Transcatheter Arterial Embolization with Ethanol Injection in Symptomatic Patients with Enlarged Polycystic Kidneys

Sakuhara, Yusuke; Nishio, Saori; Morita, Ken; Abo, Daisuke; Hasegawa, Yu; Yuasa, Noriaki; Mochizuki, Toshio; Soyama, Takeshi; Oba, Koji; Shirato, Hiroki; Kudo, Kohsuke

doi:10.1148/radiol.2015141637

Cited by 15 publications

(9 citation statements)

References 28 publications

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“…Sukuhara et al [32] concluded that kidney contraction treatment by the undertaking of TAE with ethanol injection did appear to be a safe and effective treatment with regard to patients who have symptomatic enlarged polycystic kidney disease.…”

Section: Discussionmentioning

confidence: 99%

“…Sakuhara et al [32] undertook a study to evaluate the safety and effectiveness of trans-catheter arterial embolization (TAE) with utilization of ethanol in symptomatic patients who have enlarged polycystic kidneys. With regard to the materials and methods, Sakuhara et al [32] stated that their prospective study was an institutional review board approved study which had been planned for patients who had symptoms that were related to enlarged polycystic kidney disease, such as a markedly distended abdomen, gastro-oesophageal reflux, as well as abdominal pain. At the time of the undertaking of the TAE, all of the patients had been undergoing dialysis treatment for chronic kidney failure, and their urine volume had decreased to less than 500 mL per day.…”

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confidence: 99%

“…Pursuant to the TAE, they evaluated changes in the volume of the kidney, clinical symptoms, laboratory data, as well as complications They analysed the differences in the kidney volumes of the patients, the clinical symptoms, abdominal circumference, and dry weights before the TAE and after the TAE with a mixed effect volume. Sakuhara et al [32] summarized the results as follows:…”

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confidence: 99%

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Simple Cysts of the Kidney: A Review and Update

Venyo¹

2022

JCSR

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Based upon radiology imaging features of cysts of the kidney, cysts of the kidney tend to be classified as (a) simple kidney cysts which fall under the sub-classification of Bosniak Category I and II cysts, or (b) complex renal cysts which tend to be classified as belonging to Bosniak Category III and IV cysts, or intermediate category kidney cysts which are sub-classified as belonging to Bosniak Category IIF group of renal cysts. Simple renal cysts represent benign kidney cysts that quite often tend to be asymptomatic so that generally they tend not to require any treatment and they tend to be managed conservatively or expectantly. Nevertheless, if a simple cyst of the kidney becomes symptomatic, it does need to be treated and percutaneous drainage of the kidney cyst combined with sclerotherapy or surgical treatment tends to be selected. Additionally if the size of a simple renal cysts is increasing clinicians often undertake treatment of the cysts to provide reassurance to their patients. There is no global consensus opinion regarding the treatment of simple kidney cysts. Some of the manifestations of simple renal cyst include: (a) Asymptomatic cysts of the kidney that are found incidentally upon radiology imaging investigation of a different condition, (b) a palpable lump/mass in the loin, (c) abdominal / loin pain, (d) hypertension and during investigation of the hypertension the simple cyst or cysts are found, (e) visible haematuria, (f) non-visible haematuria, (g) increasing abdominal girth, (i) loss of appetite, (j) nausea and vomiting, (k) constipation, (l) weight gain and other non-specific symptoms. Diagnosis of simple cysts tend to be undertaken and distinguished from complex renal cysts or cystic renal tumours based upon imaging features of radiology imaging options including non-contrast ultrasound scan of the renal tract, contrast-enhanced ultrasound scan (CEUS) of the renal tract, non-contrast computed tomography (CT) scan of the renal tract, contrast-enhanced computed tomography (CECT) scan of the renal tract, non-contrast magnetic resonance imaging (MRI) scan of the renal tract, and contrast-enhanced magnetic resonance imaging (CEMRI) scan of the renal tract. Treatment options for simple kidney cysts have tended to involve various options including (a) conservative treatment / leave alone, (b) Expectant management with periodical radiology imaging for follow-up assessments, (c) Per-cutaneous aspiration of the kidney cyst(s)/drainage of the cyst(s), percutaneous aspiration / drainage and sclerotherapy of the kidney cysts, (d) selective renal artery angiography and super-selective embolization of the simple renal cyst(s), (e) marsupialization / decortication of the simple renal cysts by the open method or laparoscopy technique, (f) marsupialization / decortication of the simple renal cysts by the open method or laparoscopy technique plus wadding of the operation site with omental / fat interposition, (g) partial nephrectomy by the open or laparoscopy approach to excise the cyst(s), (h) nephrectomy by the open or laparoscopy technique for large simple polycystic kidneys. Complications that could be associated with aspiration / drainage and sclerotherapy of simple renal cysts include bleeding, infection, and pain plus recurrence and persistence of renal cysts and with regard to cysts in the upper pole of the kidney could be ensued by accidental injury to the spleen and basal lung atelectasis. Embolization of the arterial branch of large and multiple renal cysts could also be associated with post-embolization phenomenon (Wunderlich’s syndrome) including general malaise, fever, loss of appetite and raised white blood cell count that may mimic infection as well as last for a few weeks and this can be prevented by administration of pre-procedure and peri-procedure steroids for a short time. Other possible treatment options for simple kidney cysts that have not been tried include radiofrequency ablation of the residual cyst pursuant to aspiration / drainage / sclerotherapy of the renal cyst, and irreversible electroporation of the residual kidney cyst pursuant to aspiration/drainage/sclerotherapy of the kidney cyst. Considering that the morbidity that tends to be associated with open surgical treatment and laparoscopy treatment options for the management of simple kidney cysts tends to be worse in comparison with per-cutaneous aspiration/drainage/sclerotherapy, generally most clinicians tend not to undertake treatment of kidney cysts initially by the open and laparoscopy procedures. Considering that persistence / recurrence of simple renal cysts can occur or do occur pursuant to percutaneous aspiration/drainage/sclerotherapy of simple kidney cysts, it would be suggested that the undertaking of percutaneous angiography and super-selective embolization of residual simple renal cysts pursuant to the initial treatment or utilization of post-procedure radiofrequency ablation or irreversible electroporation of simple kidney cysts would help reduce the incidence of recurrent and persistent simple kidney cysts and if this is undertaken hopefully the need to undertake open or laparoscopy procedures for dimple kidney cysts would be reduced. There is a need to undertake a global multi-centre trial of various treatment options for simple kidney cysts in order to ascertain the best treatment option with durable long-term outcome of non-recurrence or persistence of the renal cyst(s).

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

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confidence: 99%

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Simple Cysts of the Kidney: A Review and Update

Venyo¹

2022

JCSR

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“…subscale. Regarding measures that were not specifically designed to assess pain, number of items ranged from one (n = 4 measures [17][18][19][20]), two (n = 3 measures [21][22][23]), three (n = 5 measures [24][25][26][27][28]), four (n = 1 measure [29]), five (n = 1 measure [30]), and 10 items (n = 1 measure [31]).…”

Section: Plos Onementioning

confidence: 99%

Patient-reported outcome measures for pain in autosomal dominant polycystic kidney disease: A systematic review

et al. 2021

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Pain is a common symptom in people with autosomal dominant polycystic kidney disease (ADPKD), but it is assessed and reported inconsistently in research, and the validity of the measures remain uncertain. The aim of this study was to identify the characteristics, content, and psychometric properties of measures for pain used in ADPKD. We conducted a systematic review including all trials and observational studies that reported pain in people with ADPKD. Items from all measures were categorized into content and measurement dimensions of pain. We assessed the general characteristics and psychometric properties of all measures. 118 studies, we identified 26 measures: 12 (46%) measures were developed for a non-ADPKD population, 1 (4%) for chronic kidney disease, 2 (8%) for polycystic liver disease and 11 (42%) specifically for ADPKD. Ten anatomical sites were included, with the lower back the most common (10 measures [39%]), four measurement dimensions (intensity (23 [88%]), frequency (3 [12%]), temporality (2 [8%]), and sensory (21 [81%]), two pain types, nociceptive including visceral (15 [58%]) and somatic (5 [20%]), and neuropathic (2 [8%]), and twelve impact dimensions, where the most frequent was work (5 [31%]). The validation data for the measures were variable and only the ADPKD Impact Scale reported all psychometric domains. The measures for pain in ADPKD varied in terms of content and length, and most had not been validated in ADPKD. A standardized psychometrically robust measure that captures patient-important dimensions of pain is needed to evaluate and manage this debilitating complication of ADPKD.

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“…Each embolic agent is characterized by its respective strengths and weaknesses and can be used alone or combined with other occlusive agents to enhance its embolic power. Embolic agents can also divided into solids, as coils for example, and liquids (Brassel & Meila, 2015): liquid embolic materials include adhesive agents, like acrylates, like n-butyl cyanoacrylate (n-BCA) (Kim et al, 2017), non-adhesive agents, such as ethylene-vinyl alcohol copolymer (EVOH) (Sadeh-Gonike et al, 2018) and cytotoxics, like ethanol (Sakuhara et al, 2015). Coils are largely used in TE: advantages of coils are their marked radiopacity and ability of replacement or removal if necessary but their major limit is the difficulty to obtain a complete occlusion.…”

Section: Introductionmentioning

confidence: 99%

Transcatheter embolization with Squid, combined with other embolic agents or alone, in different abdominal diseases: a single-center experience in 30 patients

et al. 2019

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Background: Squid, as Onyx, is an ethylene-vinyl alcohol copolymer (EVOH)-based liquid embolic agent developed for neuroradiologic interventions with poor application in abdominal district. Our aim was to evaluate safety, complications, and efficacy of transcatheter embolization using the two available formulations Squid-18 and 12, in 30 patients affected by different abdominal diseases. Results: Transcatheter embolization with Squid, combined with other embolic agents, as poly vinyl alcohol (PVA) particles, coils and amplatzer plugs, or alone (type 2 endoleak), was performed in 30 patients, as follows: 10 portal vein embolizations (PVEs), 6 arteriovenous malformations (AVMs), 5 visceral artery aneurysms (VAAs), 4 type 2 endoleaks, 3 preoperative embolizations, 1 acute arterial bleeding, 1 female varicocele. Squid was always administered using dimethyl sulfoxide (DMSO) compatible microcatheters. Technical success, 30-day clinical success and complications were assessed. Technical success was 90%. 3 patients (2 AVMs, 1 VAA) required re-intervention successfully performed in all cases. Major complications, cases of microcatheter entrapment and DMSO-related poor pain control were not recorded. 30-day clinical success was 93.3%: in 2 patients submitted to PVE a sufficient future liver remnant (FLR) hypertrophy was not achieved. Conclusion:Squid was successfully used with low complication rate in many abdominal diseases showing a valid embolic action either combined with other embolic agents or alone in type 2 endoleak. The availability of different formulations (Squid-18 and Squid-12) variable for viscosity makes Squid preferable to Onyx as EVOH-based liquid embolic agent, even though comparable studies in different abdominal districts with a larger cohort of patients will be necessary.

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Transcatheter Arterial Embolization with Ethanol Injection in Symptomatic Patients with Enlarged Polycystic Kidneys

Abstract: Renal contraction therapy by TAE with ethanol injection appears to be a safe and effective treatment in patients with symptomatic enlarged polycystic kidney disease.

Cited by 15 publications

References 28 publications

Simple Cysts of the Kidney: A Review and Update

Simple Cysts of the Kidney: A Review and Update

Patient-reported outcome measures for pain in autosomal dominant polycystic kidney disease: A systematic review

Transcatheter embolization with Squid, combined with other embolic agents or alone, in different abdominal diseases: a single-center experience in 30 patients

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