Year: 2024
Type: article
Study design: Observational Study
Abstract: Background: AAST grade 5 traumatic renal injuries have traditionally been managed surgically; however, there is an expanding literature base demonstrating successful non-operative management of AAST grade 5 injuries treated with angioembolization. Our aim was to evaluate post-angioembolization outcomes for this subsection of patients at a major trauma centre. Patient and methods: Patients presenting with traumatic renal injury that underwent angioembolization were retrospectively identified over a 12-year period (2012–2024). Data on demographics, clinical presentation, AAST grade and angioembolization outcome were recorded. Results: Twenty-eight patients (22 males; 6 female) underwent renal angioembolization between 2012 and 2024. Blunt trauma accounted for the majority of injuries (n = 25; 89%), with road traffic accidents being the most common mechanism (43%). The AAST grade distribution comprised the following: 21.4% grade 3 (n = 6); 46.4% grade 4 (n = 13); and 32.1% grade 5 (n = 9). Of the nine AAST grade 5 cases identified, one patient died within 24 h of admission, and four patients failed non-operative management and required nephrectomy. All four patients underwent selective embolization (targeting a pseudoaneurysm/AV fistula/cut off vessel at the subsegmental or segmental level). Of the four patients who were managed non-operatively, two required retrograde ureteric stenting for the management of urine leak, and one patient developed worsening chronic kidney disease (CKD) post-angioembolization (CKD stage 2 to 3B). All four patients underwent non-selective embolization (multiple segmental arteries with/without main renal artery embolization). Conclusion: AAST grade 5 renal injuries can undergo successful non-operative management with angioembolization; however, this requires judicious patient selection and close trauma team, urological and renal clinical follow-up. A consideration for non-selective rather than selective embolization may improve successful non-operative management in AAST grade 5 injuries.
Language: English
Subfield: Surgery
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
OpenAlex ID: W4402646406