Selective arterial embolization of renal angiomyolipomas: A 10‐year experience

Nozadze, Guram; Larsen, Signe Benzon; Heerwagen, Søren T; Jensen, Rigmor; Lönn, Lars; Røder, Martin Andreas

doi:10.1002/bco2.107

Cited by 9 publications

(1 citation statement)

References 32 publications

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“…3 SAE has been demonstrated to decrease tumor volume, decrease risk of bleeding, and successfully manage acute bleeding in several retrospective articles and systematic reviews. [3][4][5][6] Yet SAE is not effective for all patients with some achieving very minimal reduction in overall tumor volume and others presenting with pain or bleeding postembolization. 7,8 Current theories state the fat, muscle and vascular composition of the AML are linked to the success of SAE, however this is yet to be demonstrated in the literature.…”

Section: Introductionmentioning

confidence: 99%

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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