ESPN 50th Annual Meeting

ESPN 2017


 
Gelfoam Biopsy Tract Embolization is Safe and Minimizes Complications after Renal Biopsy
Alan Alper Sag 1 Mehmet Taşdemir 2 Yağmur Kılıç 3 Ilmay Bilge 4

1- Koç University School Of Medicine, Department of Radiology, Division of Interventional Radiology, Istanbul, Turkey
2- Koç University Hospital, Department of Pediatrics, Division of Pediatric Nephrology, Istanbul, Turkey
3- Koç University School Of Medicine, Istanbul, Turkey
4- Koç University School of Medicine, Department of Pediatrics, Division of Pediatric Nephrology, Istanbul, Turkey
 
Introduction:

The kidney is the organ with the highest post-biopsy clinically-relevant bleeding risk, estimated at 1.5-10% in pediatric patients. Gelfoam slurry tract embolization may improve post-biopsy outcomes.

 

Material and methods:

Retrospective review of 13 biopsies performed in 12 patients. A fully-automatic core-biopsy needle was used coaxially in all patients, (19/20-gauge in one patient, 17/18-gauge in the rest). Gelfoam slurry was performed by agitating gelfoam pledgets with normal saline until achieving slurry consistency, and injected at the completion of biopsy. All biopsies were completed with real-time pathologic verification using 4 or less needle passes.  All patients were admitted overnight with ultrasound follow-up the next day.

 

Results:

Biopsy and gelfoam administration was technically successful during all biopsy sessions. One hematoma (1/13 biopsies, 7.9%) occurred in a patient with acute renal failure (Cr 2.3) increased from 3 mm to 12 mm on post-procedure day 1 but was clinically insignificant and required no treatment. One episode of hematuria (mild to moderate severity, 1/13, 7.9%) occurred in a patient with acute renal failure (Cr. 2.7) but was self-limited and required no treatment. Hemoglobin levels remained stable after the procedure (pre versus post-biopsy hemoglobin 12.4 g/dL versus 11.6 g/dL, within the range of error of the laboratory machine, p = 0.0173 paired student t-test). Creatinine levels (available at both time points for 10 biopsies) did not show a statistically significant increase after biopsy (0.82 pre versus 0.9 post, p = 0.2576 paired student t-test).

 

Conclusions:

In this small pilot series, there were no clinically significant complications (complications that require treatment or an unplanned elevation in level of care) in the cohort of patients who received gelfoam slurry embolization. Furthermore, creatinine levels remained at safe levels in the immediate term (any longer term follow-up of creatinine would be confounded by treatment response for the renal failure).