Clinical And Angiographic Features Of Iatrogenic Renal Hemorrhage And The Effect Of Interventional Therapy

Objective:To explore the clinical,imaging features and interventional treatment of iatrogenic renal hemorrhage,summarize the cases of rebleeding after interventional therapy and analyze its causes in order to reduce the incidence of rebleeding.Methods:140 cases of iatrogenic renal hemorrhage from December 2014 to December 2018 in the second affiliated Hospital of Kunming Medical University were retrospectively analyzed.Results:Among 140 cases of iatrogenic renal hemorrhage,80 cases were right renal hemorrhage and 60 cases were left renal hemorrhage.The clinical manifestations were persistent massive hemorrhage in 41 cases,inte(?)mittent or periodic massive hemorrhage in 25 cases,persistent and intermittent massive hemorrhage in 25 cases;There were 11 cases of massive bleeding after removal of fistula,11 cases of massive bleeding after exercise,10 cases of intermittent small amount of hematuria,8 cases of gradually redness of urine and drainage fluid,4 cases of anuria with renal distension and 4 cases of persistent small hematuria.The whole course of gross hematuria occurred in 1 case for half a year.There were 48 cases of pseudoaneurysm,38 cases of pseudoaneurysm complicated with arteriovenous fistula,19 cases of negative findings,17 cases of arteriovenous fistula,8 cases of small artery rupture and hemorrhage,5 cases of vascular disorder,4 cases of arteriorenal calyx fistula and 1 case of arterioureteral fistula.The main clinical manifestations of pseudoaneurysm were intermittent,periodic,bleeding after movement and after the fistula was pulled out.and the main clinical manifestation of arteriovenous fistula was persistent massive hemorrhage.The main clinical manifestation of pseudoaneurysm with arteriovenous fistula is persistent and intermittent massive bleeding.After the first interventional therapy,2 cases died of hemorrhagic shock and multiple organ failure 8 hours and 24 hours after operation respectively,although the hemostatic treatment was successful.The recurrent bleeding rate was 11.4%,and the success rate of the first interventional therapy was 87.1%.The main causes of recurrent bleeding were recanalization after embolization and newly discovered blood spots.The success rates of secondary,tertiary and fourth interventional therapy were 95.7%,97.9%and 97.9%,respectively,and the successful rate of interventional therapy was 95.7%,97.9%and 97.9%,respectively.Among the patients with recurrent hemorrhage,one patient failed after 4 times of interventional embolization and chose to undergo nephrectomy on the affected side of the surgery.Hemoglobin and red blood cells in the other patients were significantly higher or not decreased compared with those before intervention,urea nitrogen and creatine were lower than those at admission.Conclusion:Bleeding after percutaneous nephroscopy is the main cause of iatrogenic renal hemorrhage.Serious cases may cause renal failure,even life-threatening.Therefore,it is necessary to diagnose and judge the indication of interventional therapy in time according to the clinical bleeding characteristics of the patients.PA and PA combined with AVF were the main manifestations of renal arteriography.Interventional therapy had high success rate of hemostasis and few short-term complications.Permanent embolic agent could be selected according to the diameter of the bleeding artery,but there was also the risk of bleeding again.The main causes of recurrent bleeding are recanalization of blood vessels after embolization and newly discovered blood points.It is necessary for recurrent bleeding to be treated with interventional therapy again,which can effectively improve the hemostatic rate.