Interventional radiology in renal vascular lesionss

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• Percutaneous Biopsies

• Percutaneous Nephrostomy (PCN)

• Percutaneous Renal Tumor Ablation (Using

Radiofrequency Or Cryoablation)

Occlude Pathological

Arteries

• Bleeding Arteries

• Arterio-venous Fistulae

• Tumour Feeding Artery

Restoring Caliber of Narrow

Arteries

Renal Angioplasty with or without Stent

Insertion

• Renal bleeding can occur after

abdominal trauma, which can be

blunt or penetrating.

• Penetrating trauma include iatrogenic trauma following percutaneous procedures such as biopsy, percutaneous nephrostomy and percutaneous nephrolithotomy

The end result of both blunt and penetrating/Iatrogenic traumas can be:

1. Pseudoaneurysm

2. AV Fistula

Both pseudoaneurysms and AV Fistulas can bleed around the injured kidney leading to retroperitoneal hematoma

Also both pseudoaneurysms and AV Fistulas can bleed into the collecting system when a concomitant injury to a calyx co-exists leading to hematuria

A 39 years old male with a right renal pseudoaneurysm after PCNL

45 years old male with a post-PCN massive hematuria

34 years old male with a post-nephrectomy swelling

• About 40 years ago arterial embolization was

introduced to facilitate the surgical excision of

the carcinomatous kidney or to palliate

symptoms, such as haemorrhage from non-

resectable tumours.

• The role of this technique as a therapeutic

procedure has been a source of debate in the

literature.

• Indications for embolization include:

1. Prophylaxis

2. Life-threatening hemorrhage

3. Recurrent flank pain

• Symptoms rarely occur in lesions measuring

less than 4 cm in contrast to those measuring 4

cm or larger, of which 80%– 90% are

symptomatic and 50%–60% bleed

spontaneously.

• Angiomyolipoma less than 4 cm can be managed

conservatively.

• Larger lesions are at greater risk of spontaneous bleeding

and are treated with Selective embolization particularly in

patients with multiple and bilateral disease.

• The basis of treatment for localized disease is surgical

resection, as the tumors are relatively resistant to

both radiotherapy and chemotherapy.

• Transarterial embolization (TAE) of renal tumours was

first described in 1973 as a preoperative aid to

resecting localized RCC and to palliate symptoms in

metastatic disease.

Pre-Operative:

• Decreases vascularity and hence bleeding.

• Creates edema to facilitate resection.

Palliative:

• Stops massive hematuria.

• Cytoreductive.

• Renovascular hypertension (RVHT)

denotes non-essential hypertension

in which a causal relationship exists

between anatomically evident

arterial occlusive disease and

elevated blood pressure.

• RVHT is the clinical consequence of

renin-angiotensin-aldosterone

activation as a result of renal

ischemia

• Renal artery stenosis (RAS) is a major

cause of RVHT. In older patients,

atherosclerosis is the most common

cause of RAS while Medial fibroplasia

(MFP), as a cause of RAS, usually affects

young to middle-aged adults, mostly

women, but it can also affect children.

• PTRA appears to be as

effective as open surgery for

the treatment of isolated renal

artery stenosis.

Thank

You