Factors Influencing Clinical Success of Renal Artery Embolization for Bleeding after Percutaneous Nephrolithotomy

Monday, March 6, 2023

12:00 PM – 1:00 PM

Location: Phoenix Convention Center, North Ballroom 120 D

Poster Presenter(s)

IR

Ian Rumball, BS

Medical Student
Zucker School of Medicine at Hofstra/Northwell

Disclosure(s): No financial relationships to disclose

Author/Co-author(s)

Kan Chen, MD

Interventional Radiology Resident
HOFSTRA NORTHWELL SOM
MM

Mark Mikhitarian, DO

Radiology Resident
HOFSTRA NORTHWELL SOM
Joseph Moirano, BS

Medical Student
Donald and Barbara Zucker School of Medicine At Hofstra/Northwell
Eric J. Gandras, MD

Interventional Radiology Attending
North Shore University Hospital-Manhasset
CG

Craig Greben, MD/MBA

Interventional Radiology Attending
Northwell Health
JW

Jonathan Weinstein, MD

IR Faculty
Northwell Health

Disclosure(s):

Ian Rumball, BS: No financial relationships to disclose

Joseph Moirano, BS: No financial relationships to disclose

Purpose: Renal artery embolization (RAE) has become the preferred treatment for vascular injury and bleeding after percutaneous nephrolithotomy (PCNL) {1-4}. Several retrospective studies report high rates of technical and clinical success with few complications {5,6}. We sought to identify patient, angiographic, and technical factors that may predict clinical outcomes after RAE for post-PCNL bleeding.

Materials and Methods: We retrospectively identified 80 consecutive cases of RAE performed for bleeding after PCNL from two hospitals in our health system from 2013 to 2021.  Demographics, clinical characteristics, angiographic findings, and embolization details were collected and analyzed against outcomes including hospital length of stay and a categorical composite outcome of reintervention or 30-day readmission for bleeding. Fisher’s exact test, logistic regression, and linear regression were employed to analyze these factors.

Results: Technical success was achieved in 80 patients (100%) with 1 complication (access hematoma). Median post-RAE length of stay was 5.7 days, and 7 patients required reintervention or readmission for bleeding. Among analyzed factors, none significantly increased the likelihood of 30-day readmission or reintervention (Table). Patients requiring 30-day readmission or reintervention were 4.5 times more likely to have ≥2 vessels embolized, though this relationship was not statistically significant (p = 0.07). Pre-embolization vasopressor and transfusion requirement increased length of stay by 5.5 days (p = 0.001) and 3.1 days (p = 0.018), respectively.

Conclusion: As previously reported, RAE is associated with high technical and clinical success, and few complications. Length of stay was predictably increased by factors associated with severe hemorrhage, such as vasopressor and transfusion requirement. While no factors analyzed significantly predicted reintervention or readmission for bleeding, there was a trend towards significance among patients undergoing embolization of multiple vessels. Future research with a larger cohort should explore angiographic and operative factors impacting RAE outcomes.