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2017 (1)

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Dissertation
Hemorrhagic complications after partial nephrectomy: treatment by arterial embolization

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Abstract

Abstract Purpose: To report our tertiary center experience in treating iatrogenic vascular lesions after partial nephrectomy by arterial embolization. Materials and methods: The medical records of 25 patients were retrospectively analysed and extensive data were collected including demographic information, clinical presentation, diagnostic process, technical and clinical success rate, and the evolution of renal function. Results: The incidence of vascular complications after partial nephrectomy in our institution is 1.8%. The most frequent presenting symptom was macroscopic hematuria (48%), diagnosed on a mean of 5 days after surgery. Diagnosis was made on clinical basis alone with direct referral to the interventional radiology department in 20%. Pre-interventional imaging was done in the remaining patients with ultrasound in 32%, contrast enhanced computed tomography(CECT) in 24% and a combination of ultrasound and CECT in 24%. In 32% of patients, multiple vascular lesions were present. Clinical success was achieved in all cases after one (96%) or two endovascular interventions (4%). Only one patient with a solitary kidney suffered a sustained decrease in renal function. Conclusions: We confirm selective arterial embolization of active hemorrhage after partial nephrectomy as an efficient and safe treatment with low risk of renal insufficiency.

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