Endovascular Management of Iatrogenic Renal Vascular Injuries Complicating Percutaneous Nephrolithotripsy: Role of Renal Angiography and Superselective Coil Embolisation

Objective: To describe the use of renal angiography in the detection of renal vascular injuries following percutaneous nephrolithotripsy and to assess the efficacy of endovascular management of these complications. Methods: This was a retrospective review of 131 consecutive patients who underwent percutaneous nephrolithotripsy for renal calculi from January 2001 to July 2005. All patients who presented with significant postoperative haemorrhage were evaluated by renal angiography as a first-line diagnostic study, followed by superselective coil embolisation of identified renal vascular injuries at the same session. The mean follow-up period was 5.8 months (range, 1 to 17 months). The parameters assessed for each patient included preoperative investigation findings, surgical technique, clinical presentation following surgery, type of renal vascular injury identified, embolisation technique, and therapeutic outcome. Results: Five arterial lesions were diagnosed in 4 patients (3 men and 1 woman) with a mean age of 51.5 years (range, 45 to 62 years). Three pseudoaneurysms and 2 arteriovenous fistulas were identified. All patients were treated with superselective coil embolisation, with complete resolution of haemorrhage, no further clinical deterioration, and preservation of renal function. Conclusions: Renal vascular injury is a rare complication of percutaneous nephrolithotripsy. Early renal angiography and superselective coil embolisation can play an integral diagnostic and therapeutic role.