Treatment of angiomyolipoma at a tertiary care centre: the decision between surgery and angioembolization

Faddegon, Stephen

doi:10.5489/cuaj.758

Cited by 4 publications

(4 citation statements)

References 21 publications

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“…With improvement of cross sectional imaging and even in cases of low-fat tumors, AMLs can now be confidently diagnosed with an MRI specificity of up to 99% (52,53 (25)(26)(27)36). Literature comparing nephrectomy and NSS with SAE in the management of AMLs is limited (3,8,55,56) with medical and economic analyses favoring embolization in symptomatic renal AMLs or AMLs at risk of complications. Endovascular therapy for AMLs has less postoperative morbidity (6.9%) compared to partial nephrectomy (12%), with minimal invasiveness and shorter hospitalization (54,57).…”

Section: Discussionmentioning

confidence: 99%

Selective arterial embolization of symptomatic and asymptomatic renal angiomyolipomas: a retrospective study of safety, outcomes and tumor size reduction

Bardin¹,

Chevallier²,

Bertaut³

et al. 2017

Quant. Imaging Med. Surg.

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Background: Angiomyolipoma (AML) is the most common renal benign tumor. Treatment should be considered for symptomatic patients or for those at risk for complications, especially retroperitoneal bleeding which is correlated to tumor size, grade of the angiogenic component and to the presence of tuberous sclerosis complex (TSC). This study reports our single-center experience with the use of selective arterial embolization (SAE) in the management of symptomatic and asymptomatic renal AMLs. Methods:In this retrospective mono-centric study, all demographic and imaging data, medical records, angiographic features, outpatient charts and follow-up visits of patients who underwent prophylactic or emergency SAE for AMLs between January 2005 and July 2016 were reviewed. Tumor size and treatment outcomes were assessed at baseline and after the procedure during follow-up. Computed tomography (CT), magnetic resonance imaging (MRI) or ultrasonography was used to evaluate AML shrinkage. Renal function was measured pre-and post-procedure.Results: Twenty-three patients (18 females, 5 males; median age, 45 years; range, 19-85 years) who underwent SAE either to treat bleeding AML (n=6) or as a prophylactic treatment (n=17) were included.Overall, 34 AMLs were embolized. TSC status was confirmed for 6 patients. Immediate technical success rate was 96% and 4 patients benefitted from an additional procedure. Major complications occurred in 3 patients and minor post-embolization syndrome (PES) in 14 patients. The mean AML size reduction rate was 26.2% after a mean follow-up was 20.5 months (range, 0.5-56 months), and only non-TSC status was significantly associated with better shrinkage of tumor (P=0.022). Intralesional aneurysms were significantly more frequent in patients with hemorrhagic presentation (P=0.008). There was no change in mean creatinine level after SAE.Conclusions: SAE is a safe and effective technique to manage renal AMLs as a preventive treatment as well as in emergency setting, with significant reduction in tumor size during follow-up. A multidisciplinary approach remains fundamental, especially for TSC patients. In addition to size, the presence of intralesional aneurysms should be considered in any prophylactic treatment decision.

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Section: Discussionmentioning

confidence: 99%

Selective arterial embolization of symptomatic and asymptomatic renal angiomyolipomas: a retrospective study of safety, outcomes and tumor size reduction

Bardin¹,

Chevallier²,

Bertaut³

et al. 2017

Quant. Imaging Med. Surg.

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“…11 Many centers now favor transarterial embolization of angiomyolipoma, and reserve surgery for patients with refractory symptoms, complex renal artery anatomy, failure of embolization, and rare cases of diagnostic uncertainty. 12 The adoption of embolization as the treatment of choice has not been paralleled by a strengthening of the evidence supporting its use. Small studies, primarily case series report embolization as the sole form of therapy has a reported success of 86-90%, with a morbidity of 10-17%.…”

Section: Current Management Strategies Of Angiomyolipomamentioning

confidence: 99%

Transarterial Embolization of Angiomyolipoma: A Systematic Review

2015

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“…The mass appears to be echogenic on ultrasound and has the density of fat on CT scanning. When the diameter of renal AML becomes >4 cm, particularly for giant tumors with persistent hemorrhage or suspicion of malignancy, partial or total nephrectomy is the treatment of choice (11). In the present case, total nephrectomy was performed as the left kidney was non-functional.…”

Section: Discussionmentioning

confidence: 99%

Giant renal angiomyolipoma: A case report

Chen

Jin

et al. 2017

mol clin onc

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Abstract. Renal angiomyolipoma (AML), also referred to as renal hamartoma, is a rare solid tumor without malignant characteristics. The inheritance pattern of renal AML is autosomal dominant. If the lesion grows to a large size, a series of clinical manifestations and serious complications may occur. We herein present a case of giant renal AML in a 34-year-old female patient, who presented with left-sided abdominal bloating for ~6 months. Following abdominal ultrasound and computed tomography examination, the patient underwent total left nephrectomy. The resected mass was sized 29x20x10 cm. Postoperative histopathological examination confirmed the lesion as a giant renal AML. There are only few cases of giant renal AML (>20 cm) reported in the literature to date. Due to the large size of the tumor, it is crucial to report similar cases, their diagnosis and treatment.

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Treatment of angiomyolipoma at a tertiary care centre: the decision between surgery and angioembolization

Cited by 4 publications

References 21 publications

Selective arterial embolization of symptomatic and asymptomatic renal angiomyolipomas: a retrospective study of safety, outcomes and tumor size reduction

Selective arterial embolization of symptomatic and asymptomatic renal angiomyolipomas: a retrospective study of safety, outcomes and tumor size reduction

Transarterial Embolization of Angiomyolipoma: A Systematic Review

Giant renal angiomyolipoma: A case report

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