To investigate the success rate of super selective renal artery embolization (RAE) in the treatment of acute renal hemorrhage in our center and the role of computed tomography angiography (CTA) in the identification of offending arteries.

Patients with acute renal hemorrhage treated by RAE in our center in recent 6 years were included. Technical success was defined as to find and embolize the offending arteries, stop bleeding and restore blood pressure. Clinical success was determined by rehabilitation and discharge. The safety was evaluated by the changes of creatinine, urea nitrogen and estimated glomerular filtration rate before and after RAE, and the complications related to embolism. Further screening the cases caused by trauma or iatrogenic damage, with definite bleeding signs, and with pre-RAE enhanced CT. The enhanced CT data was returned to the workstation, and the maximal intensity projection (MIP), curved planar reformation (CPR), and volume rendering (VR) reconstruction were performed in the arterial phase. The sensitivity and specificity of CTA were studied compared with intra-RAE angiography as the gold standard.

A total of 52 cases were included, including 29 cases caused by iatrogenic damage, 9 cases caused by trauma and 14 cases caused by other reasons. The first technical success rate was 90.4%, the remedial technical success rate was 96.2%, and the clinical success rate was 92.3%. In 48 patients with clinical success, the changes of creatinine, urea nitrogen and glomerular filtration rate before and after RAE were not statistically significant, and all were within the normal range. There were no RAE-related complications during follow-up. CTA reconstruction was completed in 16 patients. The sensitivity of MIP, VR and CPR were 68.8%, 62.5% and 68.8%, respectively. The overall sensitivity of the three reconstruction methods was 75.0%. The specificity was 100%.

The technical success rate of RAE in the treatment of acute renal hemorrhage is 96.2% in our center. For acute renal hemorrhage caused by trauma or iatrogenic injury, pre-RAE CTA can display the offending arteries, and it can obtain a better effect to combine multiple reconstruction methods.