Trauma/Reconstruction/Diversion Selective Transarterial Embolization for Posttraumatic Renal Hemorrhage: A Second Try is Worthwhile Johannes Huber,* Sascha Pahernik, Peter Hallscheidt, Christof M. Sommer, Nina Wagener, Gencay Hatiboglu, Axel Haferkamp and Markus Hohenfellner† From the Departments of Urology and Radiology (PH, CMS), University of Heidelberg, Heidelberg, Germany Purpose: Selective percutaneous transarterial embolization has proved to be effective, safe treatment for posttraumatic renal hemorrhage but inefficacious procedures often lead to nephrectomy. Thus, the success rate of transarterial embolization should be maximized. Material and Methods: We retrospectively investigated the clinical success rate of transarterial embolization for posttraumatic bleeding. Study inclusion criteria were imaging evidence and clinical signs of hemorrhage or a hemoglobin decrease of more than 2 gm/dl in urological cases. We excluded spontaneous bleeding from analysis. Results: A total of 21 patients with a median age of 66 years (range 12 to 78) met study inclusion criteria. Etiology was blunt trauma in 3 cases (14%), stab wound in 1 (5%) and an iatrogenic cause in 17 (81%). In 2 patients an active bleeding site could not be detected during selective angiography. Transarterial embolization was done in 19 patients and led to primary clinical success in 12 (63%), including 2 with grade V parenchymal injury. In 6 of 7 cases (86%) in which primary treatment failed transarterial embolization was repeated. It resulted in clinical success in 4 of 6 patients (67%) with equal efficiency (p =1). Three patients (16%) who could not be sufficiently treated with transarterial embolization underwent nephrectomy. Conclusions: When conservative measures fail and clinical symptoms or a rele- vant hemoglobin decrease occur, transarterial embolization should be considered. Since the success rate is equally high for initial and repeat interventions, re- intervention is justified when the clinical course allows. Key Words: kidney; wounds and injuries; hemorrhage; embolization, therapeutic; reoperation Abbreviations and Acronyms CT = computerized tomography GFR = glomerular filtration rate NSS = nephron sparing surgery TAE = selective transarterial embolization Submitted for publication August 21, 2010. * Correspondence: Department of Urology, University of Heidelberg, Im Neuenheimer Feld 110, D-69120 Heidelberg, Germany (telephone: +49(0)6221-5636341; FAX: +49(0)6221-565366; e-mail: johannes.huber@med.uni-heidelberg.de). † Financial interest and/or other relationship with Allergan, APPY and Palatin. RETROPERITONEAL bleeding is a poten- tially life threatening event that de- mands rapid multimodal treatment. It can occur spontaneously as a result of impaired coagulation 1 or secondary to anatomical malformations, such as renal angiolipoma. 2 However, post- traumatic bleeding is more common and more important for urologists. 3 Most trauma is blunt while penetrat- ing injuries such as gunshot and stab wounds tend to be more severe. Each mechanism is also found in urological interventions. 3 Selective TAE has proved to be ef- fective, safe treatment for posttrau- matic renal hemorrhage when conser- vative measures fail. 4,5 Although high success rates of greater than 70% have been reported, further treatment esca- lation often leads to nephrectomy after inefficacious procedures. 3,6 Thus, the 0022-5347/11/1855-1751/0 Vol. 185, 1751-1755, May 2011 THE JOURNAL OF UROLOGY ® Printed in U.S.A. © 2011 by AMERICAN UROLOGICAL ASSOCIATION EDUCATION AND RESEARCH,INC. DOI:10.1016/j.juro.2010.12.045 www.jurology.com 1751