Angiographic Findings and Embolotherapy in Renal Arterial Trauma Constantinos T. Sofocleous, 1 Clay Hinrichs, 1 Basil Hubbi, 2 Elias Brountzos, 3 Sanjeev Kaul, 4 George Kannarkat, 2 Philip Bahramipour, 1 Alison Barone, 1 Daniel G. Contractor, 1 Tanmaya Shah 2 1 Section of Vascular & Interventional Department of Radiology, University of Medicine and Dentistry of New Jersey UMDNJ-Newark, Newark, New Jersey, USA 2 New Jersey Medical School, University of Medicine and Dentistry of New Jersey UMDNJ-Newark, Newark, New Jersey, USA 3 Second University Department of Radiology School of Medicine, National and Kapodistrian University of Athens, Athens, Greece 4 Trauma Center Department of Surgery, University of Medicine and Dentistry of New Jersey UMDNJ-Newark, Newark, New Jersey, USA Abstract Purpose: To evaluate the angiographic findings and embo- lotherapy in the management of traumatic renal arterial in- jury. Methods: This is a retrospective review of 22 patients with renal trauma who underwent arteriography and percutane- ous embolization from December 1995 to January 2002. Medical records, imaging studies and procedural reports were reviewed to assess the type of injury, arteriographic findings and immediate embolization results. Long-term clinical outcome was obtained by communication with the trauma physicians and by clinical chart review. Results: Arteriography was performed in 125 patients admitted to a State Trauma Center with suspected internal bleeding. Renal arterial injury was documented in 22 and was the result of a motor-vehicle accident (10), auto–pe- destrian accident (1), gunshot (4) or stab wounds (6) and a fall (1). Percutaneous renal arterial embolization was undertaken in 22 of 125 (18%) patients to treat extravasation (11), arterial pedicle rupture (5), abnormal arteriovenous (3) or arteriocalyceal (2) communication and pseudoaneurysm (3). One of the pseudoaneurysms and one of the arteriove- nous fistulae were found in addition to extravasation. All 22 patients (16 men, 6 women) were hemodynamically stable, or controlled during arteriography and embolotherapy. Selective and/or superselective embolization of the abnor- mal vessels was performed using coils in 9 patients, mi- crocoils in 9 patients and Gelfoam pledgets in 3 patients. In one patient Gelfoam pledgets mixed with polyvinyl alcohol (PVA) particles were used for embolization. Immediate angiographic evidence of hemostasis was demonstrated in all cases. Two initial technical failures were treated with repeat arteriography and embolization. There was no pro- cedure-related death. There was no non-target embolization. One episode of renal abscess after embolization was treated by nephrectomy and 3 patients underwent elective post- embolization nephrectomy to prevent infection. Follow-up ranged from 1 month to 7 years (mean 31 months). No procedure-related or delayed onset of renal insufficiency occurred. Conclusion: In hemodynamically stable and controlled pa- tients selective and superselective embolization is a safe and effective method for the management of renal vascular in- jury. Key words: Embolization—Aneurysm—Arterial injuries —Arteriography—Renal trauma—Arteriovenous fistula— Angiography—Extravasation—Arterial bleeding Non-iatrogenic renal arterial injury is a potentially life- threatening emergency that can require immediate diagnosis and therapeutic intervention. Injury can occur secondary to stab and gunshot wounds, falls, motor-vehicle accidents (MVAs) and auto–pedestrian accidents. Aortography in conjunction with selective and superselective renal arteri- ography with subsequent embolization has emerged as an alternative method to surgical management [1–8]. A small number of series have described the utilization of renal arterial embolization in patients with vascular renal injuries secondary to iatrogenic and non-iatrogenic trauma [1–8]. This report describes our experience with the use of Correspondence to: C.T. Sofocleous, M.D., Weill Medical College, Cornell University, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, New York, USA; email: constant@pol.net ª Springer Science+Business Media, Inc. 2005 Published Online: 26 October 2004 CardioVascular and Interventional Radiology Cardiovasc Intervent Radiol (2005) 28:39–47 DOI: 10.1007/s00270-004-0042-4