BackTable / VI / Podcast / Episode #322
Renal Trauma Embolization
with Dr. Nima Kokabi
In this episode, host Dr. Chris Beck interviews Dr. Nima Kokabi about renal trauma embolizations, including imaging workup, embolization technique, and a warning on renal biopsies.
BackTable, LLC (Producer). (2023, May 15). Ep. 322 – Renal Trauma Embolization [Audio podcast]. Retrieved from https://www.backtable.com
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Dr. Nima Kokabi
Dr. Nima Kokabi is an interventional radiologist at Alberta Health in Calgary, Canada.
Dr. Christopher Beck
Dr. Chris Beck is a practicing interventional radiologist with Regional Radiology Group in New Orleans.
Dr. Kokabi was born in Iran, then moved to Canada where he grew up. He attended medical school in Australia due to the shortage of English speaking medical schools in Canada. After his medical training, he was interested in IR, and came to Yale for a fellowship. He then joined Emory as an attending, where he serves one of the largest trauma hospitals in the country. IR and trauma surgery have a close relationship at Emory, and Dr. Kokabi notes they rely more and more on IR for trauma management, even for things such as penetrating trauma, which is traditionally handled by surgery.
Most IR consults for kidney injury are iatrogenic from non-target renal biopsies in a nephrology office. The rules for getting access to a kidney that IRs are trained in are generally not followed by nephrology, and only some have ultrasound guidance for their biopsies. Other consults for bleeding from kidney injury are post-op from a partial nephrectomy or from blunt trauma. To work it up, he gets a 2 phase arterial and venous CT. All kidney injuries are evaluated and reported using the American Association for the Surgery of Trauma (AAST) grading scale. If there is an active bleed, they will go to IR for embolization. If the injury is severe, and there is no parenchymal enhancement, this indicates either the artery or both the artery and vein were transected, and this patient requires surgery. In cases where there is only a small pseudo-aneurysm or a perinephric hematoma, these patients can be monitored with repeat imaging.
For the embolization, Dr. Kokabi uses radial access. For his microcatheter, he likes the True Select. He always uses coils in the kidney, while in the liver, he uses gel foam. Some of his colleagues use glue for the kidney. He prefers detachable Embold coils, which are fiber coils with a nitinol pusher, so they don’t kink when being pushed very fast, and can be adjusted if positioning is unsatisfactory. When he is finished, he injects first through the microcatheter and then again through the base catheter to ensure he hasn’t missed any bleeding. He generally follows patients in the hospital for 1-2 days, before signing off. His parting advice to trainees and anyone doing kidney biopsies is to exercise caution, because although it is just a biopsy, it can cause life-threatening bleeding.
AAST Kidney Injury Scale:
[Nima Kokabi MD]
That's another good application for doing an angiography through a radial access because unlike the liver, which is much easier, if you have a biliary drain and they have hemobilia to do an angiography with the patients supine, you can remove the catheter or wire, and then do another angiography. With kidneys, it becomes very difficult to do that. If you put them in a prone position, you can easily actually access the radial artery with the arm of the patient on their side, and then go into the kidney, do an angiogram with the nephrostomy tube in place, and then if you don't see anything removed in a nephrostomy tube over the wire, then repeat that angiogram. I think for people that are not a believer in radial access, that's another good application for it.
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