Are iatrogenic renal artery pseudoaneurysms more challenging to embolize when associated with an arteriovenous fistula?

Background: Iatrogenic injuries of the renal artery include pseudoaneurysms (PSA) and pseudoaneurysms with arteriovenous fistula (PSA + AVF). They can cause hematuria, anemization and flank pain. Endovascular treatment is recommended due to its effectiveness.

Objective: To assess the potential difference between the embolization of iatrogenic renal PSA and iatrogenic renal PSA + AVF, in terms of technical and clinical success rate, procedure complexity and impact on the renal function.

Methods: We retrospectively reviewed 30 embolization procedures of iatrogenic renal PSA and renal PSA + AVF in 27 patients in two centers between December 2006 and February 2017, comparing technical and clinical success rate, total procedural time, creatinine before and after the procedure and parenchymal ischemic area after the procedure. All patients underwent CT before embolization procedure and different embolization materials were used.

Results: We identified 15 iatrogenic renal PSA and 15 iatrogenic renal PSA + AVF (causes: 23 nephron-sparing surgery, 2 nephrostomies, 1 lithotripsy, 1 ureteroscopic pyelolithotomy, 1 renal biopsy). Microcoils were used in 21 cases, microcoils and Spongostan in 3 cases, microcoils and controlled-release microcoils in 4 cases and controlled-release microcoils in 1 case. No significant statistical differences were found in the comparison of technical and clinical success rate, total procedural time, creatinine and parenchymal ischemic area after the procedure.

Conclusions: Transarterial embolization can be considered as the first-line treatment for renal artery iatrogenic lesions, considering its effectiveness. No statistical significant differences were found in the comparison of the embolization procedures of iatrogenic renal PSA and PSA + AVF.