Targeted Endovascular Temporary Vessel Occlusion with a Reverse Thermosensitive Polymer for Near-Bloodless Partial Nephrectomy: Comparison to Standard Surgical Clamping Techniques

• Published in: Cardiovascular and interventional radiology 2012-10, Vol.35 (5), p.1163-1171
• Main Authors: Flacke, Sebastian, Harty, Niall J., Laskey, Daniel H., Moinzadeh, Alireza, Benn, James A., Villani, Rosanna, Kalra, Aarti, Libertino, John A., Madras, Peter N.
• Format: Article
• Language: English
• Subjects: Animals; ARTERIES; BIOMEDICAL RADIOGRAPHY; BLOOD; BLOOD FLOW; Cardiology; HAZARDS; Hemostasis, Surgical - methods; Imaging; INJECTION; Iohexol - pharmacology; ISCHEMIA; Kidney - blood supply; KIDNEYS; Laboratory Investigation; Medicine; Medicine & Public Health; NEPHRECTOMY; Nephrectomy - methods; Nuclear Medicine; Poloxamer - pharmacology; Radiology; RADIOLOGY AND NUCLEAR MEDICINE; Random Allocation; Surgical Instruments; SWINE; THERMOPLASTICS; Ultrasound
• ISSN: 0174-1551; 1432-086X
• DOI: 10.1007/s00270-011-0304-x

Purpose To determine whether reversible blood flow interruption to a randomly chosen target region of the kidney may be achieved with the injection of a reverse thermoplastic polymer through an angiographic catheter, thereby facilitating partial nephrectomy without compromising blood flow to the remaining kidney or adding risks beyond those encountered by the use of hilar clamping. Methods Fifteen pigs underwent partial nephrectomy after blood flow interruption by vascular cross-clamping or injection of polymer (Lumagel™) into a segmental artery. Five animals were euthanized after surgery (three open and two laparoscopic resection, cross-clamping n  = 2), and 10 (open resection, cross-clamping n  = 4) were euthanized after 6 weeks’ survival. Blood specimens were obtained periodically, and angiogram and necropsy were performed at 6 weeks. Results Selective renal ischemia was achieved in all cases. Surgical resection time averaged 9 and 24.5 min in the open and laparoscopic groups, respectively. Estimated blood loss was negligible with the exception of one case where an accessory renal artery was originally overlooked. Reversal of the polymer to a liquid state was consistent angiographically and visually in all cases. Time to complete flow return averaged 7.4 and 2 min for polymer and clamping, respectively. Angiography at 6 weeks revealed no evidence of vascular injury. Laboratory data and necropsies revealed no differences between animals undergoing vascular clamping or polymer injection. Conclusion Lumagel was as effective as vascular clamping in producing a near bloodless operative field for partial nephrectomy while maintaining flow to the uninvolved portion of the affected kidney.