Transcatheter Arterial Embolization in Patients with Kidney Diseases: an Overview of the Technical Aspects and Clinical Indications

Abstract

Therapeutic embolization is defined as the voluntary occlusion of one or several vessels, and this is achieved by inserting material into the lumen to obtain transient or permanent thrombosis in the downstream vascular bed. There are a number of indications for this approach in urological practice, in particular for the patients with parenchymatous or vascular kidney disease. In this review, we present the different embolization techniques and the principally employed occluding agents, and then we present the principal clinical indications and we discuss other pathologies that may benefit from this non-invasive therapy. The complications, side effects and main precautions associated with this approach are also described.

Selective Arterial Embolization of Giant Renal Angiomyolipoma Associated with Tuberous Sclerosis Complex Using Particular and Liquid Embolic Agents

“…Post-embolization syndrome occurs as a result of renal tissue necrosis and is characterized by nausea, vomiting, fever, abdominal pain, and leukocytosis. The syndrome has been reported to occur in up to 80% of cases and is conservatively treated [2,11]. In our case, no complication was encountered during embolization and postoperatively.…”

“…The peripheral dissolution and speed of polymerization depend on the degree of dilution in an oily contrast agent lipiodol [11]. In experienced hands, glue provides a very fast and effective distal embolization with a high dilution of lipiodol (glue:lipiodol ratio, 1:3-1:6).…”

“…The major risk with the use of ethanol is non-target embolization resulting from the reflux out of tumor-feeding vessels, which can result in devastating consequences [6,11].…”

Transcatheter ablation of an iatrogenic renal artery pseudoaneurysm with absolute alcohol: A rare case report

“…3 Agents currently available for renal artery embolization include resorbable materials like gelfoam, microfibrillated collagen, thrombin, and starch microspheres; particulate materials like polyvinyl alcohol (PVA) and trisacryl gelatin microspheres; vascular occlusion coils; and liquid agents like NBCA, ethylene vinyl alcohol copolymer (Onyx), Embol, Ethibloc, absolute alcohol and sodium tetradecyl sulfate. 10 Metallic vascular occlusion coils or microcoils are preferred for embolizing pseudoaneurysms and AV fistulas where superselective catheterization is possible, because these can be delivered precisely into the target lesion with minimal risk of antegrade or retrograde migration while preserving perfusion of downstream vascular bed and minimizing tissue loss. 10 Main disadvantage of coils is that usually more than one coil is required for complete occlusion which increases cost and procedure time.…”

“…10 Metallic vascular occlusion coils or microcoils are preferred for embolizing pseudoaneurysms and AV fistulas where superselective catheterization is possible, because these can be delivered precisely into the target lesion with minimal risk of antegrade or retrograde migration while preserving perfusion of downstream vascular bed and minimizing tissue loss. 10 Main disadvantage of coils is that usually more than one coil is required for complete occlusion which increases cost and procedure time. 8 Since appropriate sized vascular coils were not available in our catheterization laboratory at the time of procedure, we decided to use NBCA and lipiodol mixture.…”