IMAGING EVALUATION OF IATROGENIC RENAL VASCULAR INJURIES AND THEIR ENDOVASCULAR MANAGEMENT

Objective: To study the role of USG Doppler, CT renal angiography in evaluation of iatrogenic renal vascular injuries and to assess the effectiveness & safety of endovascular intervention of Iatrogenic Renal Vascular Injuries (IRVIs). Materials and methods: A total of 23 patients with IRVIs were initially evaluated with USG Doppler followed by CT angiography and DSA was performed in 20 patients. Four out of 23 patients showed spontaneous resolution as confirmed by preprocedural USG Doppler. Endovascular embolization of IRVIs was performed using micro coils in 19 patients. Technical success was confirmed at the end of the procedure by a renal angiogram. The patients were followed up for a period of 6 months to assess the clinical success. Results: The most common cause of IRVI in our study was PCNL seen in 16(70%) patients followed by Partial Nephrectomy and PCN. All patients presented to us within 10-14 days of the etiological event with hematuria flank pain or drop in hematocrit. USG was able to detect IRVIs in the form of RAPs in 17(74%) and perirenal/intrarenal hematoma in 2(7%) cases. CT angiography was able to detect IRVIs in all the patients, however, additional aneurysms in two patients were not detected which were later seen on DSA renal angiography. Embolization was performed for 21 aneurysms in 19 patients using micro coils and showed 100 % technical and clinical success. Conclusion: USG Doppler and CT angiography play a very important role in diagnosis of iatrogenic renal vascular injuries. Endovascular embolization is an effective and safe method for management of injuries.