1528 IATROGENIC VASCULAR LESIONS AFTER MINIMALLY INVASIVE PARTIAL NEPHRECTOMY: A MULTI-INSTITUTIONAL STUDY OF CLINICAL AND RENAL FUNCTIONAL OUTCOMES

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You have accessJournal of UrologyKidney Cancer: Localized1 Apr 20111528 IATROGENIC VASCULAR LESIONS AFTER MINIMALLY INVASIVE PARTIAL NEPHRECTOMY: A MULTI-INSTITUTIONAL STUDY OF CLINICAL AND RENAL FUNCTIONAL OUTCOMES Elias Hyams, Phillip Pierorazio, Ornab Proteek, Shyam Sukumar, Jodi Mechaber, Andrew Wagner, Craig Rogers, Louis Kavoussi, and Mohamad Allaf Elias HyamsElias Hyams Baltimore, MD More articles by this author , Phillip PierorazioPhillip Pierorazio Baltimore, MD More articles by this author , Ornab ProteekOrnab Proteek New Hyde Park, NY More articles by this author , Shyam SukumarShyam Sukumar Detroit, MI More articles by this author , Jodi MechaberJodi Mechaber Boston, MA More articles by this author , Andrew WagnerAndrew Wagner Boston, MA More articles by this author , Craig RogersCraig Rogers Detroit, MI More articles by this author , Louis KavoussiLouis Kavoussi New Hyde Park, NY More articles by this author , and Mohamad AllafMohamad Allaf Baltimore, MD More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.1521AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Iatrogenic vascular lesions (e.g. pseudoaneurysm, arteriovenous fistula) are uncommon after minimally invasive partial nephrectomy (MIPN) but can be associated with significant morbidity. While there have been several small published experiences with these lesions, we report the first large multi-institutional series including clinical and renal functional outcomes following treatment. METHODS A retrospective review of MIPN including both laparoscopic and robotic-assisted procedures was performed at 4 centers. Patients with iatrogenic vascular lesions in follow up (i.e. pseudoaneurysm and AV fistula) were identified. Disease, patient, and operative details were collected as well as details of angiographic procedures. RESULTS Among 998 patients undergoing MIPN, 20 (2.0%) presented with iatrogenic vascular lesions (17 pseudoaneurysm, 3 AV fistula). Mean age was 55.9 years (27–80) among 15 male and 5 female patients. Mean tumor size was 2.6cm (1–4.5), and mean body mass index was 30.8 (22–39.7). Twelve patients (60%) had >50% endophytic tumors, and seven patients (35%) had collecting system repair. Mean warm ischemia time was 26 minutes (0–42), 0 patients had intraoperative transfusion, and mean OR time was 194 minutes (103–300). Mean length of stay was 2.2 days. All patients had gross hematuria at representation at mean 14.5 days (3–24) postoperatively. Diagnosis was made by urgent CT scan in all cases. Selective or superselective embolization was performed in 16 patients; 2 patients had no intervention and spontaneous resolution, and 2 had negative angiograms implying resolution of previously detected lesions. Four patients required transfusion during rehospitalization. While 4 patients had worsening of chronic kidney disease (CKD) stage pre- to post-operatively from their MIPN, all patients had stable function acutely following angioembolization, and three patients had improvement of CKD stage from preoperative levels through mean 20 month follow up. No patients had recurrent hemorrhagic events after treatment. CONCLUSIONS Iatrogenic vascular lesions occur in approximately 2% of MIPN. While a subset of patients resolve with observation only, most undergo angioembolization which results in excellent clinical and renal functional outcomes. Risk factors for formation of these lesions are not well elucidated based on the relative rarity of these events. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e613-e614 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Elias Hyams Baltimore, MD More articles by this author Phillip Pierorazio Baltimore, MD More articles