Category: Laparoscopic/ Robotic: Other

MP25-3 - Renal artery pseudoaneurysm and conservative management after laparoscopic partial nephrectomy

Sun, Sep 23
10:00 AM - 12:00 PM

Introduction & Objective :

Arterial pseudoaneurysms (AP) are relatively rare complications of nephron sparing surgery, with an incidence of 1.7% to 2.6% for laparoscopic partial nephrectomies (LPN). Arterial embolization can play an important role in the management of these cases and avoid radical nephrectomy.


The objective is to evaluate the rate of appearance of AP and other vascular complications after NPL, as well as its treatment.


Methods :

Retrospective analysis of 146 patients treated with PN for renal tumor, of which 114 were performed by laparoscopic approach between January 2012 and October 2017, with a mean post-surgical follow-up time of 43 months (3-70).

Different demographic, morphometric variables (PADUA classification), intra and postoperative complications (Clavien classification), treatment of complications are collected. A descriptive analysis of the series was carried out, as well as the characteristics of the patients who developed AP.


Results :

 


The majority of patients were men (70%) with a median age of 62 years, with a Charlson index ≥3 and anticoagulation or antiaggregation in 15.4% of the patients respectively. The mean size of the renal tumor was 31.8 mm (15-70), being 39.8, 31.2 and 29% of low, medium and high complexity according to the PADUA classification, respectively.


A postoperative complication rate of 43% was observed, being higher (Clavien III-IV) in 15.8% of the series. Of the 18 patients with major complications, half were of vascular cause, with three cases of AP, with an appearance rate of 2.6%. The mean time of diagnosis of AP was 16.3 days after surgery, after debuting with macroscopic hematuria in two cases, the other case being asymptomatic. The treatment of vascular complications was performed in 55.6% (including AP) by selective arterial embolization.


Conclusions : The rates of complications and the appearance of AP after LPN in our series are similar to those described in the literature. Selective arterial embolization is a safe and minimally invasive treatment option for vascular complications such as AP.

Gema Del Pozo Jiménez

Staff Urologist
University Hospital Puerta de Hierro, Majadahonda.
Madrid, Madrid, Spain

1. EDUCATION:
- 2003-2009: Doctor of Medicine and Surgery (MD). University of Alcalá, Madrid, with a final grade of Honours.
- 2010-2015: Urology Residency. General University Hospital Gregorio Marañón, Madrid.
- 2013-2017: Degree in Design and Statistics in Health Sciences. Autonoma University of Barcelona.
- November, 2014: European Board of Urology (EBU) Online Written Examination. Madrid.
- June, 2015: European Board of Urology (EBU) Oral Examination. Brussels.
- 2013-2017: PhD. Complutense University of Madrid with mention of "Cum laude" with the title: Predictive model of mortality in patients with transitional bladder cancer treated with radical cystectomy.
- October 2017: Enrollment in the Master in Health Research Methodology. Autonoma University of Barcelona.
- January-May 2018: University Title of Expert in Urooncology of the Autonoma University of Madrid,
- Currently working as FEA of Urology since June 2015 in Puerta de Hierro University Hospital (Majadahonda), as well as a private activity in H.U. La Zarzuela and H. University H.M. Torrelodones.
2. - TEACHING:
• Practical teaching in the subject of Urology of the Autonoma University of Madrid in H.U.Puerta de Hierro (2015-2018).
• Online teaching as a professor in the course of laparoscopic and robotic radical cystectomy (1st Edition) of the European School of Urological Laparoscopy (2018).
3.-PUBLICATIONS IN JOURNALS: Five publications as author, four publications as co-author (three in Spanish Archives of Urology and one chapter of the Urology Resident's Book (Internet)) and four abstracts of European and world congresses, three as author and one as co-author (European Urology Supplements and Journal of Endourology).
4- COMMUNICATIONS PRESENTED AT NATIONAL CONGRESS: As author 32 papers: Eighteen papers and as co-author 36 co-author papers.
5- SUBMITTED VIDEOS IN CONGRESS: 14 videos as author and 6 videos as co-author.
6-COMMUNICATIONS/VIDEOS PRESENTED AT INTERNATIONAL CONGRESS: As author (9 presentations) and as co-author (4 presentations).

Ignacio T. Castillón Vela

Staff urologist
H.U. Puerta de Hierro. Majadahonda
Villaviciosa de Odón, Madrid, Spain

IGNACIO T. CASTILLÓN VELA M.D, PhD
Consultant Urologist. Department of Urology.
Hospital Universitario Puerta de Hierro Majadahonda
H.U. Madrid Torrelodones.
Director
Escuela Europea de Laparoscopia Urológica. Madrid
Schooloflaparoscopy.org


1984-1990 Doctor of Medicine. Universidad Autónoma de Madrid
1992-1997 Urology Residency. Department of Urology. Fundación Jiménez Díaz. Madrid.
1998. Certificate. Educational Comission for Foreign Medical Graduates (ECFMG).
2/1999- 1/2001 Clinical Fellow in Kidney and Pancreas Tansplantation
National Institute of Transplantation - St Vincent Medical Center. Departament of Urology. University of Southern California (USC). Los Ángeles, California. EEUU.
2001 PhD in Medicine and Surgery. Universidad Autónoma de Madrid.
2005-2006 Master in Medical Direction and Clinical Management Universidad Nacional de Educación a Distancia (UNED)
2008 University Expert Certificate in “E learning 2.0: Internet Education and On line training". Universidad Nacional de Educación a Distancia (UNED)
2009 Accreditation as Da Vinci Robot Console Surgeon.

Editor of 4 Books
Author in 5 chapters in urological Books
Editor/Author of 9 Audiovisual Projects
27 Articles in indexed Journals
85 Panel Presentations in Urological Meetings
114 Podium/Poster/Video presentations at urological meetings.

Reviewer for the following Journals:
- Archivos Españoles de Urología
- Urology
- Journal of Endourology
Reviewer for the selection commitee:
- Spanish AEU Annual Meeting
- European Association of Urology (EAU) Annual Meeting

Jorge Turo-Antona

University Hospital Puerta de Hierro, Majadahonda.
SERMAS
Madrid, Madrid, Spain

Jorge Turo Antona
Especialista en Urología
Facultativo Especialista en el Servicio de Urología del Hospital Universitario Puerta de Hierro de Majadahonda (Madrid)

Diego Rengifo-Abbad

University Hospital Puerta de Hierro, Majadahonda.
Madrid, Madrid, Spain

Esau Fernández Pascual

University Hospital Puerta de Hierro, Majadahonda.
Madrid, Madrid, Spain

Diego Marcos-Marín

University Hospital Puerta de Hierro, Majadahonda.
Madrid, Madrid, Spain

Joaquin Carballido-Rodríguez

University Hospital Puerta de Hierro, Majadahonda.
Madrid, Madrid, Spain