Diagnostic and Interventional Radiology
Interventional Radiology - Original Article

Intermittent quick-check CT fluoroscopy-guided percutaneous drainage placement in patients with infected renal and perirenal fluid collections: 11-year experience

1.

Institute for Diagnostic and Interventional Neuroradiology, Ludwig-Maximilians-University of Munich, Munich, Germany

2.

Department of Radiology, Ludwig-Maximilians-University of Munich, Munich, Germany

3.

Medical Imaging Department, Mater Dei Hospital, Triq tal-Qroqq, Msida, Malta

Diagn Interv Radiol 2020; 1: -
Read: 101 Published: 19 June 2020

PURPOSE: To evaluate technical success (TS), clinical success (CS) and safety of CT fluoroscopy (CTF)-guided percutaneous pigtail drainage (PPD) placement in patients with infected renal and perirenal fluid collections.

METHODS: This retrospective analysis comprised 44 patients (52.27 % men; 57.1±18.5 years [MV±SD]) undergoing low-milliampere CTF-guided (10-20 mA) PPD placement in 61 sessions under local anaesthesia from 08/2005 to 11/2016. Infected fluid collections (n=71) included infected renal cysts (12.68 %), renal (r) and perirenal (p) abscesses due to comorbidities (23.94 %) or after renal surgery or urological intervention (63.38 %). TS was defined as PPD placement with consecutive fluid aspiration, CS as normalization or marked improvement of clinical symptoms (e.g. flank pain, fever) and inflammatory parameters (leucocytes, CRP) after minimally invasive combination therapy (i.v. broad-spectrum antibiotics, drainage). Complications were classified according to the CIRSE Classification.

RESULTS: 73 single lumen PPD (7.5 to 12F) were utilized (1 PPD per session, 69.86 %; 2 PPD per session; 15.07 %). In 4 cases PPD could not be inserted into the fluid collection (4.11 %) or not be aspirated (1.37%), (94.5% primary TS). Mean duration of functioning PPD before removal was 10.9 days. Adverse events (AEs) within 30 days comprised PPD failure (2.27 %) or secondary dislocation (11.36 %), (Grade 3) and one death (Grade 6; unrelated to intervention), (2.27 %). Additional invasive measures after primary CTF-guided PPD were required in 5 patients (nephrectomy (NE) [6.82 %], partial nephrectomy [2.27 %], surgical drainage [2.27 %]). Thus, CS using minimally invasive measures only was achieved in 39/44 patients (88.64 %).

  

CONCLUSION: Given a minor proportion of patients requiring surgical revision, combined antibiotics and CTF-guided PPD of infected renal and perirenal fluid collections provides an excellent technical and clinical outcome.

 

EISSN 1305-3612