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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 1) 10 years after acute embolizaton of spontaneous bleeding from a 7 cm angiomyolipoma in left kidney. About one-third of the kidney was selectively embolized. At follow-up the residual tumor measured 2 cm and the renographic functional distribution of left/right kidney was 39/61% and the total kidney function (eGFR) was normal.
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fig5-2058460115592442: A 54-year-old woman (Patient 1) 10 years after acute embolizaton of spontaneous bleeding from a 7 cm angiomyolipoma in left kidney. About one-third of the kidney was selectively embolized. At follow-up the residual tumor measured 2 cm and the renographic functional distribution of left/right kidney was 39/61% and the total kidney function (eGFR) was normal.

Mentions: The patients were followed up until July 2014 or until they died. The patient with nephrectomy after 1 month was not followed up with radiological imaging. Otherwise, no intercurrent renal bleeding episodes were registered in any patient. Disease-specific survival of the entire cohort was 100%. Two patients (Patients 6 and 7) died during the follow-up period (2.5 years and 2 weeks). Patient 7 died 2 weeks after sufficient AML embolization. He was a 75-year-old man with unstable angina and myocardial infarction. He died following coronary artery bypass surgery because of heart failure without relation to the AML. The other patient (Patient 6) died 2.5 years after the embolization because of lymphoma without relation to the AML. Three out of the eight patients (38%) lost a kidney: one during the embolization procedure (Patient 4) and two during follow-up by nephrectomy (Patient 8 4 weeks after embolization and Patient 3 2.5 years after the embolization). In the latter case, the AML had decreased in size from 10 cm before embolization to 6 cm after, but the nephrectomy was performed based on a clinical decision to prevent the supposed increased risk of bleeding because of AML size over 4 cm. Thus five patients were followed up for a mean of 4.5 years (range, 2.5–10 years) with clinical examinations, blood samplings and MRI in four cases, and CT in one case (Table 1). The size (longest axis) of the AML in these five patients had decreased significantly from median 7 cm to 2.5 cm (64%) and mean 7.2 cm to 2.9 cm (60%) (P = 0.04, paired samples t-test). In all patients cortical infarctions of about one-third of the circumference of the kidneys could be detected on follow-up examinations (Fig. 5). We have had no cases of re-growth of the AML, and no revascularizations or insufficient embolizations. All patients had normal total kidney function (eGFR) with a renographic distribution of about one-third on the embolized kidney and two-thirds on the non-embolized kidney (Table 1). All patients had normal blood pressure, one patient on treatment with three different antihypertensive drugs, two with one antihypertensive drugs, and the rest without medical treatment. All patients declared to be in good health.Fig. 5.


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 1) 10 years after acute embolizaton of spontaneous bleeding from a 7 cm angiomyolipoma in left kidney. About one-third of the kidney was selectively embolized. At follow-up the residual tumor measured 2 cm and the renographic functional distribution of left/right kidney was 39/61% and the total kidney function (eGFR) was normal.
© Copyright Policy - creative-commons
Related In: Results  -  Collection

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

fig5-2058460115592442: A 54-year-old woman (Patient 1) 10 years after acute embolizaton of spontaneous bleeding from a 7 cm angiomyolipoma in left kidney. About one-third of the kidney was selectively embolized. At follow-up the residual tumor measured 2 cm and the renographic functional distribution of left/right kidney was 39/61% and the total kidney function (eGFR) was normal.
Mentions: The patients were followed up until July 2014 or until they died. The patient with nephrectomy after 1 month was not followed up with radiological imaging. Otherwise, no intercurrent renal bleeding episodes were registered in any patient. Disease-specific survival of the entire cohort was 100%. Two patients (Patients 6 and 7) died during the follow-up period (2.5 years and 2 weeks). Patient 7 died 2 weeks after sufficient AML embolization. He was a 75-year-old man with unstable angina and myocardial infarction. He died following coronary artery bypass surgery because of heart failure without relation to the AML. The other patient (Patient 6) died 2.5 years after the embolization because of lymphoma without relation to the AML. Three out of the eight patients (38%) lost a kidney: one during the embolization procedure (Patient 4) and two during follow-up by nephrectomy (Patient 8 4 weeks after embolization and Patient 3 2.5 years after the embolization). In the latter case, the AML had decreased in size from 10 cm before embolization to 6 cm after, but the nephrectomy was performed based on a clinical decision to prevent the supposed increased risk of bleeding because of AML size over 4 cm. Thus five patients were followed up for a mean of 4.5 years (range, 2.5–10 years) with clinical examinations, blood samplings and MRI in four cases, and CT in one case (Table 1). The size (longest axis) of the AML in these five patients had decreased significantly from median 7 cm to 2.5 cm (64%) and mean 7.2 cm to 2.9 cm (60%) (P = 0.04, paired samples t-test). In all patients cortical infarctions of about one-third of the circumference of the kidneys could be detected on follow-up examinations (Fig. 5). We have had no cases of re-growth of the AML, and no revascularizations or insufficient embolizations. All patients had normal total kidney function (eGFR) with a renographic distribution of about one-third on the embolized kidney and two-thirds on the non-embolized kidney (Table 1). All patients had normal blood pressure, one patient on treatment with three different antihypertensive drugs, two with one antihypertensive drugs, and the rest without medical treatment. All patients declared to be in good health.Fig. 5.

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