Efficacy and safety of selective renal arterial embolization in renal angiomyolipoma: a prospective single-center study

Abouelkheir, Rasha T.; El-Ksas, Mostafa; Fattah, Sherif Abdel; Amer, Talal; El-Diasty, Tarek

doi:10.1186/s43055-022-00848-3

Cited by 3 publications

(2 citation statements)

References 31 publications

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“…Our cohort did have complications with post-embolization syndrome (PES) presenting in 27% of our cohort. This is in line with similar reviews with a mean incidence ranging between 33 and 60% 5,11,12 and is an expected sequalae of embolization. Major complications were present in five patients.…”

Section: Discussionsupporting

confidence: 92%

Is Size All That Matters? New Predictors of Complications and Bleeding in Renal Angiomyolipoma

Combes¹,

McQueen²,

Palma³

et al. 2023

RRU

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Renal angiomyolipoma (AML) is the most common benign renal tumor. Whilst generally asymptomatic, they can cause life-threatening bleeding. Selective angioembolization (SAE) may be used to treat large symptomatic and asymptomatic AMLs. We aimed to evaluate the efficacy of SAE for symptomatic and asymptomatic renal AMLs and determine characteristics that predict spontaneous bleeding. Patients and Methods: Data were retrospectively collected from a prospectively maintained database from July 2011 to April 2022. Patients were included if AML was >4cm and they underwent subsequent SAE. Follow-up imaging was analyzed to calculate mean reduction in AML size. Clinical notes were reviewed to analyze lesion characteristics including vascularity, fat content and presence of aneurysm as well as post-procedural complications. Results: 26 patients with 30 AMLs were identified. Interval of follow-up imaging ranged from 1 to 60 months. 25 AMLs were embolized electively with 5 emergency embolizations performed for bleeding. Mean reduction in AML volume was 41% at 3 months (p=0.013) and 63% at 12 months (p=0.007). All 5 bleeding AMLs had a rich vascularity with 60% also having either aneurysms or a low fat content. Complications included post-embolic syndrome (n=9), segmental renal parenchyma devascularization (n=3), acute bleeding requiring re-embolization (n=2), nephrectomy for ongoing bleeding (n=1) and delayed bleeding managed conservatively (n=1). No deterioration in renal function was observed. Conclusion: SAE is an effective procedure for managing symptomatic and asymptomatic renal AML, with minimal significant complications. AML vascularity, fat content and aneurysms may be useful characteristics to assess future risk of bleeding in patients with renal AML.

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Section: Discussionsupporting

confidence: 92%

Is Size All That Matters? New Predictors of Complications and Bleeding in Renal Angiomyolipoma

Combes¹,

McQueen²,

Palma³

et al. 2023

RRU

View full text Add to dashboard Cite

show abstract

“…Women who have successfully undergone embolisation should be followed up regularly under a combined care regime to improve maternal and foetal outcomes. Several cases have reported successful outcomes with transarterial embolisation, which was subsequently followed by vaginal delivery or elective caesarean section 4 7. Nevertheless, some cases required emergency nephrectomy 8…”

Section: Discussionmentioning

confidence: 99%

Spontaneous rupture of renal angiomyolipoma in pregnancy mimicking preterm labour

Basri,

Dasrilsyah

2024

BMJ Case Rep

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Ruptured renal angiomyolipoma in pregnancy is uncommon. Pregnant women may present with nonspecific symptoms such as flank or abdominal pain, contraction pain and haematuria. A thorough assessment is needed to reach the correct diagnosis. Management varies between conservative measures, radiological intervention or surgery depending on the patient’s haemodynamic status and foetal condition. We present a case of a woman in her 30s, gravida 5 para 3+1 at 28 weeks of gestation, who presented with pain. The pain worsened, and she went into hypovolaemic shock. An exploratory laparotomy and emergency caesarean section were done. Retroperitoneal haematoma was found intraoperatively, but the source of bleeding was difficult to determine. An abdominal CT angiogram subsequently revealed an ongoing bleeding from a ruptured angiomyolipoma. An emergency nephrectomy was performed, and the bleeding was secured.

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Giant renal angiomyolipomas – Can they be managed safely through minimally invasive selective angioembolisation? Case series and literature review

Combes

Palma

March

et al. 2023

Journal of Clinical Urology

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Objective: The objective was to determine whether giant renal angiomyolipomas (AMLs) can be managed through selective angioembolisation (SA) and compare outcomes to nephron-sparing surgery (NSS) and nephrectomy. Methods: A retrospective case series was compiled from a prospectively maintained database, commenced in 2011 of renal AMLs that underwent SA. We extracted patient demographics, size of AMLs, intervention and outcomes. A literature review of case reports and case series was performed on the management of giant renal AMLs managed through SA, NSS or nephrectomy. Results: Of 30 AMLs that underwent SA, 6 patients met the inclusion criteria. The mean diameter of AMLs prior to embolisation was 14.3 cm. All embolised AMLs decreased in size post-embolisation by an average of 18% (mean: 39-month follow-up). There were no complications in our cohort’s follow-up period, including no rise in any patients’ creatinine associated with SA. Our literature review of 284 articles found 82 articles pertaining to 102 giant renal AMLs. Our review identified SA, NSS and nephrectomy to all be effective management pathways for giant AMLs with minimal complications. Total nephrectomy did result in five patients requiring dialysis post-procedure. Conclusions: SA is an effective intervention for giant AMLs with comparable outcomes to NSS and nephrectomy and should be considered a suitable management option for giant renal AMLs. Level of evidence: Not applicable

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Efficacy and safety of selective renal arterial embolization in renal angiomyolipoma: a prospective single-center study

Cited by 3 publications

References 31 publications

Is Size All That Matters? New Predictors of Complications and Bleeding in Renal Angiomyolipoma

Is Size All That Matters? New Predictors of Complications and Bleeding in Renal Angiomyolipoma

Spontaneous rupture of renal angiomyolipoma in pregnancy mimicking preterm labour

Giant renal angiomyolipomas – Can they be managed safely through minimally invasive selective angioembolisation? Case series and literature review

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