J Korean Soc Radiol.  2015 Dec;73(6):375-383. 10.3348/jksr.2015.73.6.375.

Risk Factors Related to Hemorrhage Necessitating Renal Artery Embolization after Percutaneous Nephrostomy

• Byon JH
• Han YM
• Jin GY
• Song JS

• KMID: 2130942
• DOI: http://doi.org/10.3348/jksr.2015.73.6.375

Abstract

PURPOSE
To investigate risk factors related to severe bleeding necessitating renal artery embolization (RAE) after percutaneous nephrostomy (PCN).
MATERIALS AND METHODS
36 patients who underwent RAE from January 2005 to June 2014 were retrospectively reviewed. Among them, 10 patients underwent embolization because of severe bleeding after PCN (bleeding group). From 1762 patients who underwent PCN in the same period, we selected 21 patients who underwent PCN without bleeding after the procedure (non-bleeding group). We investigated possible related risk factors, such as the presence of underlying diseases, activated partial thromboplastin time (aPTT), prothrombin time (PT), platelet count, puncture site, procedure time, size of the kidney, distance from skin to renal cortex, maximum caliber of the indwelling catheter, parenchymal thickness, and grade of hydronephrosis. We used Fisher's exact test and independent t test for data analyses.
RESULTS
We classified hydronephrosis as either 'mild hydronephrosis,' or 'moderate or severe hydronephrosis.' The frequency of mild hydronephrosis was 80.0% (8/10) in the bleeding group and 33.3% (7/21) in the non-bleeding group (p = 0.023). There were no significant differences between the two groups in the incidence of underlying diseases. Similarly, other risk factors (PT, aPTT, platelet count, procedure time, distance from skin to renal cortex, maximum caliber of the indwelling catheter, kidney size, and parenhcymal thickness) also did not differ significantly between the two groups.
CONCLUSION
Mild hydronephrosis is a risk factor for severe bleeding necessitating RAE after PCN. Therefore, when performing PCN, careful attention should be paid to patients with mild hydronephrosis.

MeSH Terms

Catheters, Indwelling
Embolization, Therapeutic
Hemorrhage*
Humans
Hydronephrosis
Incidence
Kidney
Nephrostomy, Percutaneous*
Partial Thromboplastin Time
Platelet Count
Pregnenolone Carbonitrile
Prothrombin Time
Punctures
Renal Artery*
Retrospective Studies
Risk Factors*
Skin
Statistics as Topic
Pregnenolone Carbonitrile

Figure

• 

  Fig. 1 A 47-year-old woman with a left staghorn stone (arrow). A. The grade of hydronephrosis is 0 because there is no forniceal or calyceal dilatation. B. Contrast medium is administered intravenously to visualize the pelvocalyceal system. C. The patient had excessive hematuria 3 days after percutaneous nephrolithotomy. Pseudoaneurysm of interlobar artery (arrow) is detected on a renal arteriography.

• 

  Fig. 2 An 83-year-old man with bladder cancer with invasion of the right distal ureter. A. The grade of hydronephrosis is 1 (arrow) because there is mild dilatation of the pelvis without dilatation of calyces. B. Successful percutaneous nephrostomy was performed in the mid to low pole. Dilated calyces (arrow) are filled with contrast media. C. Renal arteriography is performed because of persistent hematuria. Pseudoaneurysm (arrow) is detected in the low pole on the renal arteriography. D. Arteriovenous fistula (AVF) (arrow) is also discovered at selective angiogarphy. E. Psuedoaneurysm and AVF lesions are devascularized after coil embolization.

• 

  Fig. 3 A 78-year-old man with right distal ureteral stricture. The patient exhibited excessive hematuria after the procedure. A. The grade of hydronephrosis is 2 (arrow) because there is mild dilatation of the pelvis and calyces. B. Successful percutaneous nephrostomy was performed in the low pole. C. Hemorrhage in perinephric space of right kidney (arrow) is detected by abdominal CT following the procedure. D. Two arteriovenous fistulae of the interlobar artery (arrows) are present in the low pole of the right kidney. E. The feeding vessels are devascularized after coil embolization (arrows).

• 

  Fig. 4 A 69-year-old woman with cervical cancer given bilateral D-J stents for double-sided ureteral invasion. A. Malfunction of both D-J stents was suggested. The grade of hydronephrois is 3 in the right kidney (arrow) and 4 in the left kidney (arrowhead). B. After removal of both D-J stents with snares, percutaneous nephrostomy was performed successfully. A filling defect caused by hematoma is discovered in the right pelvocalyceal system (arrow). C. Upon renal arteriography, a pseudoaneurym of an interlobar artery (arrow) is discovered in the low pole of the right kidney. D. The feeding vessel is devascularized after coil embolization (arrow).

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