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Utility and Outcome of Angioembolization for High-Grade Renal Trauma Management in a Large Hospital-Based Trauma Registry.

Authors
  • Hakam, Nizar1
  • Amend, Gregory M2
  • Nabavizadeh, Behnam1
  • Allen, I Elaine3
  • Shaw, Nathan M1
  • Cuschieri, Joseph4
  • Wilson, Mark W5
  • Stein, Deborah M4
  • Breyer, Benjamin N1, 3
  • 1 Department of Urology, University of California San Francisco, San Francisco, California.
  • 2 Department of Urology, Icahn School of Medicine at Mount Sinai, New York, New York.
  • 3 Department of Epidemiology & Biostatistics, University of California San Francisco, San Francisco, California.
  • 4 Department of Surgery, University of California San Francisco, San Francisco, California.
  • 5 Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California.
Type
Published Article
Journal
The Journal of urology
Publication Date
May 01, 2022
Volume
207
Issue
5
Pages
1077–1085
Identifiers
DOI: 10.1097/JU.0000000000002424
PMID: 34981946
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

We evaluated angioembolization (AE) use for high-grade renal trauma (HGRT) management and compared AE vs surgical repair (SR) in requiring nephrectomy. Using National Trauma Data Bank® 2013-2018, we identified patients with HGRT who underwent AE or SR as initial management. Therapy failure was defined as performing subsequent nephrectomy, partial nephrectomy, SR or AE. Logistic regression was performed to assess the association between intervention type (AE vs SR) and nephrectomy. Analysis was repeated in a propensity score-matched cohort constructed by matching AE to SR patients on American Association for the Surgery of Trauma (AAST) grade, injury mechanism (blunt vs penetrating) and hemodynamic instability (systolic blood pressure <90 mmHg). There were 266 patients in the AE group and 215 in the SR group. Median age was 29.5 years and 212 patients (44.1%) had penetrating injuries. AE was successful in 94.2% and 85.3% of grade IV and V injuries, respectively, whereas SR was successful in 82.1% and 56%, respectively. Grade V injury was associated with AE failure in the adjusted analysis (OR 3.55, 95% CI 1.22-10.2, p=0.02). Nephrectomy was less likely to be performed after AE vs after SR in HGRT (6.4% vs 17.2%, p=0.01), AAST grade IV (4.2% vs 13.7%, p=0.001) and AAST grade V (12% vs 44%, p=0.001). The matched cohort comprised 528 patients. In post-match regression, AE, compared to SR, was associated with lower odds of nephrectomy (OR 0.18, 95% CI 0.04-0.70, p=0.013). AE achieved superior kidney salvage compared to SR in this observational cohort. These results inform both clinical practice and future prospective trials.

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