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Interventional treatment of renal angiomyolipoma: immediate results and clinical and radiological follow-up of 4.5 years.

Andersen PE, Thorlund MG, Wennevik GE, Pedersen RL, Lund L - Acta Radiol Open (2015)

Bottom Line: To investigate the technical and clinical effect of this treatment and to evaluate long-term clinical outcomes with clinical control and radiological imaging.The technical success was 7/8 (88%) and clinical success was 6/8 patients (75%).The reduction in tumor size after embolization is significant and long-lasting.

View Article: PubMed Central - PubMed

Affiliation: Odense University Hospital, Odense C, Denmark.

ABSTRACT

Background: Renal angiomyolipoma is rare, but many of these patients may have an acute debut with severe bleeding. These patients need urgent treatment with interventional embolization as an attractive option.

Purpose: To investigate the technical and clinical effect of this treatment and to evaluate long-term clinical outcomes with clinical control and radiological imaging.

Material and methods: Eight patients with angiomyolipoma were treated with embolization. Five patients were treated acutely. Five patients were followed-up for mean 4.5 years with clinical and radiological examinations.

Results: The renal angiomyolipoma decreased significantly from mean 7.2 cm to 2.9 cm after embolization (p = 0.04). Cortical infarctions of about one-third of the circumference of the embolized kidneys could be detected on follow-up examinations, but all patients had normal total kidney function. The bleeding was primarily stopped in all patients, however, in one patient bleeding from a lumbar artery was supplementary embolized within 24 h. In another case the interventional procedure ended up in embolization of the whole kidney as it was impossible to embolize all the feeding arteries selectively. One patient had a nephrectomy one month after embolization because of infection and re-bleeding and one patient after 2.5 years because of tumor size >4 cm. The technical success was 7/8 (88%) and clinical success was 6/8 patients (75%).

Conclusion: Selective embolization of renal angiomyolipoma is a minimally invasive and safe procedure with few complications. It is a nephron sparing alternative to renal resection. The reduction in tumor size after embolization is significant and long-lasting.

No MeSH data available.


Related in: MedlinePlus

A 54-year-old woman (Patient 5) with spontaneous bleeding from a 4 cm angiomyolipoma laterally in right kidney. Hemodynamically stable (a,b). Angiography 5 days later. No ongoing bleeding. Angiomyolipoma vessels (c,d). Selective distal embolization of two segmental renal arteries with use of microcoils with following flow-stop to the angiomyolipoma (c,d). MRI at 2.5-year follow-up demonstrating a 1.5 cm residual angiomyolipoma and a small cortical infarction with reduced cortex of the right kidney laterally (g,h,i,j). The kidney function estimated by renography showed a left/right distribution of 63/37%. Total kidney function was normal (eGFR).
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fig1-2058460115592442: A 54-year-old woman (Patient 5) with spontaneous bleeding from a 4 cm angiomyolipoma laterally in right kidney. Hemodynamically stable (a,b). Angiography 5 days later. No ongoing bleeding. Angiomyolipoma vessels (c,d). Selective distal embolization of two segmental renal arteries with use of microcoils with following flow-stop to the angiomyolipoma (c,d). MRI at 2.5-year follow-up demonstrating a 1.5 cm residual angiomyolipoma and a small cortical infarction with reduced cortex of the right kidney laterally (g,h,i,j). The kidney function estimated by renography showed a left/right distribution of 63/37%. Total kidney function was normal (eGFR).

Mentions: The study is a retrospective observational study from a single center and approved by the Regional Scientific Ethical Committees for Southern Denmark. Tracking down patients was performed through the central computerized patient register, through the manual registrations of all interventional procedures at the Department of Radiology, and the radiological information system (RIS) and picture archiving system (PACS) of the Radiologic Department at Odense University Hospital back till 2008. In all cases of interventional embolization of renal bleedings, all available case records and radiological imaginings were perused and the patients ending up with the diagnosis of AML entered the study. The diagnosis was based on clinical findings combined with CT and angiographic findings (Fig. 1a,b,c,d). Angiography was performed under local anesthesia via the femoral artery. Abdominal aortography was followed by selective right and left renal angiography. The bleeding vessels were selectively catheterized with 4 F or microcatheters and embolized with use of standard or micro coils according to the size of the vessel being embolized (Fig. 1e,f), and in one case with use of a supplementary vascular plug to occlude the main renal artery.Fig. 1.


Interventional treatment of renal angiomyolipoma: immediate results and clinical and radiological follow-up of 4.5 years.

Andersen PE, Thorlund MG, Wennevik GE, Pedersen RL, Lund L - Acta Radiol Open (2015)

A 54-year-old woman (Patient 5) with spontaneous bleeding from a 4 cm angiomyolipoma laterally in right kidney. Hemodynamically stable (a,b). Angiography 5 days later. No ongoing bleeding. Angiomyolipoma vessels (c,d). Selective distal embolization of two segmental renal arteries with use of microcoils with following flow-stop to the angiomyolipoma (c,d). MRI at 2.5-year follow-up demonstrating a 1.5 cm residual angiomyolipoma and a small cortical infarction with reduced cortex of the right kidney laterally (g,h,i,j). The kidney function estimated by renography showed a left/right distribution of 63/37%. Total kidney function was normal (eGFR).
© Copyright Policy - creative-commons
Related In: Results  -  Collection

License 1 - License 2 - License 3
Show All Figures
getmorefigures.php?uid=PMC4548745&req=5

fig1-2058460115592442: A 54-year-old woman (Patient 5) with spontaneous bleeding from a 4 cm angiomyolipoma laterally in right kidney. Hemodynamically stable (a,b). Angiography 5 days later. No ongoing bleeding. Angiomyolipoma vessels (c,d). Selective distal embolization of two segmental renal arteries with use of microcoils with following flow-stop to the angiomyolipoma (c,d). MRI at 2.5-year follow-up demonstrating a 1.5 cm residual angiomyolipoma and a small cortical infarction with reduced cortex of the right kidney laterally (g,h,i,j). The kidney function estimated by renography showed a left/right distribution of 63/37%. Total kidney function was normal (eGFR).
Mentions: The study is a retrospective observational study from a single center and approved by the Regional Scientific Ethical Committees for Southern Denmark. Tracking down patients was performed through the central computerized patient register, through the manual registrations of all interventional procedures at the Department of Radiology, and the radiological information system (RIS) and picture archiving system (PACS) of the Radiologic Department at Odense University Hospital back till 2008. In all cases of interventional embolization of renal bleedings, all available case records and radiological imaginings were perused and the patients ending up with the diagnosis of AML entered the study. The diagnosis was based on clinical findings combined with CT and angiographic findings (Fig. 1a,b,c,d). Angiography was performed under local anesthesia via the femoral artery. Abdominal aortography was followed by selective right and left renal angiography. The bleeding vessels were selectively catheterized with 4 F or microcatheters and embolized with use of standard or micro coils according to the size of the vessel being embolized (Fig. 1e,f), and in one case with use of a supplementary vascular plug to occlude the main renal artery.Fig. 1.

Bottom Line: To investigate the technical and clinical effect of this treatment and to evaluate long-term clinical outcomes with clinical control and radiological imaging.The technical success was 7/8 (88%) and clinical success was 6/8 patients (75%).The reduction in tumor size after embolization is significant and long-lasting.

View Article: PubMed Central - PubMed

Affiliation: Odense University Hospital, Odense C, Denmark.

ABSTRACT

Background: Renal angiomyolipoma is rare, but many of these patients may have an acute debut with severe bleeding. These patients need urgent treatment with interventional embolization as an attractive option.

Purpose: To investigate the technical and clinical effect of this treatment and to evaluate long-term clinical outcomes with clinical control and radiological imaging.

Material and methods: Eight patients with angiomyolipoma were treated with embolization. Five patients were treated acutely. Five patients were followed-up for mean 4.5 years with clinical and radiological examinations.

Results: The renal angiomyolipoma decreased significantly from mean 7.2 cm to 2.9 cm after embolization (p = 0.04). Cortical infarctions of about one-third of the circumference of the embolized kidneys could be detected on follow-up examinations, but all patients had normal total kidney function. The bleeding was primarily stopped in all patients, however, in one patient bleeding from a lumbar artery was supplementary embolized within 24 h. In another case the interventional procedure ended up in embolization of the whole kidney as it was impossible to embolize all the feeding arteries selectively. One patient had a nephrectomy one month after embolization because of infection and re-bleeding and one patient after 2.5 years because of tumor size >4 cm. The technical success was 7/8 (88%) and clinical success was 6/8 patients (75%).

Conclusion: Selective embolization of renal angiomyolipoma is a minimally invasive and safe procedure with few complications. It is a nephron sparing alternative to renal resection. The reduction in tumor size after embolization is significant and long-lasting.

No MeSH data available.


Related in: MedlinePlus