Failure of Angiographic Management in Cases of Postrenal Intervention Bleed: Risk Factors and Management Approach.

Objective: To evaluate the factors predicting the risk for failed angiographic management (AM), we retrospectively studied cases of digital subtraction angiography (DSA) and superselective angiography (SSA) to control severe/delayed bleeding following renal interventions, which may otherwise be life threatening and often require nephrectomy.

Methods: We have retrospectively evaluated the data of 154 patients who underwent DSA and or SSA during January 2006 to June 2016. Twenty-one patients (Group A) with failed AM were compared to patients with success AM (n = 133, Group B).

Results: Out of 21 patients in whom AM failed, 20 should be managed with subsequent sessions of DSA/SSA and only 1 had to undergo nephrectomy. On univariate analysis, low hemoglobin (P = .025), multiple tracts (n > 1) during percutaneous nephrolithotomy (P = .01), multiple bleeding site (>1 = 0.01 and >2 = 0.001) and patients, who needed inotropes (P = .008) were found to predict risk for failure. On multivariate analysis, multiple bleeding site >2 (P = .003, odds ratio 5.23, 95% confidence interval = 1.3-22.5) and patients on inotropes (P = .02, odds ratio 2.56, 95% confidence interval = 2.15-4.75) were found to independently predict the failure.

Conclusion: Patients with multiple bleeding lesions and who are on inotropic (leading to intrarenal vasoconstriction) are at high risk for failure of AM. Most of them can be successfully managed by subsequent session AM.