1Basir Kunduzi, 3Rebecca Rowe, 1Samiullah Dost, 2James Walker
1Guy’s Hospital, 2King’s College London, 3Royal Papworth Hospital
The management options for blunt renal trauma are non-operative management (NOM), Renal Artery Embolisation (RAE) and Nephrectomy. There is currently no strong evidence for the use of RAE in patients suffering from blunt renal trauma or, if used, there is no review to indicate at which injury grade it has the maximal treatment efficacy. Therefore, the primary aim of this systematic review is to evaluate whether RAE is an useful adjunct to NOM in renal trauma patients and to investigate the differences in treatment efficacy across all grades. The American Association for the Surgery of Trauma (AAST) classification was used for grading renal injuries.
Material(s) and Method(s):
Using PRISMA guidelines, a search strategy was conducted using electronic databases (such as PubMed and Medline). Initially, abstracts then the full papers were screened by two reviewers based on the inclusion and exclusion criteria. The primary outcome was treatment failure which was defined as a need for a Nephrectomy or a repeat RAE. Secondary outcomes included mortality, need for blood transfusion and length of hospital admission. A quality assessment was conducted using the SIGN criteria to assess the studies’ methodology. The Newcastle-Ottawa Scale was used for assessing observational studies.
21 studies (time frame 2001-2018) were included. Among the embolisation techniques, coils were the most used technique with some studies also including the use of more than one method of RAE. Most studies indicated that NOM was used to manage patients with injury grades I and II. Studies that included renal grade III injuries, 31% received selective RAE while for grade IV and V it was 42% and 36% respectively. Success rates were similar for grades III and IV (89%, 82% respectively). Time (early intervention), having <2 concomitant organ/visceral injuries and effective multidisciplinary team coordination are salient factors in determining RAE success. Possible suggestions for RAE failures within the studies were grade/status of the kidney (shattered/separation from the renal pelvis) and iatrogenic reasons like incidental embolisation of unaffected arterial branches.
This systematic literature review concluded that RAE was most commonly used in AAST Grade IV renal blunt trauma injuries with the majority of the selected studies demonstrating positive outcomes and recommended the use of RAE, especially in cases where conservative management failed.