La radiologia medica
Are iatrogenic renal artery pseudoaneurysms more challenging
to embolize when associated with an arteriovenous stula?
· Stefano Gro
· Michele Battistel
· Andrea Casarin
· Alessandro Guarise
· Diego Miotto
Received: 5 March 2018 / Accepted: 20 May 2018
© Italian Society of Medical Radiology 2018
Background Iatrogenic injuries of the renal artery include pseudoaneurysms (PSA) and pseudoaneurysms with arteriovenous
ﬁstula (PSA + AVF). They can cause hematuria, anemization and ﬂank pain. Endovascular treatment is recommended due
to its eﬀectiveness.
Objective To assess the potential diﬀerence between the embolization of iatrogenic renal PSA and iatrogenic renal
PSA + AVF, in terms of technical and clinical success rate, procedure complexity and impact on the renal function.
Methods We retrospectively reviewed 30 embolization procedures of iatrogenic renal PSA and renal PSA + AVF in 27
patients in two centers between December 2006 and February 2017, comparing technical and clinical success rate, total
procedural time, creatinine before and after the procedure and parenchymal ischemic area after the procedure. All patients
underwent CT before embolization procedure and diﬀerent embolization materials were used.
Results We identiﬁed 15 iatrogenic renal PSA and 15 iatrogenic renal PSA + AVF (causes: 23 nephron-sparing surgery, 2
nephrostomies, 1 lithotripsy, 1 ureteroscopic pyelolithotomy, 1 renal biopsy). Microcoils were used in 21 cases, microcoils
and Spongostan in 3 cases, microcoils and controlled-release microcoils in 4 cases and controlled-release microcoils in 1
case. No signiﬁcant statistical diﬀerences were found in the comparison of technical and clinical success rate, total procedural
time, creatinine and parenchymal ischemic area after the procedure.
Conclusions Transarterial embolization can be considered as the ﬁrst-line treatment for renal artery iatrogenic lesions, con-
sidering its eﬀectiveness. No statistical signiﬁcant diﬀerences were found in the comparison of the embolization procedures
of iatrogenic renal PSA and PSA + AVF.
Keywords Iatrogenic pseudoaneurysm · Arteriovenous ﬁstula · Transarterial embolization · Endovascular treatment
The most common causes of renal hematuria are iatrogenic
(i.e., biopsy, percutaneous nephrolithotomy, percutaneous
nephrostomy, nephron sparing surgery, guide wire induced
arterial perforation) and non-iatrogenic (i.e., angiomyolipo-
mas, cancer, vascular lesions as arteriovenous malformations
and ﬁstulas, trauma, spontaneous bleeding, medical renal
diseases as end-stage renal disease).
Pseudoaneurysm (PSA) and arteriovenous ﬁstula (AVF)
are the most common iatrogenic renal artery lesions that
A PSA does not comprise all vessel wall layer and it
arises from a vessel wall disruption, resulting in an abnormal
ﬂow between the intima and media (dissection) or limited
only by adventitia or by surrounding tissues (rupture).
* Giulio Barbiero
Radiologia Universitaria, Dipartimento di Medicina,
Università di Padova – Azienda Ospedaliera di Padova, Via
Giustiniani 2, 35128 Padua, PD, Italy
Radiology, Department of Radiology, St. Bassiano Hospital,
46 Via dei Lotti, 36061 Bassano del Grappa, VI, Italy