Failure Of Initial Superselective Renal Arterial Embolization For Post-PCNL Hemorrhage:A Clinical Study Of 7 Cases

Objective:To investigate the cause and countermeasure of failed initial superselective renal arterial embolization for severe post-PCNL hemorrhage.Methods:Retrospectively review the records of 7 cases with failed initial superselective renal arterial embolization after PCNL in our hospital from September 2013 to September 2016.Analyze the patients' clinical characteristics and compare the imaging difference among CTA,initial SRAE and second SRAE.Results:In the 7 cases,1 female patient and 6 male patients are included and the median age is 54 years(range 38 to 67).3 patients have a surgery history of homolateral pyelolithotomy or PCNL.Coagulation function before surgery was normal and a single-tract PCNL was performed in all 7 cases.4 patients underwent left PCNL,and 3 right PCNL.Mean duration of the PCNL procedure was 58 minutes.All patients were found normal PT and decreased Fib before initial embolization,and normal PT before second embolization.4 of 7 patients were in a normal level of Fib and 3 patients in a low level before second embolization.7 patients underwent CTA examination before initial embolization and 5 of them were coincident with selective arteriography.4 patients did CTA before second embolization and 1 of them corresponded.3 patients were found abnormalities in the distal of embolized arteries in second SRAE and 4 patients had new lesions superior or far apart to embolized arteries.Conclusion:The reasons for failed initial renal arterial embolization may lie in a surgery history of kidney,coagulation function,variation of renal vascular,vasospasm,lack of experience and improper embolic materials.To decrease the failure of embolization,blood coagulation function should be corrected.Additionally,call an experienced interventional radiologist and make an extra effort to identify all bleeding vessels.Then,embolize the vessels one by one using proper embolic materials.