Spectrum of Endovascular Embolization Techniques for the Treatment of Renal Vascular Lesions

 

 Permissions and Reprints

Abstract

Renal vascular lesions are rare and often asymptomatic. They can be congenital or acquired. Congenital lesions include aneurysms, arteriovenous malformations (AVMs), and arteriovenous fistulas (AVFs). Acquired lesions are usually secondary to trauma or iatrogenic injury and include pseudoaneurysms, AVFs, and vessel transection. Management of renal vascular lesions depends on the location and type of the lesion. AVMs are managed by endovascular embolization of the nidus. It can be done by transarterial route when a single or a few arterial feeders are present. The transvenous route is preferred for complete obliteration of the nidus if multiple arterial feeders and a single collector vein are present. Liquid embolic agents are the preferred embolizing agents in AVMs. Congenital or acquired AVFs are managed by coil embolization. Superselective embolization using coils or n-butyl cyanoacrylate glue is the treatment of choice for aneurysms, pseudoaneurysms, and transections involving the segmental renal arteries. Aneurysms and pseudoaneurysms involving the main renal artery are treated by stent graft placement.

Note

This study has been presented as a poster at the annual conference of the Indian Society of Vascular and Interventional Radiology (ISVIR) held in Jaipur on January 11–14, 2024.

Authors' Contributions

M.C. worked as guarantor for the integrity of the entire study. V.P.P. and S.P. conceptualized and designed the study. V.P.P. also performed literature research. V.P.P., N.S.H., S.A.B., and S.U.R. prepared the manuscript. S.P., P.M., and M.C. edited the manuscript.

Ethical Approval

Ethical approval is not required as the article does not involve research on animal/human subjects.

Publication History

Article published online:
04 June 2025

© 2025. Indian Radiological Association. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Thieme Medical and Scientific Publishers Pvt. Ltd.
A-12, 2nd Floor, Sector 2, Noida-201301 UP, India

• References

• 1 Chimpiri AR, Natarajan B. Renal vascular lesions: diagnosis and endovascular management. Semin Intervent Radiol 2009; 26 (03) 253-261
  PubMedSearch in Google Scholar
• 2 Riedlinger WFJ, Kissane JM, Gibfried M, Liapis H. Congenital bilateral renal arteriovenous malformation: an unrecognized cause of renal failure. Pediatr Dev Pathol 2004; 7 (03) 285-289
  PubMedSearch in Google Scholar
• 3 Henke PK, Cardneau JD, Welling III TH. et al. Renal artery aneurysms: a 35-year clinical experience with 252 aneurysms in 168 patients. Ann Surg 2001; 234 (04) 454-462 , discussion 462–463
  PubMedSearch in Google Scholar
• 4 Chaer RA, Abularrage CJ, Coleman DM. et al. The Society for Vascular Surgery clinical practice guidelines on the management of visceral aneurysms. J Vasc Surg 2020; 72 (1S): 3S-39S
  CrossrefPubMedSearch in Google Scholar
• 5 Maruno M, Kiyosue H, Tanoue S. et al. Renal arteriovenous shunts: clinical features, imaging appearance, and transcatheter embolization based on angioarchitecture. Radiographics 2016; 36 (02) 580-595
  PubMedSearch in Google Scholar
• 6 Hatzidakis A, Rossi M, Mamoulakis C. et al. Management of renal arteriovenous malformations: a pictorial review. Insights Imaging 2014; 5 (04) 523-530
  CrossrefPubMedSearch in Google Scholar
• 7 Lessne ML, Holly B, Huang SY, Kim CY. Diagnosis and management of hemorrhagic complications of interventional radiology procedures. Semin Intervent Radiol 2015; 32 (02) 89-97
  PubMedSearch in Google Scholar
• 8 Yakes W., Baumgartner I. Interventional treatment of arterio-venous malformations. Gefässchirurgie 2014; 19: 325-330
  Search in Google Scholar
• 9 Eom HJ, Shin JH, Cho YJ, Nam DH, Ko GY, Yoon HK. Transarterial embolisation of renal arteriovenous malformation: safety and efficacy in 24 patients with follow-up. Clin Radiol 2015; 70 (11) 1177-1184
  PubMedSearch in Google Scholar
• 10 Murata S, Onozawa S, Nakazawa K. et al. Endovascular embolization strategy for renal arteriovenous malformations. Acta Radiol 2014; 55 (01) 71-77
  PubMedSearch in Google Scholar
• 11 Wetter A, Schlunz-Hendann M, Meila D, Rohde D, Brassel F. Endovascular treatment of a renal arteriovenous malformation with Onyx. Cardiovasc Intervent Radiol 2012; 35 (01) 211-214
  PubMedSearch in Google Scholar
• 12 Hwang JH, Do YS, Park KB, Chung HH, Park HS, Hyun D. Embolization of congenital renal arteriovenous malformations using ethanol and coil depending on angiographic types. J Vasc Interv Radiol 2017; 28 (01) 64-70
  PubMedSearch in Google Scholar
• 13 Lee SY, Do YS, Kim CW, Park KB, Kim YH, Cho YJ. Efficacy and safety of transvenous embolization of type II renal arteriovenous malformations with coils. J Vasc Interv Radiol 2019; 30 (06) 807-812
  PubMedSearch in Google Scholar
• 14 Ghosh S, Dutta SK. Endovascular interventions in management of renal artery aneurysm. Br J Radiol 2021; 94 (1124): 20201151
  PubMedSearch in Google Scholar
• 15 Eldem G, Erdoğan E, Peynircioğlu B, Arat A, Balkancı F. Endovascular treatment of true renal artery aneurysms: a single center experience. Diagn Interv Radiol 2019; 25 (01) 62-70
  PubMedSearch in Google Scholar
• 16 Kozar RA, Crandall M, Shanmuganathan K. et al; AAST Patient Assessment Committee. Organ injury scaling 2018 update: spleen, liver, and kidney. J Trauma Acute Care Surg 2018; 85 (06) 1119-1122
  CrossrefPubMedSearch in Google Scholar
• 17 Coccolini F, Moore EE, Kluger Y. et al; WSES-AAST Expert Panel. Kidney and uro-trauma: WSES-AAST guidelines. World J Emerg Surg 2019; 14: 54
  CrossrefPubMedSearch in Google Scholar
• 18 Kwon H, Bae M, Jeon CH, Hwangbo L, Lee CM, Kim CW. Volume preservation of a shattered kidney after blunt trauma by superselective renal artery embolization. Diagn Interv Radiol 2022; 28 (01) 72-78
  PubMedSearch in Google Scholar
• 19 Desai D, Ong M, Lah K, Clouston J, Pearch B, Gianduzzo T. Outcome of angioembolization for blunt renal trauma in haemodynamically unstable patients: 10-year analysis of Queensland public hospitals. ANZ J Surg 2020; 90 (09) 1705-1709
  PubMedSearch in Google Scholar
• 20 Brewer Jr ME, Strnad BT, Daley BJ. et al. Percutaneous embolization for the management of grade 5 renal trauma in hemodynamically unstable patients: initial experience. J Urol 2009; 181 (04) 1737-1741
  PubMedSearch in Google Scholar
• 21 Contegiacomo A, Amodeo EM, Cina A. et al. Renal artery embolization for iatrogenic renal vascular injuries management: 5 years' experience. Br J Radiol 2020; 93 (1106): 20190256
  PubMedSearch in Google Scholar
• 22 Haochen W, Jian W, Li S, Tianshi L, Xiaoqiang T, Yinghua Z. Superselective renal artery embolization for bleeding complications after percutaneous renal biopsy: a single-center experience. J Int Med Res 2019; 47 (04) 1649-1659
  PubMedSearch in Google Scholar
• 23 Hawthorn B, Kawa B, Cavenagh T. et al. Weeping sponge kidney: an unusual phenomenon that should be considered in cases of severe renal haemorrhage. Clin Radiol 2023; 78 (12) e1010-e1016
  PubMedSearch in Google Scholar