Factors Predictive of Selective Angioembolization Failure for Moderate- to High-grade Renal Trauma: A French Multi-institutional Study
| Autor: | C. Millet, Thomas Caes, A. Chebbi, Charles Dariane, Lucas Freton, Ines Dominique, N. Szabla, J. Rizk, Marina Ruggiero, Benoit Peyronnet, François-Xavier Madec, Benjamin Pradere, François-Xavier Nouhaud, Bastien Gondran-Tellier, R. Betari, P. Patard, Gaelle Fiard, M. Hutin, X. Rod, Jonathan Olivier, X. Matillon, Cedric Lebacle, Paul Panayotopoulos, S. Bergerat, Michael Baboudjian, L. Sabourin |
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| Rok vydání: | 2020 |
| Předmět: |
medicine.medical_specialty
Urology medicine.medical_treatment 030232 urology & nephrology Logistic regression Kidney Wounds Nonpenetrating Nephrectomy 03 medical and health sciences 0302 clinical medicine parasitic diseases Medicine Humans In patient Embolization Patient summary Hematuria Retrospective Studies medicine.diagnostic_test business.industry Odds ratio Confidence interval Surgery 030220 oncology & carcinogenesis Angiography business |
| Zdroj: | European urology focus. 8(1) |
| ISSN: | 2405-4569 |
| Popis: | Background Angiography with selective angioembolization (SAE) is safe and effective in addressing bleeding in patients with renal trauma. However, there are no validated criteria to predict SAE efficacy. Objective To evaluate factors predictive of SAE failure after moderate- to high-grade renal trauma. Design, setting, and participants TRAUMAFUF was a retrospective multi-institutional study including all patients who underwent upfront SAE for renal trauma in 17 French hospitals between 2005 and 2015. Outcome measurements and statistical analysis The primary outcome was SAE efficacy, defined as the absence of repeat SAE, salvage nephrectomy, and/or death for each patient. Results and limitations Out of 1770 consecutive patients with renal trauma, 170 (9.6%) with moderate- to high-grade renal trauma underwent SAE. Overall upfront SAE was successful in 131 patients (77%) and failed in 39 patients: six patients died after the embolization, ten underwent repeat SAE, 22 underwent open nephrectomy, and one underwent open surgical exploration. In multivariate logistic regression analysis, gross hematuria (odds ratio [OR] 3.16, 95% confidence interval [CI] 1.29–8.49; p = 0.015), hemodynamic instability (OR 3.29, 95% CI 1.37–8.22; p = 0.009), grade V trauma (OR 2.86, 95% CI 1.06–7.72; p = 0.036), and urinary extravasation (OR 3.49, 95% CI 1.42–8.83; p = 0.007) were predictors of SAE failure. The success rate was 64.7% (22/34) for patients with grade V trauma and 59.6% (31/52) for those with hemodynamic instability. The study was limited by its retrospective design and the lack of a control group managed with either surgery or surveillance. Conclusions We found that gross hematuria, hemodynamic instability, grade V trauma, and urinary extravasation were significant predictors of SAE failure. However, success rates in these subgroups remained relatively high, suggesting that SAE might be appropriate for those patients as well. Patient summary Selective angioembolization (SAE) is a useful alternative to nephrectomy to address bleeding in patients with renal trauma. Currently, there are no validated criteria to predict SAE efficacy. We found that gross hematuria, hemodynamic instability, grade V trauma, and urinary extravasation were significant predictors of SAE failure. |
| Databáze: | OpenAIRE |
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