ABSTRACT

The decision for Transcatheter Embolization (TCE) which is the most ideal method for the management of the hemorrhagic complications after renal procedures is not accepted universally with variations among centers, and there is no exact cut- off value for its indication in the literature. Our aim in this study was to evaluate hemoglobin (Hb) cut-off values for the indication of TCE in the literature and try to formulate an algorithm for the management of hemorrhages after the renal procedures by TCE.

A total of 21 cases with complications of hemorrhage after an invasive renal procedure referred to our clinic and managed by TCE were analysed retrospectively. Our cases cases consisted of patients who had developed hemorrhagic complications following percutaneous nephrolithotomy (PNL, n=14) percuteneous renal biopsy (n=2) nephrostomy (n=2), open partial nephrectomy (n=2) and laparoscopic partial nephrectomy (n=1). Evaluation criteria were total blood transfusion volume for each case, average time after renal procedure to TCE management and hemoglobin values. All TCE procedures were done by using right femoral seldinger method for access and after superselective radiograms bleeding vascular structures were occluded with an suitable embolization agent.

The mean age of the 14 male and 7 female patients was 39.8±11.4. The mean time to TCE procedure t was 4.52±3.86 days (between 24 hours and 14 days).The average hemoglobin value was 8.8±1.3 mg/dl (between 5-11 mg/dl) for the patients referred to TCE. The average blood transfusion was 2.76±2.12 units (1-8 units).

In iatrogenic renal hemorrhages there is no consensus regarding grade IIIa indications according to Clavien classifications among different clinicians and there is no laboratuary and/or clinical cut off value detected. In our study, no matter what the postoperative bleeding velocity was, indication for TCE management is the lower hemoglobin value requiring blood transfusion (Clavien classification grade II).