|LETTER TO EDITOR
|Year : 2019 | Volume
| Issue : 2 | Page : 232-233
An urgent call for further study on endovascular management for renal trauma
Wesam T Abuznadah
Department of Surgery, College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, King Abdulaziz Medical City, Ministry of National Guard Health Affairs-Western Region, Jeddah, Saudi Arabia
|Date of Web Publication||4-Apr-2019|
Dr. Wesam T Abuznadah
Department of Surgery, King Abdulaziz Medical City, Ministry of National Guard Health Affairs-Western Region, P. O. Box: 12723, Jeddah 21483
|How to cite this article:|
Abuznadah WT. An urgent call for further study on endovascular management for renal trauma. Urol Ann 2019;11:232-3
I read with great interest the Saudi Urology Conferences abstract titled “Urology Trauma” (cited as Urology Trauma. Urol Ann 2016;8 Suppl S2:146-62) that was published 2 years ago in your esteemed journal to determine the clinical pattern in the management of blunt renal trauma among hospitals in Saudi Arabia. In this article, three retrospective studies (i.e., Yousef et al., Al Oraifi et al., and Benchekroun) showed that, since the year 1986 up to 2000, there were cases of blunt renal trauma that was not treated successfully by conservative methods and surgery. Several complications were also identified after the operation since then. Two decades had past and no follow-up studies ever made in Saudi Arabia to address the therapeutic problems in the above-mentioned treatment options. With these, I would like to draw the reader's attention and consideration about the endovascular treatment as an option that could solve the puzzle in improving the outcome in the management of blunt renal trauma based on the latest literature available.
To date, Beyer et al. extensively reported 27 case series of blunt renal trauma that was treated with endovascular intervention such as angioplasty and endovascular stenting. Based on the result of their study, 89% of those were treated as successful and concluded that the endovascular intervention is a feasible and reasonable choice for the treatment of blunt renal artery injury. However, due to the paucity in literature and rareness of blunt renal artery injuries, the described high success rate (89%) of endovascular treatment in this retrospective study is indeed not yet characterized and concluded for its effectiveness in the management of renal arterial injuries. This was demonstrated in the failure of endovascular treatment among the three of the patients (11%), of which 2 (7%) patients required embolization of the renal artery due to iatrogenic hemorrhage and 1 (4%) required nephrectomy for hypertension. Several literatures also described conflicting reports of failure and success of endovascular treatment for renal injuries based on the context of patients' hemodynamic status and grade of renal injury.,,,
Although endovascular treatment nowadays increasingly favored over the operative management, still, there was no concise recommendations in the literature about the advantage of endovascular intervention as compared to other approaches (i.e., conservative and surgery). With these, the utility of endovascular intervention as treatment of blunt renal artery injuries as compared to other approaches cannot be concluded until a case–control trial is done. Nevertheless, the role and technical aspect of endovascular intervention in the treatment guideline for blunt renal artery injuries must be clearly defined based on the set of clinical criteria to predict subsets of patients that need for endovascular intervention.
This letter, therefore, suggests for an urgent call for further study necessary to define the role of endovascular treatment in the management of traumatic blunt renal artery injury to optimize treatment outcomes and prevent morbidity and mortality associated with blunt renal injuries.
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Conflicts of interest
There are no conflicts of interest.
| References|| |
Beyer C, Zakaluzny S, Humphries M, Shatz D. Multidisciplinary management of blunt renal artery injury with endovascular therapy in the setting of polytrauma: A case report and review of the literature. Ann Vasc Surg 2017;38:318.e11-3.18E+18.
Santucci RA, Fisher MB. The literature increasingly supports expectant (conservative) management of renal trauma – A systematic review. J Trauma 2005;59:493-503.
Sangthong B, Demetriades D, Martin M, Salim A, Brown C, Inaba K, et al.
Management and hospital outcomes of blunt renal artery injuries: Analysis of 517 patients from the national trauma data bank. J Am Coll Surg 2006;203:612-7.
Natarajan B, Gupta PK, Cemaj S, Sorensen M, Hatzoudis GI, Forse RA, et al.
FAST scan: Is it worth doing in hemodynamically stable blunt trauma patients? Surgery 2010;148:695-700.
Brewer ME Jr., Strnad BT, Daley BJ, Currier RP, Klein FA, Mobley JD, et al.
Percutaneous embolization for the management of grade 5 renal trauma in hemodynamically unstable patients: Initial experience. J Urol 2009;181:1737-41.