Long‐term follow‐up of the treatment of renal angiomyolipomas after selective arterial embolization with alcohol

Abstract

and the mean (range) size was 11.9 (2.9-24.4) cm. All patients were treated by selective embolization using a mixture of alcohol and lipiodol. Three patients also had coiling of aneurysms and two patients had additional embolization with polyvinyl alcohol particles. The follow-up was both radiological and clinical, with recurrence defined as growth by > 2 cm or symptoms requiring further treatment. RESULTSThe technical success rate was 100%, with only one significant complication of nontarget renal embolization, with self-limiting effects. Minor complications included 11 patients with post-embolization syndrome, all of which settled with conservative measures. The mean (range) combined radiological and clinical follow-up was 44.2 (12-116) months, with all patients having a follow-up of > 1 year. Radiological success was achieved in 97%, with only one lesion growing by > 2 cm. The combined clinical and radiological success rate was 85%, with two patients undergoing surgery, two having repeat embolization and one currently offered surgery due to a recent increase in size. CONCLUSIONOur study provides long-term evidence that selective arterial embolization with alcohol is a safe and effective method for improving clinical symptoms (85%) and preventing tumour progression (97%) in patients with renal angiomyolipoma.

Selective arterial embolization of symptomatic and asymptomatic renal angiomyolipomas: a retrospective study of safety, outcomes and tumor size reduction

“…With improvement of cross sectional imaging and even in cases of low-fat tumors, AMLs can now be confidently diagnosed with an MRI specificity of up to 99% (52,53 (25)(26)(27)36). Literature comparing nephrectomy and NSS with SAE in the management of AMLs is limited (3,8,55,56) with medical and economic analyses favoring embolization in symptomatic renal AMLs or AMLs at risk of complications.…”

“…SAE can be used for prophylaxis of high-risk tumor, for acute management of tumor bleeding, or as a preoperative adjunct treatment for surgery to prevent intraoperative blood loss (8,20,24,25). This minimally invasive interventional radiology technique has become the primary treatment for AMLs since several years because it is less invasive than a surgical intervention and enables targeted treatment of bleeding vessels with a low risk of severe complications (20,(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37)(38)(39)(40)(41). The objective of this retrospective mono-centric study was to present our 11-year experience with planned prophylactic and emergency SAE of renal AMLs by reviewing our institution's series of 23 patients and evaluating complications, outcomes and tumor size reduction (TSR) after SAE.…”

Recurrent, Giant Renal Angiomyolipoma Treated with Selective Arterial Embolization: A Case Report

“…Since the first report by Adler et al [6], transarterial embolization has been applied increasingly; therefore, it has become the new standard for preventive or emergency treatment of AMLs in which small arterial feeders are targeted selectively and minimally invasively [7]. The decision to treat AMLs is affected by tumor size and the oc- currence of symptoms [5].…”

Super-Selective Artery Embolization before Laparoscopic Partial Nephrectomy in Treating Renal Angiomyolipoma

“…RAMLs with a diameter >4 cm or symptomatic RAMLs of any size should be managed by surgery such as laparoscopic or robot-assisted partial nephrectomy [10][11][12] , super-selective arterial embolization (SAE) [13][14][15][16][17][18] , radiofrequency ablation [19] , or cryoablation [20] ( Table 1 ). The most common intervention is SAE (73%) followed by surgery (13%) [1] .…”

“…SAE can decrease the size of RAML and the risk of hemorrhage [21,22] . However, most RAMLs only shrink slowly by 20-30% [13] . For large RAMLs (>7 cm), spontaneous rupture and hemorrhage cannot be totally prevented after the embolization and need further reembolization.…”