Download PDF
CC BY-NC-ND 4.0 · Journal of Clinical Interventional Radiology ISVIR 2022; 06(02): 075-082
DOI: 10.1055/s-0041-1732795
Original Article

N-Butyl Cyanoacrylate Embolization in Management of Iatrogenic Renal Hemorrhages—Single-Center Study Evaluating Safety and Efficacy

Amey Narkhede
1   Department of Interventional Radiology, Sir Ganga Ram Hospital, New Delhi, India
,
Ajit Kumar Yadav
1   Department of Interventional Radiology, Sir Ganga Ram Hospital, New Delhi, India
,
Arun Gupta
1   Department of Interventional Radiology, Sir Ganga Ram Hospital, New Delhi, India
› Author Affiliations
› Further Information
Also available at
   Permissions and Reprints

Abstract

Objectives The aim of the study was to evaluate the efficacy of endovascular N-butyl cyanoacrylate (NBCA)/glue embolization alone in the management of iatrogenic renal injuries and its effect on renal function.

Methods Thirty-one patients who presented with significant iatrogenic renal injuries over a time period ranging from June 2013 to June 2018 were evaluated. The clinical features, lab parameters, and imaging findings were recorded. The embolizing agent used was exclusively NBCA. The success rate was calculated along with the effect of glue embolization on kidney in the form of postembolization ischemia and change in the serum creatinine levels in immediate pre- and postembolization period. The time between the iatrogenic injury and angioembolization as well as the time from angioembolization to discharge was also calculated. Recurrence was evaluated at 1 and 6 months follow-up.

Results NBCA embolization showed 100% technical and clinical success in our study and no recurrence was noted at follow-up. Glue was also able to achieve complete embolization in patients with coagulopathy (n = 14, 45.1%). Percentage area deficit of normal renal blush in the postembolization check angiogram varied from 4 to 15.7% with a mean deficit of 7.65%. No significant difference in the serum creatinine was noted in immediate postembolization period.

Conclusions We conclude that glue is an effective embolizing agent for management of iatrogenic renal injuries even in coagulopathy patients with minimal area of parenchymal loss, no significant effect on renal functions, and no recurrence on 6 months follow-up.

Keywords

NBCA - Iatrogenic renal injury - renal artery pseudoaneurysm.


Publication History

Article published online:
20 September 2021

© 2021. Indian Society of Vascular and Interventional Radiology. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

Thieme Medical and Scientific Publishers Pvt. Ltd.
A-12, 2nd Floor, Sector 2, Noida-201301 UP, India

 

  • References

  • 1 Huppert PE, Duda SH, Erley CM. et al. Embolization of renal vascular lesions: clinical experience with microcoils and tracker catheters. Cardiovasc Intervent Radiol 1993; 16 (06) 361-367
    CrossrefPubMedGoogle Scholar
  • 2 Mavili E, Dönmez H, Ozcan N, Sipahioğlu M, Demirtaş A. Transarterial embolization for renal arterial bleeding. Diagn Interv Radiol 2009; 15 (02) 143-147
    PubMedGoogle Scholar
  • 3 Chatziioannou A, Brountzos E, Primetis E. et al. Effects of superselective embolization for renal vascular injuries on renal parenchyma and function. Eur J Vasc Endovasc Surg 2004; 28 (02) 201-206
    CrossrefPubMedGoogle Scholar
  • 4 Malloy PC, Grassi CJ, Kundu S. et al. Standards of Practice Committee with Cardiovascular and Interventional Radiological Society of Europe (CIRSE) Endorsement. Consensus guidelines for periprocedural management of coagulation status and hemostasis risk in percutaneous image-guided interventions. J Vasc Interv Radiol 2009; 20 (Suppl. 07) S240-S249
    CrossrefPubMedGoogle Scholar
  • 5 Vignali C, Lonzi S, Bargellini I. et al. Vascular injuries after percutaneous renal procedures: treatment by transcatheter embolization. Eur Radiol 2004; 14 (04) 723-729
    CrossrefPubMedGoogle Scholar
  • 6 Phadke RV, Sawlani V, Rastogi H. et al. Iatrogenic renal vascular injuries and their radiological management. Clin Radiol 1997; 52 (02) 119-123
    CrossrefPubMedGoogle Scholar
  • 7 Dotter CT, Goldman ML, Rösch J. Instant selective arterial occlusion with isobutyl 2-cyanoacrylate. Radiology 1975; 114 (01) 227-230
    CrossrefPubMedGoogle Scholar
  • 8 Yonemitsu T, Kawai N, Sato M. et al. Evaluation of transcatheter arterial embolization with gelatin sponge particles, microcoils, and n-butyl cyanoacrylate for acute arterial bleeding in a coagulopathic condition. J Vasc Interv Radiol 2009; 20 (09) 1176-1187
    CrossrefPubMedGoogle Scholar
  • 9 Kim J, Shin JH, Yoon HK. et al. Transcatheter renal artery embolization with N-butyl cyanoacrylate. Acta Radiol 2012; 53 (04) 415-421
    CrossrefPubMedGoogle Scholar
  • 10 Frodsham A, Berkmen T, Ananian C, Fung A. Initial experience using N-butyl cyanoacrylate for embolization of lower gastrointestinal hemorrhage. J Vasc Interv Radiol 2009; 20 (10) 1312-1319
    CrossrefPubMedGoogle Scholar
  • 11 Park JH, Kim HC, Chung JW, Jae HJ, Park JH. Transcatheter arterial embolization of arterial esophageal bleeding with the use of N-butyl cyanoacrylate. Korean J Radiol 2009; 10 (04) 361-365
    CrossrefPubMedGoogle Scholar
  • 12 Pollak JS, White Jr RI. The use of cyanoacrylate adhesives in peripheral embolization. J Vasc Interv Radiol 2001; 12 (08) 907-913
    CrossrefPubMedGoogle Scholar
  • 13 Takeuchi Y, Morishita H, Sato Y. et al. Committee of Practice Guidelines of the Japanese Society of Interventional Radiology. Guidelines for the use of NBCA in vascular embolization devised by the Committee of Practice Guidelines of the Japanese Society of Interventional Radiology (CGJSIR), 2012 edition. Jpn J Radiol 2014; 32 (08) 500-517
    CrossrefPubMedGoogle Scholar
  • 14 Kish JW, Katz MD, Marx MV, Harrell DS, Hanks SE. N-butyl cyanoacrylate embolization for control of acute arterial hemorrhage. J Vasc Interv Radiol 2004; 15 (07) 689-695
    CrossrefPubMedGoogle Scholar
  • 15 Savastano S, Feltrin GP, Miotto D, Chiesura-Corona M. Renal aneurysm and arteriovenous fistula. Management with transcatheter embolization. Acta Radiol 1990; 31 (01) 73-76
    CrossrefPubMedGoogle Scholar
  • 16 Fisher RG, Ben-Menachem Y, Whigham C. Stab wounds of the renal artery branches: angiographic diagnosis and treatment by embolization. AJR Am J Roentgenol 1989; 152 (06) 1231-1235
    CrossrefPubMedGoogle Scholar
  • 17 Moreau JF, Merland JJ, Descamps JM. Post-biopsy false arterial aneurysm of a transplanted kidney: treatment by bucrylate transcatheter embolization. J Urol 1982; 128 (01) 116-118
    CrossrefPubMedGoogle Scholar
  • 18 Bryk DJ, Zhao LC. Guideline of guidelines: a review of urological trauma guidelines. BJU Int 2016; 117 (02) 226-234
    CrossrefPubMedGoogle Scholar
  • 19 Winkelmayer WC, Levin R, Avorn J. Chronic kidney disease as a risk factor for bleeding complications after coronary artery bypass surgery. Am J Kidney Dis 2003; 41 (01) 84-89
    CrossrefPubMedGoogle Scholar
  • 20 Ząbkowski T, Piasecki P, Zieliński H, Wieczorek A, Brzozowski K, Zięcina P. Superselective renal artery embolization in the treatment of iatrogenic bleeding into the urinary tract. Med Sci Monit 2015; 21: 333-337
    CrossrefPubMedGoogle Scholar
  • 21 Jae HJ, Chung JW, Jung AY, Lee W, Park JH. Transcatheter arterial embolization of nonvariceal upper gastrointestinal bleeding with N-butyl cyanoacrylate. Korean J Radiol 2007; 8 (01) 48-56
    CrossrefPubMedGoogle Scholar
  • 22 Izaki K, Yamaguchi M, Kawasaki R, Okada T, Sugimura K, Sugimoto K. N-butyl cyanoacrylate embolization for pseudoaneurysms complicating pancreatitis or pancreatectomy. J Vasc Interv Radiol 2011; 22 (03) 302-308
    CrossrefPubMedGoogle Scholar
  • 23 Kim BS, Do HM, Razavi M. N-butyl cyanoacrylate glue embolization of splenic artery aneurysms. J Vasc Interv Radiol 2004; 15 (1 Pt 1) 91-94
    CrossrefPubMedGoogle Scholar
  • 24 Meng CH, Elkin M. Immediate angiographic manifestations of iatrogenic renal injury due to percutaneous needle biopsy. Radiology 1971; 100 (02) 335-341
    CrossrefPubMedGoogle Scholar
  • 25 Stiles KP, Yuan CM, Chung EM, Lyon RD, Lane JD, Abbott KC. Renal biopsy in high-risk patients with medical diseases of the kidney. Am J Kidney Dis 2000; 36 (02) 419-433
    CrossrefPubMedGoogle Scholar
  • 26 Burrel M, Barrufet M, Sebastia MC. et al. Diffuse renal cortical hemorrhage in the setting of subcapsular hematoma: diagnosis and treatment with embolization. J Vasc Interv Radiol 2017; 28 (11) 1557-1562.e1
    CrossrefPubMedGoogle Scholar
  • 27 Poulakis V, Ferakis N, Becht E, Deliveliotis C, Duex M. Treatment of renal-vascular injury by transcatheter embolization: immediate and long-term effects on renal function. J Endourol 2006; 20 (06) 405-409
    CrossrefPubMedGoogle Scholar
  • 28 Sam K, Gahide G, Soulez G. et al. Percutaneous embolization of iatrogenic arterial kidney injuries: safety, efficacy, and impact on blood pressure and renal function. J Vasc Interv Radiol 2011; 22 (11) 1563-1568
    CrossrefPubMedGoogle Scholar
  • 29 Srivastava A, Singh KJ, Suri A. et al. Vascular complications after percutaneous nephrolithotomy: are there any predictive factors?. Urology 2005; 66 (01) 38-40
    CrossrefPubMedGoogle Scholar
  • 30 Güneyli S, Gök M, Bozkaya H. et al. Endovascular management of iatrogenic renal arterial lesions and clinical outcomes. Diagn Interv Radiol 2015; 21 (03) 229-234
    CrossrefPubMedGoogle Scholar
  • 31 Chiramel GK, Keshava SN, Moses V, Kekre N, Tamilarasi V, Devasia A. Clinical outcomes of endovascularly managed iatrogenic renal hemorrhages. Indian J Radiol Imaging 2015; 25 (04) 380-390
    Article in Thieme ConnectPubMedGoogle Scholar
  • 32 Seif HMA, Hameed DA. Endovascular management of iatrogenic renal vascular injury: experience in 28 cases. Med J Cairo Univ 2011; 79 (01) 177-184
    PubMedGoogle Scholar