Embolization offers safe and effective option for high-grade kidney injuries
An interventional radiology procedure may offer a safer alternative to surgery for trauma patients with high-grade kidney injuries, according to new research published in the Journal of Vascular and Interventional Radiology.
The kidney is the most commonly injured genitourinary organ and is involved in approximately 10% of trauma cases. Acute kidney injury following trauma can have consequences beyond the initial hospitalization, with some patients progressing to chronic disease and facing increased cardiovascular morbidity and risk of end-stage renal disease. As such, decisions related to the treatment of these injuries are of critical importance.
The study’s findings suggest that embolization may offer better short- and long-term outcomes than nephrectomy for initially stable patients with such injuries. In a cohort of 849 trauma patients with serious kidney injuries, embolization resulted in significantly fewer treatment-related adverse effects compared to nephrectomy.
This, experts involved in the analysis contend, warrants consideration in stable patients with high-grade renal injuries.
“Our findings show that embolization is safe, effective and associated with better outcomes than nephrectomy for this patient cohort in both the near- and long-term,” Waseem Wahood, MD, MS, the paper’s lead author and an interventional radiology resident with the University of Miami Miller School of Medicine, said in a news release from the Society of Interventional Radiology.
For their study, researchers compared outcomes among 849 patients with American Association for the Surgery of Trauma (AAST) grade 3-4 renal injuries recorded in the Trauma Quality Improvement Program (ACS-TQIP) national registry from 2017 through 2022. Of the patients studied, 469 (55%) underwent embolization, while 380 (45%) underwent nephrectomy.
Nephrectomy was associated with significantly higher rates of in-hospital mortality and acute kidney injury compared with embolization. In-hospital mortality occurred in 17% of patients who underwent nephrectomy compared with 5% of those treated with embolization, while acute kidney injury occurred in 15% and 4%, respectively.
The nephrectomy group also experienced higher rates of several other complications. Cardiac arrest requiring cardiopulmonary resuscitation occurred in 9% of patients following nephrectomy versus 2% after embolization. Unplanned return to the operating room occurred in 12% versus 4%, while severe sepsis occurred in 3% versus 1%. Myocardial infarction, deep surgical site infection and superficial incisional surgical site infection also were more common among patients who underwent nephrectomy.
By controlling hemorrhage while also avoiding removing the injured kidney, the approach could reduce the risk of acute and potentially chronic kidney disease, the authors suggested.
“By reducing the risks of acute kidney injury, embolization may help avoid chronic illness for these patients,” Wahood said. “While additional prospective work is needed to validate these findings, our initial analysis demonstrates that a renal-preservation strategy with embolization should be considered for initial management of stable patients with high-grade renal trauma.”
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In addition to her background in journalism, Hannah also has patient-facing experience in clinical settings, having spent more than 12 years working as a registered rad tech. She began covering the medical imaging industry for Innovate Healthcare in 2021.