Category: Clinical Stones: PCNL

MP32-14 - Endovascular treatment of renal arterial lesions following percutaneous nephrolithotomy

Sun, Sep 23
2:00 PM - 4:00 PM

Introduction & Objective : Percutaneous nephrolitotripsy (PCNL) is standard treatment for large and/or complex urolithiasis. However, bleeding is still one of the most common and significant morbidities of the procedure. Intrarenal pseudoaneurysm, AV-fistula and arterial laceration are rare, but potentially life-threatening complications of percutaneous stone surgery, and are usually diagnosed and treated by renal angiography with selective embolization. The objective of this study is to evaluate the efficacy and safety of renovasography with selective embolization in the diagnosis and treatment of renal arterial lesions following PCNL.


Methods :

The data on 1326 PCNL procedures performed from January 2008 to January 2018 were retrospectively reviewed. 12 patients (0.9%) had significant bleeding in the postoperative period and underwent renal angiography.


Results : Patients’ mean age was 47.3±16.2 years and mean stone size - 42.5±12.8 mm. Mean time to onset of bleeding was 3.5±3.9 days. 66.7% of patients had bleeding in the early postoperative period, 8.3% had intermittent bleeding and 25.0% presented with delayed hemorrhage. Mean hemoglobin drop was 63.5±23.0 g/l. Renal angiography revealed pseudoaneurysm in 7 patients, AV-fistula in 1 patient, arterial laceration – in 3 patients and no lesion – in 1 case. Selective embolization was performed successfully in 10 patients (83.3%) with complete resolution of hemorrhage. 1 patient with unsuccessful embolization underwent open surgery with suturing of the renal parenchyma. The patient with no lesion identified on the renovasography underwent nephrectomy due to persistent bleeding. There were no intraoperative complications. One patient developed subcapsular renal hematoma following embolization, which was treated conservatively and one patient with solitary kidney had transient deterioration of renal function, which resolved after two sessions of hemodialysis.


Conclusions :

Renal vascular injury is a rare, but potentially life-threatening complication on PCNL. Renal angiography with selective embolization is effective and safe method for diagnosis and management of renal arterial lesions following percutaneous stone surgery.

Kremena Petkova

Assistant Professor
Department of Urology and Nephrology, Military Medical Academy - Sofia
Sofia, Sofiya, Bulgaria

Iliya Saltirov

Department of Urology and Nephrology, Military Medical Academy - Sofia
Sofia, Sofiya, Bulgaria

Miroslav Lilov

Department of Radiology, Military Medical Academy - Sofia
Sofia, Sofiya, Bulgaria