Prophylactic Renal Artery Embolization

Nima Kokabi, MD, FRCRC

Interventional Radiologist

University of North Carolina

Patient developed a perinephric hematoma three days after non-targeted renal biopsy.
No active bleeding identified on angiography, but patient developed flank pain, worsening AKI and downtrending hemoglobin.
Patient referred to IR for prophylactic embolization due to worsening clinical status.
Accessory left renal artery accessed with SENDERO Microcatheter.
Proximal accessory left renal artery occluded with a single LOBO-5.
On follow-up CTA, the hematoma was found to be stable.
The patient’s hemodynamics improved and no further embolization was required.

Figure 1. Noncontrasted CT image of the abdomen demonstrating left renal hematoma.

Figure 2. Initial LOBO-5 deployment demonstrating contrast flow through the device and subsequent complete occlusion at 60 seconds post- embolization.

Figure 3. Post-embolization CT demonstrating contrast (white arrow) distal to the LOBO-5, suspicious for patency of the previously occluded vessel. Repeat left renal arteriogram demonstrating collateral flow through a small branch (blue arrow) supplying the lower renal pole distal to the LOBO-5 (orange arrow).

The LOBO-5 was successfully used for prophylactic embolization of a left accessory renal artery, providing rapid and durable occlusion. The ability of the LOBO-5 to occlude this vessel with only a single device saved both time and potentially cost when compared to the number of detachable coils or liquid embolics that would have been required to achieve the same result.