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Transcatheter arterial embolization in patients with kidney diseases: an overview of the technical aspects and clinical indications.

Loffroy R, Rao P, Kwak BK, Ota S, De Lin M, Liapi E, Geschwind JF - Korean J Radiol (2010)

Bottom Line: 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.The complications, side effects and main precautions associated with this approach are also described.

View Article: PubMed Central - PubMed

Affiliation: Russell H. Morgan Department of Radiology and Radiological Sciences, Division of Cardiovascular and Interventional Radiology, Johns Hopkins University School of Medicine, Johns Hopkins Hospital, Baltimore, Maryland 21287, USA. romaric.loffroy@yahoo.fr

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.

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Related in: MedlinePlus

Preoperative glue embolization of renal cell carcinoma before nephrectomy in 69-year-old man.A. Selective renal arteriogram: large vascular tumor in lower-pole of left kidney.B. Control angiogram after embolization of entire renal artery using radiopaque cyanoacrylate/Lipiodol mixture (1:3): complete occlusion of renal artery allows minimal intraoperative blood loss and easier nephrectomy.
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Figure 1: Preoperative glue embolization of renal cell carcinoma before nephrectomy in 69-year-old man.A. Selective renal arteriogram: large vascular tumor in lower-pole of left kidney.B. Control angiogram after embolization of entire renal artery using radiopaque cyanoacrylate/Lipiodol mixture (1:3): complete occlusion of renal artery allows minimal intraoperative blood loss and easier nephrectomy.

Mentions: Performing embolization in patients who are suitable for radical surgery (stages I to III) is controversial. It can be useful to reduce blood loss (11, 12) and to facilitate cleavage of the tumor, thanks to the reaction edema in the embolized territory. It seems advisable to limit this technique to large (> 9 cm), extensively vascularized tumors. By collapsing the perihilar vascular network, embolization may facilitate the approach to the pedicle in stage III tumors that show involvement of the renal vein. In cases where the renal capsule is involved, embolization may provide a better cleavage plane (13). In this case, embolization must be completed with distal occlusion of the vessels so as to more effectively devascularize the area to be excised (Fig. 1). Ethanol with or without Lipiodol® can be used, although cyanoacrylate or microparticles are more frequently employed for this; resorbable materials are rarely used. When microcoils are used for distal embolization, they must be positioned far enough from the ostium of the renal artery so as not to hinder the surgeon during ligature of the pedicle.


Transcatheter arterial embolization in patients with kidney diseases: an overview of the technical aspects and clinical indications.

Loffroy R, Rao P, Kwak BK, Ota S, De Lin M, Liapi E, Geschwind JF - Korean J Radiol (2010)

Preoperative glue embolization of renal cell carcinoma before nephrectomy in 69-year-old man.A. Selective renal arteriogram: large vascular tumor in lower-pole of left kidney.B. Control angiogram after embolization of entire renal artery using radiopaque cyanoacrylate/Lipiodol mixture (1:3): complete occlusion of renal artery allows minimal intraoperative blood loss and easier nephrectomy.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2864852&req=5

Figure 1: Preoperative glue embolization of renal cell carcinoma before nephrectomy in 69-year-old man.A. Selective renal arteriogram: large vascular tumor in lower-pole of left kidney.B. Control angiogram after embolization of entire renal artery using radiopaque cyanoacrylate/Lipiodol mixture (1:3): complete occlusion of renal artery allows minimal intraoperative blood loss and easier nephrectomy.
Mentions: Performing embolization in patients who are suitable for radical surgery (stages I to III) is controversial. It can be useful to reduce blood loss (11, 12) and to facilitate cleavage of the tumor, thanks to the reaction edema in the embolized territory. It seems advisable to limit this technique to large (> 9 cm), extensively vascularized tumors. By collapsing the perihilar vascular network, embolization may facilitate the approach to the pedicle in stage III tumors that show involvement of the renal vein. In cases where the renal capsule is involved, embolization may provide a better cleavage plane (13). In this case, embolization must be completed with distal occlusion of the vessels so as to more effectively devascularize the area to be excised (Fig. 1). Ethanol with or without Lipiodol® can be used, although cyanoacrylate or microparticles are more frequently employed for this; resorbable materials are rarely used. When microcoils are used for distal embolization, they must be positioned far enough from the ostium of the renal artery so as not to hinder the surgeon during ligature of the pedicle.

Bottom Line: 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.The complications, side effects and main precautions associated with this approach are also described.

View Article: PubMed Central - PubMed

Affiliation: Russell H. Morgan Department of Radiology and Radiological Sciences, Division of Cardiovascular and Interventional Radiology, Johns Hopkins University School of Medicine, Johns Hopkins Hospital, Baltimore, Maryland 21287, USA. romaric.loffroy@yahoo.fr

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.

Show MeSH
Related in: MedlinePlus