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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 74-year-old woman (Patient 8) hemodynamically instable with massive bleeding from a 10 cm angiomyolipoma in the right upper pole (a,b). Angiography demonstrating several small aneurysms in relation to the angiomyolipoma (c,d). About one-third of the kidney was selectively embolized with use of microcoils (e). She had a compartment syndrome with bladder pressure up to 22 mmHg and inflammation after embolization and was on hemodialysis for a period, but recovered slowly and completely.
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fig3-2058460115592442: A 74-year-old woman (Patient 8) hemodynamically instable with massive bleeding from a 10 cm angiomyolipoma in the right upper pole (a,b). Angiography demonstrating several small aneurysms in relation to the angiomyolipoma (c,d). About one-third of the kidney was selectively embolized with use of microcoils (e). She had a compartment syndrome with bladder pressure up to 22 mmHg and inflammation after embolization and was on hemodialysis for a period, but recovered slowly and completely.

Mentions: Six patients had spontaneous bleedings and the AMLs were discovered following this (Figs. 2a,b,c and 3a,b). Five patients (patients 1, 3, 6, 7, and 8) were embolized acutely within 12 h of symptom debut because of severe bleeding (Fig. 3c,d,e) (Table 1). They were all hemodynamically instable with low Hb, low blood pressure, and with need of transfusions. Patient 5 was stabilized hemodynamically on conservative treatment, and was embolized electively after 5 days with tumor size of 4 cm because of supposed increased risk of re-bleeding. In Patient 4 the AML was discovered incidentally, and the interventional treatment was performed electively after 3 months because of the big size of the AML (12 cm). In Patient 7, the bleeding from the AML appeared after coronary angiography, and renal trauma by the catheter or guide wire could not be excluded. Lastly, Patient 2 was treated without embolization because of a small (3 cm) AML with self-limited bleeding. Four months later a covered stent was deployed in the renal artery to exclude a renal artery aneurysm on the same side. This stent at the same time occluded a segmental artery supplying the AML. In the remaining seven patients coils were deployed for embolization. In seven patients the embolization was selective with embolization of estimated one-quarter to one-third of the kidney. In one patient with technical failure the whole kidney was embolized (Patient 4). In this patient the intention was to treat with selective embolization, but ended up with total renal embolization with use of a supplementary vascular plug, because of numerous supplying arteries to the tumor, which were impossible to embolize selectively (Fig. 4a,b,c,d). This patient had a contralateral kidney with normal function detected at renography before the embolization. Thus, the technical success with stop of bleeding as intended, no re-intervention because of re-bleeding from AML, and no associated complications within 24 h was 7/8 (88%) patients.Fig. 2.


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 74-year-old woman (Patient 8) hemodynamically instable with massive bleeding from a 10 cm angiomyolipoma in the right upper pole (a,b). Angiography demonstrating several small aneurysms in relation to the angiomyolipoma (c,d). About one-third of the kidney was selectively embolized with use of microcoils (e). She had a compartment syndrome with bladder pressure up to 22 mmHg and inflammation after embolization and was on hemodialysis for a period, but recovered slowly and completely.
© Copyright Policy - creative-commons
Related In: Results  -  Collection

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

fig3-2058460115592442: A 74-year-old woman (Patient 8) hemodynamically instable with massive bleeding from a 10 cm angiomyolipoma in the right upper pole (a,b). Angiography demonstrating several small aneurysms in relation to the angiomyolipoma (c,d). About one-third of the kidney was selectively embolized with use of microcoils (e). She had a compartment syndrome with bladder pressure up to 22 mmHg and inflammation after embolization and was on hemodialysis for a period, but recovered slowly and completely.
Mentions: Six patients had spontaneous bleedings and the AMLs were discovered following this (Figs. 2a,b,c and 3a,b). Five patients (patients 1, 3, 6, 7, and 8) were embolized acutely within 12 h of symptom debut because of severe bleeding (Fig. 3c,d,e) (Table 1). They were all hemodynamically instable with low Hb, low blood pressure, and with need of transfusions. Patient 5 was stabilized hemodynamically on conservative treatment, and was embolized electively after 5 days with tumor size of 4 cm because of supposed increased risk of re-bleeding. In Patient 4 the AML was discovered incidentally, and the interventional treatment was performed electively after 3 months because of the big size of the AML (12 cm). In Patient 7, the bleeding from the AML appeared after coronary angiography, and renal trauma by the catheter or guide wire could not be excluded. Lastly, Patient 2 was treated without embolization because of a small (3 cm) AML with self-limited bleeding. Four months later a covered stent was deployed in the renal artery to exclude a renal artery aneurysm on the same side. This stent at the same time occluded a segmental artery supplying the AML. In the remaining seven patients coils were deployed for embolization. In seven patients the embolization was selective with embolization of estimated one-quarter to one-third of the kidney. In one patient with technical failure the whole kidney was embolized (Patient 4). In this patient the intention was to treat with selective embolization, but ended up with total renal embolization with use of a supplementary vascular plug, because of numerous supplying arteries to the tumor, which were impossible to embolize selectively (Fig. 4a,b,c,d). This patient had a contralateral kidney with normal function detected at renography before the embolization. Thus, the technical success with stop of bleeding as intended, no re-intervention because of re-bleeding from AML, and no associated complications within 24 h was 7/8 (88%) patients.Fig. 2.

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