Korean J Radiol.  2014 Aug;15(4):472-480. 10.3348/kjr.2014.15.4.472.

Safety and Efficacy of Transarterial Nephrectomy as an Alternative to Surgical Nephrectomy

• Choe J
• Shin JH
• Yoon HK
• Ko GY
• Gwon DI
• Ko HK
• Kim JH
• Sung KB

• KMID: 1731051
• DOI: http://doi.org/10.3348/kjr.2014.15.4.472

Abstract

OBJECTIVE
To evaluate the safety and efficacy of transarterial nephrectomy, i.e., complete renal artery embolization, as an alternative to surgical nephrectomy.
MATERIALS AND METHODS
This retrospective study included 11 patients who underwent transarterial nephrectomy due to a high risk of surgical nephrectomy or their refusal to undergo surgery during the period from April 2002 to February 2013. Medical records and radiographic images were reviewed retrospectively to collect information regarding underlying etiologies, clinical presentations and embolization outcomes.
RESULTS
The underlying etiologies for transarterial nephrectomy included recurrent hematuria (chronic transplant rejection [n = 3], arteriovenous malformation or fistula [n = 3], angiomyolipoma [n = 1], or end-stage renal disease [n = 1]), inoperable renal or ureteral injury (n = 2), and ectopic kidney with urinary incontinence (n = 1). The technical success rate was 100%, while clinical success was achieved in eight patients (72.7%). Subsequent surgical nephrectomy was required for three patients due to an incomplete nephrectomy effect (n = 2) or necrotic pyelonephritis (n = 1). Procedure-related complications were post-infarction syndrome in one patient and necrotic pyelonephritis in another patient. Of four patients with follow-up CT, four showed renal atrophy and two showed partial renal enhancement. No patient developed a procedure-related hypertension.
CONCLUSION
Transarterial nephrectomy may be a safe and effective alternative to surgical nephrectomy in patients with high operative risks.

Keyword

Kidney; Embolization; Nephrectomy

MeSH Terms

Adult
Aged
Angiomyolipoma/therapy
Arteriovenous Malformations/therapy
Child
Embolization, Therapeutic/adverse effects/*methods
Female
Graft Rejection/therapy
Hematuria/etiology
Humans
Infarction/etiology
Kidney/blood supply
Kidney Diseases/surgery/*therapy
Kidney Failure, Chronic/therapy
Kidney Neoplasms/therapy
Male
Middle Aged
Nephrectomy/adverse effects/*methods
*Renal Artery/abnormalities
Retrospective Studies
Young Adult

Figure

• 

  Fig. 1 23-year-old male patient (No. 11) with hematuria caused by traumatic left kidney rupture. A. Renal arteriography shows parenchymal defect due to his shattered kidney (AAST grade IV). B. Arteriogram obtained after embolization reveals successful occlusion of left renal artery (arrows) using two vascular plugs. C, D. Follow-up CT scans obtained four (C) and ten (D) months following embolization show progressive renal atrophy with residual partial enhancement at lower pole (arrows).

• 

  Fig. 2 49-year-old male patient (No. 4) with chronic transplanted kidney rejection presenting with hematuria and pain. A. Arteriogram of graft renal artery (arrows) arising from right external iliac artery shows normal angiogram without bleeding focus. B. Arteriogram obtained following embolization reveals successful occlusion of graft renal artery using two vascular plugs (arrows), gelfoam pledgets and NBCA. C, D. CT scans obtained before (C) and six months after (D) embolization show decrease in size of graft kidney. There was no residual renal enhancement seen on six-month follow-up CT scan.

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