Use of Super-Selective Renal Artery Embolization for Post-Percutaneous Nephrolithotomy Renal Vascular Injury: Embolic Materials, Angiographic Pattern, and Technical Success

The aim of the study is to review our institutional experience with super-selective renal artery embolization for managing vascular injuries following percutaneous nephrolithotomy (PCNL). A retrospective review was conducted on 52 patients who underwent endovascular management for post-PCNL hemorrhage between January 2020 and August 2025. We analyzed data on demographics, clinical presentation, imaging findings from CT angiography (CTA) and invasive angiography, embolic agents used, and procedural outcomes. The mean patient age was 39.6 ± 15.4 years, with a male predominance (81%). Digital subtraction angiography findings included pseudoaneurysm (n = 41; 79%), combination of arteriovenous fistula (AVF) and pseudoaneurysm (n = 4; 8%), AVF alone (n = 2; 4%), active extravasation (n = 1; 2%), combination of active extravasation and pseudoaneurysm (n = 1; 2%), and no vascular lesion identified (n = 3; 5.76%). Anatomically, lesions were most frequently located in the lower-polar region (46%). Micro coils were the most commonly used embolic agent. Technical success, defined as successful deployment of the embolic agent and immediate aneurysm exclusion, was achieved in 100% of cases. The clinical success rate at 30 days was 94%, with three cases requiring re-intervention for re-bleeding. Super-selective renal artery embolization is a highly effective and safe first-line treatment for managing significant vascular complications after PCNL.