Transarterial embolization for renal angiomyolipomas: A single centre experience in 79 patients

Abstract

ObjectiveTo evaluate the long-term efficacy and safety of selective arterial embolization (SAE) in the treatment of renal angiomyolipomas (AMLs).MethodsThis was a retrospective review of medical records and imaging findings from patients with renal AMLs who attended our clinic and received SAE between January 2007 and January 2014. Only patents with complete medical records, preoperative computed tomography scans using typical imaging and follow-up data were included.ResultsA total of 79 patients were enrolled in the study. Technical and clinical success rates were 100% and 91% (n = 72), respectively. Only two patients experienced major complications. Post-embolization syndrome (i.e. fever, abdominal pain, nausea or vomiting) was reported in 68 (86%) patients, but all symptoms were mild and resolved with conservative measures. Mean radiological and clinical follow-up periods were 16.8 and 35.9 months, respectively. In 75 (95%) patients, tumours decreased in size; mean ± SD tumour size significantly decreased from 8.4 ± 3.5 cm pre-embolization to 6.7 ± 3.0 cm post-embolization.ConclusionsThis study provides long-term evidence that SAE is a safe and effective method in the treatment of patients with renal AMLs.

Renal angiomyolipoma-patient characteristics and treatment with focus on active surveillance

“…Treatment options have traditionally been surgical removal (radical/partial nephrectomy), but are increasingly replaced by angioembolization (AE). Some recent reports in fact suggest that this treatment strategy also might prove valuable in the long term [8,9]. There have been no prospective randomized trials comparing active surveillance (AS) of AML with active treatment at diagnosis and the reported case series are relatively small.…”

The Risks of Renal Angiomyolipoma: Reviewing the Evidence

“…As technology evolved, embolization became the treatment of choice, leaving nephrectomy only for failed embolization in the emergency setting, development of post-embolization complications, and life-threatening hemorrhage ( 19 – 21 ). Embolization is associated with a high clinical success rate more than 90% ( 22 , 23 ). Successful control of a bleeding emergency was reported in 96–100% of patients ( 20 , 24 ).…”

“…Three series included prophylactic RPN reported mostly low-grade complications, preservation of renal function, and no recurrence of lesions (39– 41 ). Prophylactic embolization of RAML has been widely used with 85–91% success rate ( 22 , 42 – 45 ) (Supplementary Table 3). The aim of prophylactic treatment is to devascularize the lesion and reduce its size.…”

“…No bleeding or need for surgical intervention was required in up to 17% of patients ( 8 , 43 , 44 , 46 , 49 , 50 ). The caveat of this approach is the need of multiple retreatments ( 8 , 22 , 42 , 43 , 47 , 50 ). The highest reported complication rate was 19.5% ( 4 , 8 , 42 , 44 , 48 ).…”

“…A prophylactic embolization of lesions at high risk for bleeding became more common. The procedure is minimally invasive and has a high success rate ( 22 , 42 ). Frequent retreatment, however, may be needed in nearly half of the patients and postembolization syndrome affecting as high as 86% ( 22 ).…”