Contemporary comparison of surgical and interventional arteriography management of blunt renal injury

Purpose: High-grade renal injuries have traditionally been treated operatively. Alternatively, embolotherapy is used to control hemorrhage, but there are few studies that validate this practice after renal injury. Embolotherapy may offer an effective and safe means to arrest hemorrhage after high-grade blunt renal injury. Materials and Methods: Retrospective analysis was performed of high-grade renal injury (grade III or higher). Patients who were initially treated with arteriography were compared with those who underwent surgery. Statistical analysis was performed with Wilcoxon rank-sum and χ² tests. Results: Sixty-nine patients were identified, 28 of whom had contrast agent extravasation on computed tomography (CT). Of these 69 patients, 17 underwent operation and 20 underwent arteriography. The surgical cohort had a higher injury severity score (39.6 vs 24.2; P < .01), but there was no difference in renal injury grade (P = .9). The arteriography cohort received significantly more contrast medium (P < .001). Contrast agent extravasation was confirmed angiographically in six of 12 patients who had this finding on CT, and embolotherapy controlled bleeding in all six. No significant difference was noted in transfusion need, recurrent hemorrhage, creatinine level at discharge, glomerular filtration rate, or length of stay (P > .4 for each endpoint). There was a trend toward a longer stay in the intensive care unit in the surgical cohort and a higher likelihood of discharge to home in the arteriography group (P = .08 for each endpoint). Conclusions: Embolotherapy offers a safe means to diagnose and arrest hemorrhage after renal injury. The additional contrast agent needed for imaging does not increase the incidence of nephropathy irrespective of renal injury grade.