Renal Arterial Injuries: A Single Center Analysis of Management Strategies and Outcomes Sean P. Elliott, Ephrem O. Olweny and Jack W. McAninch * From the.

Slides:

Advertisements

Similar presentations

Jamaica Hospital Trauma Conference July 21st, 2014 Greg Eckenrode

Advertisements

Does Preoperative Hemoglobin Value Predict Postoperative Cardiovascular Complications after Total Joint Arthroplasty? Kishor Gandhi MD, MPH, Eugene Viscusi.

KAREN L. WALKER MS JONATHAN J. SHUSTER PHD THOMAS M. BEAVER MD, MPH DIVISION OF THORACIC AND CARDIOVASCULAR SURGERY DIVISION OF BIOSTATISTICS UNIVERSITY.

Therapeutic Penetrating Keratoplasty in Fungal Keratitis: Prospective Study Sonika Gupta Consultant Ophthalmology Max Eye Care New Delhi, India Author.

TXA in trauma patients: who should we treat and when?

Renal Trauma Dr. Mohammad Amin K Mirza Presented By

TEVAR is Superior to Open Repair for Blunt Aortic Injury Royce Calhoun, MD, Stephanie Mayberg, PA-C, Bill Pevec, MD, Danh Nguyen, PhD^, Lisa Mu^ J. Nilas.

Urogenital Trauma Liping Xie

Outcome of angioembolisation for blunt renal trauma in haemodynamically unstable patients: 10 year analysis of Queensland Public hospitals ) Introduction.

The Long-Term Intervention with Pravastatin in Ischemic Disease (LIPID) The LIPID Study Group N Engl J Med 1998;339:

In a patient who has sustained blunt trauma who is found to have an occult pneumothorax on CT scan, is tube thoracostomy better than observation at reducing.

PRAGUE-6 Trial Off-Pump Versus On-Pump Coronary Artery Bypass Graft Surgery in Patients With EuroSCORE ≥6.

5 Years Results of Off-Pump VS On-Pump CABG 5 Years Results of Off-Pump VS On-Pump CABG Prospective Non-randomized Comparative Study Piya Cherntanomwong*,

To and Fro Splenorrhaphy

Open Repair of Ruptured Descending Thoracic and Thoracoabdominal Aortic Aneurysms in 100 Consecutive Cases Mario F. Gaudino, Christopher Lau, Monica Munjal,

Copyright restrictions may apply Impact of Cleft Width in Clefts of Secondary Palate on the Risk of Velopharyngeal Insufficiency Lam DJ, Chiu LL, Sie KCY,

George W. Holcomb, III, M.D., MBA Children’s Mercy Hospital

Simultaneous Coronary Artery Bypass and Carotid Endarterectomy Ye zhidong, Liu Peng Department of Cardiovascular Surgery China-Japan Friendship Hospital.

Complete Recovery of Renal Function After Acute Kidney Injury is Associated with Long-Term All-Cause Mortality In a Large Managed Care Organization Jennifer.

Intensive versus Conventional Glucose Control in Critical Ill Patients N Engl J Med 2009; 360: 雙和醫院劉慧萍藥師.

Management of Rib Fractures. Clinical Anatomy 12 pairs of ribs Attach posteriorly to vertebrae Rib 8-12 are “false ribs” Ribs 1-3 are relatively well.

Early surgery for proximal femoral fractures is associated with lower complication and mortality rates Parag Kumar Jaiswal Arthroplasty Fellow.

P Narayan, A Wong, I Davies, A J Bryan, P Wilde, G J Murphy Does TEVAR provide a financial benefit for management of descending thoracic aortic pathologies?

Endarterectomy versus Stenting in Patients with Symptomatic Severe Carotid Stenosis Dr. Quan, Dr. Mirhashemi, Dr. Chiang N Engl J Med 2006; 355:

Conservative Management of Penetrating Renal Injuries Aaron Smith, DO Efraim Serafetinides, MD Richard A. Santucci, MD.

Evaluation of craniocerebral traumatisms treated at the Mures County Emergency Hospital between Author: Duka Ede-Botond Supervisor: PhD Dr. Madaras.

The Role of Thromboprophylaxis in Elective Spinal Surgery The Role of Thromboprophylaxis in Elective Spinal Surgery VA Elwell, N Koo Ng, D Horner & D Peterson.

CPORT- E Trial Randomized trial comparing outcomes of non-primary PCI at hospitals with and without on-site cardiac surgery.

Randomized Trial of Ea rly S urgery Versus Conventional Treatment for Infective E ndocarditis (EASE) Duk-Hyun Kang, MD, PhD on behalf of The EASE Trial.

Factors Associated with Survival in HIV-Infected African Patients on Antiretroviral Therapy: The Impact of a Sampling-Based Approach to Address Losses.

Journal Club : Relationship between Intraoperative Mean Arterial Pressure and Clinical Outcomes after Noncardiac Surgery Toward an Empirical Definition.

Arezou Yaghoubian MD, Amy H. Kaji MD PhD, Brant Putnam MD and Christian de Virgilio MD.

TEMPLATE DESIGN © Objectives Methods This was a retrospective cohort data analysis of all women who presented with menorrhagia.

A comparison of open vs laparoscopic emergency colonic surgery; short term results from a district general hospital. D Vijayanand, A Haq, D Roberts, &

PJ Devereaux, Population Health Research Institute, Hamilton, Canada on behalf of POISE-2 Investigators PeriOperative ISchemic Evaluation-2 Trial POISE-2POISE-2.

HEART TRANSPLANTATION Pediatric Recipients 2014 JHLT Oct; 33(10):

Objective To assess the impact of the increasing use of MDCT angiography in the setting of blunt and penetrating neck trauma on the use of digital subtraction.

Addenbrooke’s Hospital Rosie Hospital INTRODUCTION The cumulative incidence of chronic renal impairment in intestinal transplantation is 0.25 at 72 months;

High Dose Rate Brachytherapy Boost for Prostate Cancer: Comparison of Two Different Fractionation Schemes Tania Kaprealian 1, Vivian Weinberg 3, Joycelyn.

Blunt Aortic Injury with Concomitant Intra-abdominal Solid Organ Injury: Treatment Priorities Revisited Santaniello J, et al, The Journal of TRAUMA Injury,

Tuesday’s breakfast Int. 林泰祺. Introduction Maxillofacial injuries in isolation or in combination with other injuries account for a significant percentage.

4S: Scandinavian Simvastatin Survival Study

Preoperative Hemoglobin A1c and the Occurrence of Atrial Fibrillation Following On-pump Coronary Artery Bypass surgery in Type-2 Diabetic Patients Akbar.

Pre transplant nephrectomy , our experience in Prince Hussien Center of Urology and Organ transplantation By : Dr. Ghaith Gsous third year general surgery.

External Fixation or Arteriogram in Bleeding Pelvic Fracture: Initial Therapy Guided by Markers of Arterial Hemorrhage 高雄醫學大學外傷科晨間論文研讀 Mar. 24, 2003 The.

Radical vs Partial Nephrectomy for treatment of renal cell carcinoma at Prince Hussein Urology Centre Dr. Mohammad Alserhan Urology specialist Prince Hussein.

Department of Cardiothoracic and Vascular Surgery 1 School of Public Health 2 The University of Texas Medical School at Houston Memorial Hermann Heart.

Injury profile of deer- vehicle collisions Theresa D. Oey-Devine, M.D., James M. Haan, M.D., Stephen D. Helmer, Ph.D. Department of Surgery, The University.

Renal Trauma Dr. Ibrahim Barghouth. Background 1-5% of all traumas Male to female ratio 3:1 Mechanism is classified as blunt or penetrating blunt trauma.

INTRODUCTION METHODS RESULTS DISCUSSION Sam Simmonds prize 17 th May,2013 Sohail Yousaf Will Kieffer Benedict Rogers Iain McFadyen David Ricketts Management.

Traumatic arterial injuries: endovascular treatment Martha A. Quiodettis May 25, 2010.

The JUPITER Trial Reference Ridker PM. Rosuvastatin to prevent vascular events in men and women with elevated C-reactive protein. N Engl J Med. 2008;359:2195–2207.

Ten Year Outcome of Coronary Artery Bypass Graft Surgery Versus Medical Therapy in Patients with Ischemic Cardiomyopathy Results of the Surgical Treatment.

Alcohol dependence is independently associated with sepsis, septic shock, and hospital mortality among adult ICU patients Crit Care Med 2007 ; 35 :

INTRODUCTION: Post operative pulmonary hypertension (PH) complicates 2 % of patients undergoing cardiac surgery with pulmonary hypertensive crises (PHC)

INTRODUCTION. The annual incidence of liver transplant outcomes in South America has been unknown. So far direct correlations have been reported between.

Grubnik V.V., Baydan V.V., Severgin V.E., Grubnik V.Yu., ROLE OF VIDEO- THORACOSCOPY IN CLOSED CHEST TRAUMAS.

Kidney and Ureters Trauma

COMBINED PHACOEMULSIFICATION AND TRANS-SCLERAL CYCLOPHOTOCOAGULATION

Single IMA {Single Arterial}

Patients Characteristics

Lako S, Daka A, Nurka T, Dedej T, Memishaj S

Georgia Society of the American College of Surgeons, Day of Trauma

Thirty-day Readmissions Following CABG Surgery in New York JACC: Cardiovascular Interventions 2011;4(5): Hannan EL, Zhong Y, Lahey SJ, Culliford.

Open Repair of Ruptured Descending Thoracic and Thoracoabdominal Aortic Aneurysms in 100 Consecutive Cases Mario F. Gaudino, Christopher Lau, Monica Munjal,

Traumatic Wound Dehiscence After Corneal Keratoplasty

Diffusion of new technology for the treatment of renovascular hypertension in the United States: Surgical revascularization versus catheter-based therapy,

Bernardino C. Branco, MD, Joseph J. DuBose, MD, Luke X

Thomas A. Simone, MD, Benjamin S. Brooke, MD, PhD, Philip P

Urogenital Trauma Liping Xie

Presentation transcript:

Renal Arterial Injuries: A Single Center Analysis of Management Strategies and Outcomes Sean P. Elliott, Ephrem O. Olweny and Jack W. McAninch * From the Department of Urologic Surgery, University of Minnesota, Minneapolis, Minnesota, and Department of Urology, University of California-San Francisco and San Francisco General Hospital (EOO, JWM), San Francisco, California Vol. 178, , December 2007 THE JOURNAL OF UROLOGY. DOI: /j.juro

Purpose

Renal injury occurs in up to 1.2% of trauma cases in the United States. Only 2.5% to 4% of these cases involves the renal vasculature Renovascular injuries are associated with multiple non-renal organ injuries and with a high mortality rate of 19% to 44% Management of main and segmental renal artery injury following external trauma is controversial After main renal artery injury the controversy surrounds nephrectomy vs revascularization whereas after segmental renal artery injury the debate involves operative vs nonoperative management

Materials and Methods

Data on a total of 82 renal artery injuries in 81 patients collected between 1978 and 2006 They were retrospectively reviewed Patient demographics, length of stay, transfusion requirements and injury characteristics (artery subtype, grade, mechanism, and associated parenchymal, venous and nonrenal injuries) were recorded. Management strategies and outcomes for each renal artery injury subtype were compared.

TABLE 1. Patient and injury characteristics MAI SRAI Totals No. pts (%) 36 (43) 45 (57) 81 Median age (range) 29 (15–74) 27 (4–68) 28 (4–74) No. males (%) 30 (41) 43 (59) 73 (90) No. females (%) 6 (14) 2 (5) 8 (10) No. trauma (%): Penetrating 20 (49) 21 (51) 41 (51) Blunt 16 (40) 24 (60) 40 (49) No. Parenchymal 21 (45) 26 (55) 47 (58) laceration (%) No. associated injuries (%) 34 (47) 38 (53) 72 (89) No. shock (%) 26 (57) 20 (43) 46 (57) No. hematuria/total 30/33 (91) 30/34 (88) 60/67 (90) No. (%): Gross 18/30 (60) 15/30 (50) 33/60 (55) Microscopic 12/30 (40) 15/30 (50) 27/60 (45) Absent 3/33 (9) 4/34 (12) 7/67 (10) Unknown 3/36 (8) 11/45 (24) 14/81 (17) No. RAIs (%): Isolated arterial injury 16 (29) 39 (71) 55 (67) Combined arterial 20 (74) 7 (26) 27 (33) venous injury No. injury grade/total No. (%): 4 4/48 (8) 44/48 (92) 48/82 (59) 5 32/34 (94 ) 2/34 (6) 34/82 (41)

For main renal artery injury the respective outcomes of nephrectomy vs vascular repair were a mean transfusion of 10,275 vs 6,125 ml (p 0.39) Length of stay 18 days for each, mortality rate 26% vs 13%, renal Failure rate 8% vs 25% Renal insufficiency/impaired selective function by renal scintigraphy 4% vs 13% (each p not significant).

TABLE 2. Outcomes of nephrectomy vs vessel repair for MRAI Nephrectomy Vessel Repair p Value No. pts 23 8 Mean SD transfusion requirement (ml) 10,275 12,871 6,125 5, Mean SD LOS (days) No. death during hospitalization (%) 6 (26) 1 (12.5) 0.4 No. renal failure (%) 2* (8) 2 (25) 0.29 No. hypertension 1* No. renal insufficiency (Cr mg/dl 1.5 or greater) or impaired renal function 1 (4) 1 (12.5) % or less by renal scan (%) No. other renal related complications during hospitalization (%)† 1 (4) No. nonrenal nonfatal complications during hospitalization (%) 4 (17) No. uneventful hospitalization, lost to followup (%) 6 (26) 2 (25) 1 No. no sequelae, Cr 1.5 mg/dl or less at followup 3 (13) 2 (25) 0.59 The patient who underwent bilateral renovascular surgery had hypertension associated with renal failure. †Eg infection

For segmental renal artery injury operative vs nonoperative management was associated with a mean transfusionof 4,994 vs 820 ml (p 0.01) Length of stay 29 vs 11 days (p 0.23) and mortality rate 8% vs 6% (p 1.0). Renal failure and impaired selective renal function on scintigraphy were similar between the groups.

TABLE 3. Outcomes of operative vs nonoperative SRAD management Operative Nonoperative p Value No. pts Mean SD transfusion requirement (ml) 4,994 6, Mean SD LOS (days) No. death during hospitalization (%) 2 (8) 1 (6) 1 No. renal failure (%) 2* (8) No. hypertension (%) 1* 1 (6) 1 No. renal insufficiency or impaired renal 2 (8) 3 (16) 0.65 function 40% or less by renal scan (%) No. persistent urinoma requiring intervention (%) 0 1 (6) 0.46 No. renal related complications during hospitalization (%)† 1 (4) 0 1 No. nonrenal nonfatal complications during hospitalization (%) 4 (17) No. uneventful hospitalization, lost to followup (%) 6 (25) 9 (50) 0.11 No. no sequelae, Cr 1.5 mg/dl or less at followup (%) 7 (29) 3 (16) 0.46 * The patient who underwent bilateral renovascular surgery had hypertension associated with renal failure. † Excluding urinoma.

Conclusion

Nephrectomy for main renal artery injury has outcomes similar to those of vascular repair and it does not worsen posttreatment renal function in the short term Nonoperative management for segmental renal artery injury results in excellent outcomes.

THANK YOU