22 - Angioembolization in Patients with High-Grade Kidney Injuries May Lower Rates of Acute Kidney Injury and Mortality

Sunday, April 12, 2026

3:09 PM - 3:18 PM ET

Presenting Author(s)

Waseem Wahood, MD, MS

Resident
Jackson Memorial Hospital, University of Miami, United States

Author/Co-author(s)

MS

Muhammad U. Shahid, MD

Assistant Professor of Interventional Radiology
University of Miami Miller School of Medicine, United States
MC

Michael Cobler-Lichter, MD, MS

General Surgery Resident
University of Miami Miller School of Medicine, United States
CO

Christopher F. O'Neil, MD, MPH

General Surgery Resident
University of Miami Miller School of Medicine, United States
AJ

Alexis K. Jones, BS

Medical Student
University of Miami Miller School of Medicine, United States
JM

Jonathan P. Meizoso, MD, MPH

Assistant Professor of Surgery
University of Miami Miller School of Medicine, United States
BC

Brianna L. Collie, MD

General Surgery Resident
University of Miami Miller School of Medicine, United States
TA

Talia Arcieri, MD

General Surgery Resident
University of Miami Miller School of Medicine, United States
KP

Kenneth G. Proctor, PhD

Professor
University of Miami Miller School of Medicine, United States
JK

Joyce I. Kaufman, MD

Assistant Professor
University of Miami Miller School of Medicine, Miami, United States
NN

Nicholas Namias, MD, MBA

Professor
University of Miami Miller School of Medicine, United States
EG

Enrique Ginzburg, MD

Professor
University of Miami Miller School of Medicine, United States

Purpose: Patients with high-grade kidney injuries are increasingly being managed non-operatively, yet patients remain at high risk for nephrectomy or catheter-based intervention for hemorrhage control. Despite this, the comparative effectiveness of these strategies has not been defined in a national cohort. We hypothesized that angioembolization in initially hemodynamically stable patients with blunt high-grade kidney injuries would be associated with improved outcome compared to nephrectomy.

Materials and Methods: Using the American College of Surgeons Trauma Quality Improvement Project National Trauma Databank (2017–2022), we identified all patients with AAST grade 3–5 kidney injuries after a blunt mechanism of injury. Patients with initial hypotension (systolic blood pressure < 90 mmHg), hospital stay < 24 hours, non-survivable injuries (any Abbreviated Injury Scale severity of 6), and transfers were excluded. Our primary outcome was in-hospital mortality and secondary outcome was acute kidney injury (AKI). Inverse probability–weighted regression adjustment was used to account for both differences influencing treatment selection (who underwent angioembolization vs. nephrectomy) and differences influencing outcomes: controlling for gender, hospital characteristics, initial vital signs, Glasgow Coma Scale, Injury Severity Score and kidney injury grade.

Results: In 858 cases of blunt AAST Grade 3-5 kidney injuries (75% male, average age 41.1 [±20] years), 470 (55%) underwent angioembolization and 388 (45%) underwent nephrectomy. 15% of patients had a grade 3 injury, 44% grade 4, and 41% grade 5. The overall mortality rate was 11% (5% in the angioembolization group vs. 17% in the nephrectomy group, p< 0.001), and the incidence of AKI in the cohort was 8.9% (4.1% in the angioembolization group vs. 15% in the nephrectomy group, p< 0.001. On adjusted analysis, nephrectomy was independently associated with an 8.4% increased risk of AKI based on average treatment effect (relative risk 2.27 [95% CI 1.58-2.97, p=0.001) and 10.6% increased mortality (RR: 2.56 [95% CI 1.84-3.28], p< 0.001) compared to angioembolization.

Conclusion: This study demonstrates that angioembolization is associated with both lower likelihood of AKI and mortality than nephrectomy in initially hemodynamically stable blunt trauma patients with high-grade kidney injuries. A kidney-preservation strategy with angioembolization may be considered for initial management of these patients, though future prospective work is needed to validate these findings.