The role of interventional radiology in the management of blunt renal injury: A practical protocol

Objective:. The purpose of this study was to evaluate the efficacy of a pro tocol designed to minimize the need for surgery in the management of severe blunt renal injury. Methods: Forty-six of 752 trauma patients had evidence of renal injury on c omputed tomographic (CT) scan. Two patients required emergency laparotomy, and the remaining 44 patients were classified by CT scan grade using the Am erican Association for the Surgery of Trauma classification system. Patient s with CT scan grade 3 or over underwent renal angiography. Results:. Twenty-one patients had a high-grade injury on CT scan (greater t han or equal to3). Eight had angiographic evidence of extravasation from re nal arterial branches and underwent transarterial embolization. One patient with a grade 5 injury had extravasation from a main renal vein and underwe nt immediate laparotomy. This was the only patient who required surgery for renal injury. Conclusion. Surgery can be avoided in most cases of blunt renal injury. Hem odynamic instability and injury to main renal veins remain indications for surgical exploration.