardeshir R. ; Lobko, Igor ; Siegel, David N. ; Smith, Arthur D. / First prize (tie) - Hemorrhage following percutaneous renal surgery : Characterization of angiographic findings. In: Journal of Endourology. 2008 ; Vol. 22, No. 6. pp. 1129-1135.
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abstract = "Purpose: Percutaneous surgery is an established approach to a spectrum of renal pathology, and hemorrhage is the most concerning complication of this technique. We determined the frequency of postoperative hemorrhage requiring selective angioembolization (SAE), the efficacy of this approach, and characterized the angiographic findings. Methods: We reviewed our database of 4695 patients who underwent percutaneous renal surgery and identified patients requiring SAE for postoperative hemorrhage. Angiographic findings were recorded and efficacy of SAE documented. Results: Patients undergoing percutaneous stone extraction (PSE; 3685), percutaneous antegrade endopyelotomy (PAE; 850), and upper-tract transitional cell carcinoma (UTTCC) resection (160) were reviewed. We identified 57 patients requiring SAE (1.2{\%}) who underwent 44 PSEs (77.2{\%}), 7 PAEs (12.3{\%}), and 6 UTTCC resections (10.5{\%}). This represented 1.2{\%}, 0.8{\%}, and 3.2{\%} of all PSE, PAE, and UTTCC resections, respectively. Angiography revealed treatable lesions in 94.7{\%} of patients. Overall, 64 angiographic findings were encountered including 30 pseudoaneurysms (53{\%} of patients, 47{\%} of findings), 14 arteriovenous fistulas (AVFs) (25{\%} of patients, 22{\%} of findings), and 14 instances of contrast extravasation (25{\%} of patients, 22{\%} of findings). Two arterial dissections and one instance each of a hypervascular area, a vascular {"}cut-off{"} sign, and a fistula between an artery and the percutaneous tract were identified. One bleeding vessel identified at the base of a UTTCC resection was not amenable to embolization. Ten patients (17.5{\%}) had ≥1 angiographic finding. Three patients (5.3{\%}) had no angiographic findings to account for hemorrhage. No angioembolization-related complications occurred. Complete resolution of bleeding was observed in 54 patients (95{\%}). Conclusions: Major hemorrhage requiring intervention after percutaneous renal surgery is uncommon. The most common angiographic finding is arterial pseudoaneurysm, followed by arteriovenous fistula, and contrast extravasation. In 95{\%} of cases angiography reveals a demonstrable and treatable etiology. This strongly supports the first-line use of angiography for intractable bleeding in this setting.",
author = "Lee Richstone and Ernesto Reggio and Ost, {Michael C.} and Casey Seideman and Fossett, {Lindsey K.} and Zeph Okeke and Rastinehad, {Ardeshir R.} and Igor Lobko and Siegel, {David N.} and Smith, {Arthur D.}",
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T1 - First prize (tie) - Hemorrhage following percutaneous renal surgery

T2 - Characterization of angiographic findings

AU - Richstone, Lee

AU - Reggio, Ernesto

AU - Ost, Michael C.

AU - Seideman, Casey

AU - Fossett, Lindsey K.

AU - Okeke, Zeph

AU - Rastinehad, Ardeshir R.

AU - Lobko, Igor

AU - Siegel, David N.

AU - Smith, Arthur D.

PY - 2008/6/1

Y1 - 2008/6/1

N2 - Purpose: Percutaneous surgery is an established approach to a spectrum of renal pathology, and hemorrhage is the most concerning complication of this technique. We determined the frequency of postoperative hemorrhage requiring selective angioembolization (SAE), the efficacy of this approach, and characterized the angiographic findings. Methods: We reviewed our database of 4695 patients who underwent percutaneous renal surgery and identified patients requiring SAE for postoperative hemorrhage. Angiographic findings were recorded and efficacy of SAE documented. Results: Patients undergoing percutaneous stone extraction (PSE; 3685), percutaneous antegrade endopyelotomy (PAE; 850), and upper-tract transitional cell carcinoma (UTTCC) resection (160) were reviewed. We identified 57 patients requiring SAE (1.2%) who underwent 44 PSEs (77.2%), 7 PAEs (12.3%), and 6 UTTCC resections (10.5%). This represented 1.2%, 0.8%, and 3.2% of all PSE, PAE, and UTTCC resections, respectively. Angiography revealed treatable lesions in 94.7% of patients. Overall, 64 angiographic findings were encountered including 30 pseudoaneurysms (53% of patients, 47% of findings), 14 arteriovenous fistulas (AVFs) (25% of patients, 22% of findings), and 14 instances of contrast extravasation (25% of patients, 22% of findings). Two arterial dissections and one instance each of a hypervascular area, a vascular "cut-off" sign, and a fistula between an artery and the percutaneous tract were identified. One bleeding vessel identified at the base of a UTTCC resection was not amenable to embolization. Ten patients (17.5%) had ≥1 angiographic finding. Three patients (5.3%) had no angiographic findings to account for hemorrhage. No angioembolization-related complications occurred. Complete resolution of bleeding was observed in 54 patients (95%). Conclusions: Major hemorrhage requiring intervention after percutaneous renal surgery is uncommon. The most common angiographic finding is arterial pseudoaneurysm, followed by arteriovenous fistula, and contrast extravasation. In 95% of cases angiography reveals a demonstrable and treatable etiology. This strongly supports the first-line use of angiography for intractable bleeding in this setting.

AB - Purpose: Percutaneous surgery is an established approach to a spectrum of renal pathology, and hemorrhage is the most concerning complication of this technique. We determined the frequency of postoperative hemorrhage requiring selective angioembolization (SAE), the efficacy of this approach, and characterized the angiographic findings. Methods: We reviewed our database of 4695 patients who underwent percutaneous renal surgery and identified patients requiring SAE for postoperative hemorrhage. Angiographic findings were recorded and efficacy of SAE documented. Results: Patients undergoing percutaneous stone extraction (PSE; 3685), percutaneous antegrade endopyelotomy (PAE; 850), and upper-tract transitional cell carcinoma (UTTCC) resection (160) were reviewed. We identified 57 patients requiring SAE (1.2%) who underwent 44 PSEs (77.2%), 7 PAEs (12.3%), and 6 UTTCC resections (10.5%). This represented 1.2%, 0.8%, and 3.2% of all PSE, PAE, and UTTCC resections, respectively. Angiography revealed treatable lesions in 94.7% of patients. Overall, 64 angiographic findings were encountered including 30 pseudoaneurysms (53% of patients, 47% of findings), 14 arteriovenous fistulas (AVFs) (25% of patients, 22% of findings), and 14 instances of contrast extravasation (25% of patients, 22% of findings). Two arterial dissections and one instance each of a hypervascular area, a vascular "cut-off" sign, and a fistula between an artery and the percutaneous tract were identified. One bleeding vessel identified at the base of a UTTCC resection was not amenable to embolization. Ten patients (17.5%) had ≥1 angiographic finding. Three patients (5.3%) had no angiographic findings to account for hemorrhage. No angioembolization-related complications occurred. Complete resolution of bleeding was observed in 54 patients (95%). Conclusions: Major hemorrhage requiring intervention after percutaneous renal surgery is uncommon. The most common angiographic finding is arterial pseudoaneurysm, followed by arteriovenous fistula, and contrast extravasation. In 95% of cases angiography reveals a demonstrable and treatable etiology. This strongly supports the first-line use of angiography for intractable bleeding in this setting.

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