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Byon, Han, Jin, and Song: Risk Factors Related to Hemorrhage Necessitating Renal Artery Embolization after Percutaneous Nephrostomy
Interventional Radiology

Journal of the Korean Society of Radiology 2015; 73(6): 375-383.

Published online: 3 December 2015

DOI: https://doi.org/10.3348/jksr.2015.73.6.375

Risk Factors Related to Hemorrhage Necessitating Renal Artery Embolization after Percutaneous Nephrostomy

Jung Hee Byon, MD1, Young Min Han, MD1, 2, 3, Gong Yong Jin, MD1, 2, Ji Soo Song, MD1

1Department of Radiology, Chonbuk National University Hospital and Medical School, Jeonju, Korea.

2Research Institute of Clinical Medicine, Chonbuk National University Hospital and Medical School, Jeonju, Korea.

3Institute of Cardiovascular Research, Chonbuk National University Hospital and Medical School, Jeonju, Korea.

Corresponding author: Young Min Han, MD. Department of Diagnostic Radiology, Chonbuk National University Medical School and Hospital, 20 Geonji-ro, Deokjin-gu, Jeonju 54907, Korea. Tel. 82-63-250-1176 Fax. 82-63-272-0481, ymhan@jbnu.ac.kr

Received 3 April 2015       Revised 15 August 2015       Accepted 19 September 2015

Copyright © 2015 The Korean Society of Radiology

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To investigate risk factors related to severe bleeding necessitating renal artery embolization (RAE) after percutaneous nephrostomy (PCN).

Materials and Methods

36 patients who underwent RAE from January 2005 to June 2014 were retrospectively reviewed. Among them, 10 patients underwent embolization because of severe bleeding after PCN (bleeding group). From 1762 patients who underwent PCN in the same period, we selected 21 patients who underwent PCN without bleeding after the procedure (non-bleeding group). We investigated possible related risk factors, such as the presence of underlying diseases, activated partial thromboplastin time (aPTT), prothrombin time (PT), platelet count, puncture site, procedure time, size of the kidney, distance from skin to renal cortex, maximum caliber of the indwelling catheter, parenchymal thickness, and grade of hydronephrosis. We used Fisher's exact test and independent t test for data analyses.

Results

We classified hydronephrosis as either 'mild hydronephrosis,' or 'moderate or severe hydronephrosis.' The frequency of mild hydronephrosis was 80.0% (8/10) in the bleeding group and 33.3% (7/21) in the non-bleeding group (p = 0.023). There were no significant differences between the two groups in the incidence of underlying diseases. Similarly, other risk factors (PT, aPTT, platelet count, procedure time, distance from skin to renal cortex, maximum caliber of the indwelling catheter, kidney size, and parenhcymal thickness) also did not differ significantly between the two groups.

Conclusion

Mild hydronephrosis is a risk factor for severe bleeding necessitating RAE after PCN. Therefore, when performing PCN, careful attention should be paid to patients with mild hydronephrosis.

Keywords: Percutaneous Nephrostomy, Bleeding, Renal Artery, Embolization, Therapeutic, Hydronephrosis

Figures and Tables

Fig. 1

A 47-year-old woman with a left staghorn stone (arrow).

A. The grade of hydronephrosis is 0 because there is no forniceal or calyceal dilatation.
B. Contrast medium is administered intravenously to visualize the pelvocalyceal system.
C. The patient had excessive hematuria 3 days after percutaneous nephrolithotomy. Pseudoaneurysm of interlobar artery (arrow) is detected on a renal arteriography.
jksr-73-375-g001
Fig. 2

An 83-year-old man with bladder cancer with invasion of the right distal ureter.

A. The grade of hydronephrosis is 1 (arrow) because there is mild dilatation of the pelvis without dilatation of calyces.
B. Successful percutaneous nephrostomy was performed in the mid to low pole. Dilated calyces (arrow) are filled with contrast media.
C. Renal arteriography is performed because of persistent hematuria. Pseudoaneurysm (arrow) is detected in the low pole on the renal arteriography.
D. Arteriovenous fistula (AVF) (arrow) is also discovered at selective angiogarphy.
E. Psuedoaneurysm and AVF lesions are devascularized after coil embolization.
jksr-73-375-g002
Fig. 3

A 78-year-old man with right distal ureteral stricture. The patient exhibited excessive hematuria after the procedure.

A. The grade of hydronephrosis is 2 (arrow) because there is mild dilatation of the pelvis and calyces.
B. Successful percutaneous nephrostomy was performed in the low pole.
C. Hemorrhage in perinephric space of right kidney (arrow) is detected by abdominal CT following the procedure.
D. Two arteriovenous fistulae of the interlobar artery (arrows) are present in the low pole of the right kidney.
E. The feeding vessels are devascularized after coil embolization (arrows).
jksr-73-375-g003
Fig. 4

A 69-year-old woman with cervical cancer given bilateral D-J stents for double-sided ureteral invasion.

A. Malfunction of both D-J stents was suggested. The grade of hydronephrois is 3 in the right kidney (arrow) and 4 in the left kidney (arrowhead).
B. After removal of both D-J stents with snares, percutaneous nephrostomy was performed successfully. A filling defect caused by hematoma is discovered in the right pelvocalyceal system (arrow).
C. Upon renal arteriography, a pseudoaneurym of an interlobar artery (arrow) is discovered in the low pole of the right kidney.
D. The feeding vessel is devascularized after coil embolization (arrow).
jksr-73-375-g004
Table 1

Clinical Information of Two Groups

jksr-73-375-i001
Bleeding Group
(n = 10)		 Non-Bleeding Group
(n = 21)		 p-Value
Age* 67 (range from 47 to 83 years) 70.8 (range from 58 to 86 years) 0.408
Sex (male:female)† 6:4 12:9 1.000
Underlying disease†
 HTN 5 (50.0%) 11 (52.4%) 0.901
 DM 2 (20.0%) 4 (19.0%) 1.000
 Vasculitis 0 0
Bleeding tendency*
 PLT (K) 198.8 (SD 61.7) 224.5 (SD 140.1) 0.493
 PT (sec) 12.1 (SD 1.6) 13.1 (SD 3.6) 0.101
 PT (INR) 1.1 (SD 0.1) 1.2 (SD 0.3) 0.069
 aPTT (sec) 30.3 (SD 6.0) 33.9 (SD 0.2) 0.312

*Independent t-test.

†Fisher's exact test.

aPTT = activated partial thromboplastin time, DM = diabetes mellitus, HTN = hypertension, INR = international normalized ratio, PLT = platelet count, PT = prothrombin time, SD = standard deviation

Table 2

Comparison of Hydronephrosis, Kidney Size and Caliber Size of Catheters Used between Two Groups

jksr-73-375-i002
Bleeding Group
(n = 10)		 Non-Bleeding Group
(n = 21)		 p-Value
Hydronephrosis 0.023
 ≥ Grade 3 2 (20%) 14 (66.7%)
 < Grade 3 8 (80%) 7 (33.3%)
Kidney size (cm) 9.83 ± 2.06 10.40 ± 1.16 0.078
Caliber size (Fr) 0.172
 ≥ 20 4 (40%) 3 (14.3%)
 < 20 6 (60%) 18 (85.7%)

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