Angiography is the test of choice for defining vascular injuries of the kidney. It is highly invasive, requiring cannulation of the femoral artery and the use of intravascular contrast material. Indications include the absence of a functioning kidney on IVP or CT, findings of a large retroperitoneal hematoma, major renal fractures, or segmental areas of renal nonenhancement. In some instances injuries to the parenchyma and arteries can be treated using interventional angiography to stop hemorrhage.
The femoral artery is accessed by the Seldinger technique (flexible catheter advanced over a guidewire). The tip of the catheter is placed in the aorta and a midstream aortogram obtained to evaluate the number and status of the renal arteries. The catheter tip is then placed at the upper level of the proximal artery and films are obtained to capture the arterial, capillary, and venous phases.
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