Tratamento endovascular de angiomiolipoma renal por embolização arterial seletiva

Abstract

Relata-se um caso de um paciente com queixa principal de dor lombar à esquerda, portador de angiomiolipomas renais (AMLRs) bilaterais, com a lesão mais volumosa de 6,2 cm em seu maior diâmetro, submetido a tratamento endovascular por embolização arterial superseletiva com microesferas. Os AMLRs são tumores benignos raros. A maioria é esporádica, enquanto uma minoria está associada à Esclerose Tuberosa Complexa (ETC). Os AMLRs maiores do que 4 cm devem ser tratados devido ao maior risco de complicações, principalmente hemorrágicas. A embolização arterial seletiva (EAS) é um tratamento efetivo e seguro para os AMLRs.

Embolização arterial superseletiva para tratamento de angiomiolipoma em paciente com rim único

“…There is a correlation between RAML size and the occurrence of complications and/or symptoms. 2,3 The most common manifestation is abdominal or lumbar pains in 85% of cases, palpable mass in 53% and anemia in 21%. Retroperitoneal bleeding or hematuria may also occur, and invasion of the renal parenchyma can lead to kidney failure.…”

“…Renal cell carcinomas exhibit a low intensity signal on T1 and a high intensity signal on T2, whereas the opposite is true of fatty tissues. 2 Additionally, in the presence of bleeding, RAMLs should be considered on the list of possible differential diagnoses of renal masses, even when there is no sign of fatty tissues within the lesion, because they could be masked by tumoral hemorrhage. 2 If X-ray findings are characteristic of an RAML, its hypervascularized nature means that biopsy is only indicated in exceptional circumstances because of the risk of hemorrhage and since there is a minimal possibility that the results will change the therapeutic management chosen.…”

“…2 Criteria for intervention include diameter greater than 4 cm (some authors state 3.5 cm), intratumoral aneurysms larger than 4-5 mm 1,2 and pain, active hemorrhage, 1 multiple RAMLs, bilateral RAMLs or unilateral RAML when the patient only has one kidney, and patients with tuberous sclerosis complex. 1,2,7 Several different studies have demonstrated the efficacy of embolization for treatment and prevention of hemorrhage. [1][2][3][4] The procedure can be performed under local anesthesia, with or without sedation, but some authors believe that the procedure can be conducted more quickly and with greater safety under general anesthesia.…”

“…They are hamartomas and they are composed, in varying proportions, of adipose and muscle tissues and blood vessels. [1][2][3][4] They are rare tumors 1,3 that account for 1% of renal masses, they have an incidence of 0.07 to 0.3% of the population, 1 and they are twice as common among women. 2 They occur sporadically in 80 1 to 90% 2 of patients, while in 10 2 to 20% of cases they are found in combination with tuberous sclerosis complex.…”

“…The criteria habitually used to indicate embolization are tumor size greater than 4 cm, intratumoral aneurysms larger than 4-5 mm, history of bleeding due to RAML and ocurrence of abdominal/lumbar pains. 1,2…”