Interventions in the Genito-Urinary Tract and Pelvis

Abstract

Embolization of bleeding sites, drainage of abscesses, removal of calculi from the collecting system, and removal of foreign bodies are the most common interventions in the kidney. Embolization is today most commonly deployed for the management of arterio-venous fistulae, arterio-venous malformations, and traumatic bleeding sites in the kidney. The site and vascular supply are first identified on digital angiograms. Superselective catheterization of the supply vessels is carried out with tracker catheters. Microcoils or particulate material of appropriate size, usually 300–500 micron, is then utilized to occlude the offensive vessels. Superselective techniques safeguard against excessive embolization of normal parenchyma. Depending on the size of the vessel to be embolized, the embolic material is seated at different levels. If superselective engagement proves impossible, selective flow to an arterio-venous fistulae or arterio-venous malformation can be created by pharmacologic manipulation. Adrenalin hydrochloride is injected in the main artery resulting in constriction of the normal renovascular bed, but not of the abnormal vessels leading to the arterio-venous malformation.