renal artery embolization

Kidney damage is divided into two types: open and closed. Open injuries account for about 15% to 20%, and are more common in wartime. Closed injuries are most common in traffic accidents and industrial accidents. Kidney injury can be complicated by trauma to the chest and abdomen organs and other parts, especially open injuries. At the same time, attention should be paid to the diagnosis and treatment of combined injuries. There is currently no consensus on the classification of kidney damage. According to the pathology of the injury, it is divided into contusion, laceration, crushing injury, and kidney pedicle injury. There are also those who are classified into minor renal injuries and major renal injuries according to the degree of injury. Small renal injuries include renal contusion, superficial laceration of the renal cortex and small subhepatic hematoma, which account for about 85% to 90% of the total renal injury, and are generally treated with non-surgical treatment. Large renal injuries include deep renal laceration, renal rupture, renal fragmentation, and renal pedicle injury, which require urgent surgical treatment. History of trauma and hematuria are the basic basis for diagnosing kidney damage. A person with a lump in the waist often shows severe kidney damage and often requires surgery. In order to determine the degree of kidney damage and determine whether emergency surgery, under the conditions of the condition, abdominal plain film, intravenous urography, B-ultrasound and CT examination should be performed. If necessary, abdominal aorta-kidney angiography can be performed to determine the injury. Side and contralateral kidney conditions. Surgery and treatment are required in the following situations: 1. Intravenous urography has obvious contrast of contrast agent or renal non-development or CT scan contrast agent spillover. 2. Patients with abdominal organ damage. 3. Renal angiography suggests that the renal artery is damaged or embolized. 4. During the non-surgical treatment, the kidney mass is increasing, the gross hematuria continues, and severe anemia occurs in the short term. 5. After anti-shock treatment, blood pressure can not rise or rise and fall again, suggesting that there is a major bleeding. For the surgical treatment of open kidney injury, the current opinion is that the cause of firearm injury is accompanied by chest or abdominal organ injury, and the incidence of infection is high, and surgery should be performed. For those who are stabbed by the anterior wall of the abdomen, they are often accompanied by abdominal organ injury and should be surgically explored. Non-surgical treatment can be observed under close observation if no obvious extravasation or collection system damage is found by back stab injury. Renal artery embolization is performed with non-permanent embolization material. After renal artery embolization for some severely hemorrhagic kidney injury, the embolized artery can still be recanalized. Under the protection of the kidney, the function of the embolized kidney can be restored, thus reducing the open surgery rate and nephrectomy rate of renal injury. Treatment of diseases: renal artery embolization, renal artery atherectomy Indication Renal artery embolization is suitable for: 1. Preoperative embolization or palliative treatment of renal malignant tumors. 2. Renal arteriovenous fistula, aneurysm or rupture. 3. Renal traumatic bleeding. 1) Severe renal contusion or laceration with severe hematuria. 2) For patients with severe renal injury bleeding undergoing emergency nephrectomy, embolization can temporarily stop bleeding to control shock, so that patients can tolerate surgery. 3) Secondary massive hemorrhage caused by re-rupture of renal segmental artery or rupture of pseudoaneurysm after renal injury. 4. Renal artery branch stenosis confirmed by angiography as a contraindication for renal angioplasty and confirmed as surgical removal, embolization for internal nephrectomy. Contraindications Iodine allergy and severe heart, liver and kidney dysfunction. Preoperative preparation 1. Explain the embolization process to the patient, and practice various movements required during the operation, such as inhalation, breath holding, and sedation and cooperation during the embolization process. 2. Preoperative preparation and the puncture technique of this section, and determine the bleeding time and clotting time, platelet count, prothrombin time. 3. 15 to 30 minutes before surgery, intramuscular injection of 10mg. 4. Take a flat film before surgery to facilitate comparison. 5. Install the ECG machine for monitoring. 6. Adults or older children may use local anesthesia. Those who do not cooperate fully must use general anesthesia. 7. Severe cases inhale oxygen before the start of the test. 8. Carefully inspect and test X-ray machine, quick changer, high pressure syringe. Determine the injection pressure, filming procedure, etc. 9. Contrast agent selection and dosage of 176% diatrizoate or high concentration non-ionic contrast agents, such as iodobenzene hexaol, ubiquitin, iodinol, etc. [ultravist concentration 370, ou Nai The omnipaque concentration is 350 and the iipamiro concentration is 370]. 2 The amount of contrast agent is calculated by weight, usually 1ml/kg, and 50kg is still calculated for more than 50kg. The dosage for children can be slightly larger, ranging from 1.2 to 1.5 ml/kg. The total amount of ionic contrast agent is limited to 4 ml/kg. 10. Item preparation (1) puncture needle, guide wire, dilator, catheter sheath, three-way switch, contrast catheter. There are many types of catheters, such as RH liver catheters, Cobra catheters, and RH spleen catheters (for splenic angiography). (2) Embolization materials: anhydrous ethanol, gelatin sponge, stainless steel ring, etc. Surgical procedure 1. General aneurysm puncture cannulation for abdominal aortic angiography and selective renal angiography of the affected side to further define the lesion location, size, extent, vascular anatomy and healthy kidney condition. 2. Under the guidance of the guide wire, insert the catheter into the affected renal artery as close as possible to the lesion. If embolization with gelatin sponge fragments, mix with contrast agent and inject under TV surveillance; if embolization with absolute ethanol, it is best to use a balloon catheter to block, slowly inject about 10 ~ 15ml, such as no balloon catheter Then, the contrast agent is used for pre-injection, and the observation is made under the TV so that no reflux occurs at the optimal speed. In the actual injection, it should be mixed with the contrast agent, observed under the TV, and the injection speed adjusted to ensure that it does not return to the aorta. If a stainless steel ring plug is used, the steel ring is released according to the stainless steel ring release method (see external carotid artery embolization). 3. Repeat renal angiography after embolization to understand the embolism. 4. After extubation, the puncture site is pressed to stop bleeding and pressure bandage.