IRSA ASM 2024 Abstract

Background: AAST grade 5 traumatic renal injuries have traditionally been managed surgically; however, there is an expanding literature base demonstrating successful non-operative management of AAST grade 5 injuries treated with angioembolization.Our aim was to evaluate post-angioembolization outcomes for this subsection of patients at a major trauma centre.Patient and methods: Patients presenting with traumatic renal injury that underwent angioembolization were retrospectively identified over a 12-year period (2012)(2013)(2014)(2015)(2016)(2017)(2018)(2019)(2020)(2021)(2022)(2023)(2024).Data on demographics, clinical presentation, AAST grade and angioembolization outcome were recorded.Results: Twenty-eight patients (22 males; 6 female) underwent renal angioembolization between 2012 and 2024.Blunt trauma accounted for the majority of injuries (n = 25; 89%), with road traffic accidents being the most common mechanism (43%).The AAST grade distribution comprised the following: 21.4% grade 3 (n = 6); 46.4% grade 4 (n = 13); and 32.1% grade 5 (n = 9).Of the nine AAST grade 5 cases identified, one patient died within 24 h of admission, and four patients failed non-operative management and required nephrectomy.All four patients underwent selective embolization (targeting a pseudoaneurysm/AV fistula/cut off vessel at the subsegmental or segmental level).Of the four patients who were managed non-operatively, two required retrograde ureteric stenting for the management of urine leak, and one patient developed worsening chronic kidney disease (CKD) post-angioembolization (CKD stage 2 to 3B).All four patients underwent non-selective embolization (multiple segmental arteries with/without main renal artery embolization).Conclusion: AAST grade 5 renal injuries can undergo successful non-operative management with angioembolization; however, this requires judicious patient selection and close trauma team, urological and renal clinical follow-up.A consideration for non-selective rather than selective embolization may improve successful non-operative management in AAST grade 5 injuries.