Long-term efficacy of selective arterial embolisation of renal angiomyolipoma
DOI:
https://doi.org/10.2340/sju.v58.12318Keywords:
Angiomyolipoma, Bleeding, embolisation, rebleedingAbstract
Objective: To evaluate the long-term efficacy of selective arterial embolisation in renal angiomyolipoma (AML), with emphasis on tumour shrinkage, potential regrowth and the necessity of supplementary procedures.
Material and methods: A retrospective review of all 58 consecutive embolisations at two institutions, between 1999 and 2018, was performed. Clinical notes, laboratory data and imaging were reviewed.
Results: The overall complication rate was 6.8%, with no Clavien-Dindo grades III–V complications. Kidney function was unaffected by embolisation as measured by creatinine. Median radiological follow-up was 4.8 years (interquartile range [IQR]: 2.8–7.8), and median clinical follow-up was 7.5 years (IQR: 4.7–14.0). Decreasing AML size was observed in 96% of procedures. Maximal shrinkage (30% median diameter decrease; IQR: 15–44) was reached after median 2.2 years (IQR: 0.6–4.8). During follow-up, regrowth occurred in 38% of patients, and four bleeding episodes occurred in three patients with tuberous sclerosis. Growing size and/or rebleeding prompted a redo embolisation in 9% of spontaneous AML and 50% of tuberous sclerosis-associated AML.
Conclusions: Being a well-tolerated treatment with few complications, selective arterial embolisation renders a pronounced size-reduction in most patients with AML, and kidney function is preserved. Regrowth is common, and a radiological follow-up is necessary. Tuberous sclerosis is a risk factor for the need of reintervention.
Downloads
References
Fittschen, A., I. Wendlik, S. Oeztuerk, et al., Prevalence of sporadic renal angiomyo-lipoma: a retrospective analysis of 61,389 in- and out-patients. Abdominal Imaging, 2014. 39(5): p. 1009-1013. https://doi.org/10.1007/s00261-014-0129-6 DOI: https://doi.org/10.1007/s00261-014-0129-6
Buj Pradilla, M.J., T. Martí Ballesté, R. Torra, et al., Recommendations for imaging-based diagnosis and management of renal angiomyolipoma associated with tuberous sclerosis complex. Clinical Kidney Journal, 2017. 10(6): p. 728-737. https://doi.org/10.1093/ckj/sfx094 DOI: https://doi.org/10.1093/ckj/sfx094
Bernstein, J., T.O. Robbins and J.M. Kissane, The renal lesions of tuberous sclerosis. Semin Diagn Pathol, 1986. 3(2): p. 97-105.
Ahn, T., M.J. Roberts, A. Navaratnam, et al., Changing etiology and management pat-terns for spontaneous renal hemorrhage: a systematic review of contemporary series. Int Urol Nephrol, 2017. 49(11): p. 1897-1905. https://doi.org/10.1007/s11255-017-1694-8 DOI: https://doi.org/10.1007/s11255-017-1694-8
Bhatt, J.R., P.O. Richard, N.S. Kim, et al., Natural History of Renal Angiomyolipoma (AML): Most Patients with Large AMLs >4cm Can Be Offered Active Surveillance as an Initial Management Strategy. Eur Urol, 2016. 70(1): p. 85-90. https://doi.org/10.1016/j.eururo.2016.01.048 DOI: https://doi.org/10.1016/j.eururo.2016.01.048
Sward, J., O. Henrikson, D. Lyrdal, et al., Renal angiomyolipoma-patient characteristics and treatment with focus on active surveillance. Scand J Urol, 2020. 54(2): p. 141-146. https://doi.org/10.1080/21681805.2020.1716066 DOI: https://doi.org/10.1080/21681805.2020.1716066
Jinzaki, M., S.G. Silverman, H. Akita, et al., Renal angiomyolipoma: a radiological classification and update on recent developments in diagnosis and management. Abdom Imag-ing, 2014. 39(3): p. 588-604. https://doi.org/10.1007/s00261-014-0083-3 DOI: https://doi.org/10.1007/s00261-014-0083-3
Anis, O., U. Rimon, J. Ramon, et al., Selective Arterial Embolization for Large or Symptomatic Renal Angiomyolipoma: 10 Years of Follow-up. Urology, 2020. 135: p. 82-87. https://doi.org/10.1016/j.urology.2019.09.035 DOI: https://doi.org/10.1016/j.urology.2019.09.035
Wang, C., M. Yang, X. Tong, et al., Transarterial embolization for renal angiomyo-lipomas: A single centre experience in 79 patients. J Int Med Res, 2017. 45(2): p. 706-713. https://doi.org/10.1177/0300060516684251 DOI: https://doi.org/10.1177/0300060516684251
Sheth, R.A., A.S. Feldman, E. Paul, et al., Sporadic versus Tuberous Sclerosis Com-plex-Associated Angiomyolipomas: Predictors for Long-Term Outcomes following Transcatheter Embolization. J Vasc Interv Radiol, 2016. 27(10): p. 1542-9. https://doi.org/10.1016/j.jvir.2016.05.029 DOI: https://doi.org/10.1016/j.jvir.2016.05.029
Lee, S., H.S. Park, D. Hyun, et al., Radiologic and clinical results of transarterial etha-nol embolization for renal angiomyolipoma. Eur Radiol, 2021. 31(9): p. 6568-6577. https://doi.org/10.1007/s00330-021-07831-y DOI: https://doi.org/10.1007/s00330-021-07831-y
Kuusk, T., F. Biancari, B. Lane, et al., Treatment of renal angiomyolipoma: pooled analysis of individual patient data. BMC Urol, 2015. 15: p. 123. https://doi.org/10.1186/s12894-015-0118-2 DOI: https://doi.org/10.1186/s12894-015-0118-2
Fernandez-Pello, S., M. Hora, T. Kuusk, et al., Management of Sporadic Renal Angi-omyolipomas: A Systematic Review of Available Evidence to Guide Recommendations from the European Association of Urology Renal Cell Carcinoma Guidelines Panel. Eur Urol On-col, 2020. 3(1): p. 57-72. https://doi.org/10.1016/j.euo.2019.04.005 DOI: https://doi.org/10.1016/j.euo.2019.04.005
Moorhead, J.D., P. Fritzsche and H.L. Hadley, Management of hemorrhage secondary to renal angiomyolipoma with selective arterial embolization. J Urol, 1977. 117(1): p. 122-3. https://doi.org/10.1016/S0022-5347(17)58367-6 DOI: https://doi.org/10.1016/S0022-5347(17)58367-6
Makki, A., O. Graumann, S. Hoyer, et al., Cryoablation of Renal Angiomyolipoma: An Evaluation of Safety and Efficacy. J Endourol, 2017. 31(11): p. 1117-1122. https://doi.org/10.1089/end.2017.0376 DOI: https://doi.org/10.1089/end.2017.0376
Castle, S.M., V. Gorbatiy, O. Ekwenna, et al., Radiofrequency ablation (RFA) therapy for renal angiomyolipoma (AML): an alternative to angio-embolization and nephron-sparing surgery. BJU Int, 2012. 109(3): p. 384-7. https://doi.org/10.1111/j.1464-410X.2011.10376.x DOI: https://doi.org/10.1111/j.1464-410X.2011.10376.x
Nozadze, G., S.B. Larsen, S. Heerwagen, et al., Selective arterial embolization of renal angiomyolipomas: A 10-year experience. BJUI Compass, 2022. 3(1): p. 86-92. https://doi.org/10.1002/bco2.107 DOI: https://doi.org/10.1002/bco2.107
Murray, T.E., F. Doyle and M. Lee, Transarterial Embolization of Angiomyolipoma: A Systematic Review. J Urol, 2015. 194(3): p. 635-9. https://doi.org/10.1016/j.juro.2015.04.081 DOI: https://doi.org/10.1016/j.juro.2015.04.081
Hocquelet, A., F. Cornelis, Y. Le Bras, et al., Long-term results of preventive emboliza-tion of renal angiomyolipomas: evaluation of predictive factors of volume decrease. Eur Radi-ol, 2014. 24(8): p. 1785-93. https://doi.org/10.1007/s00330-014-3244-4 DOI: https://doi.org/10.1007/s00330-014-3244-4
Duan, X.H., M.F. Zhang, J.Z. Ren, et al., Urgent transcatheter arterial embolization for the treatment of ruptured renal angiomyolipoma with spontaneous hemorrhage. Acta Radiol, 2016. 57(11): p. 1360-1365. https://doi.org/10.1177/0284185115588125 DOI: https://doi.org/10.1177/0284185115588125
Bardin, F., O. Chevallier, A. Bertaut, et al., Selective arterial embolization of sympto-matic and asymptomatic renal angiomyolipomas: a retrospective study of safety, outcomes and tumor size reduction. Quant Imaging Med Surg, 2017. 7(1): p. 8-23. https://doi.org/10.21037/qims.2017.01.02 DOI: https://doi.org/10.21037/qims.2017.01.02
Lin, L., C. Wang, R. Pei, et al., Prophylactic selective arterial embolization for renal an-giomyolipomas: efficacy and evaluation of predictive factors of significant shrinkage. Int Urol Nephrol, 2018. 50(10): p. 1765-1770. https://doi.org/10.1007/s11255-018-1953-3 DOI: https://doi.org/10.1007/s11255-018-1953-3
Oesterling, J.E., E.K. Fishman, S.M. Goldman, et al., The management of renal angio-myolipoma. J Urol, 1986. 135(6): p. 1121-4. https://doi.org/10.1016/S0022-5347(17)46013-7 DOI: https://doi.org/10.1016/S0022-5347(17)46013-7
Chapman, D., M. Tyson and B. Buckley, Single-institution, retrospective review of elective and emergency embolization of renal angiomyolipoma. Can Urol Assoc J, 2021. 15(11): p. E598-E602. https://doi.org/10.5489/cuaj.7143 DOI: https://doi.org/10.5489/cuaj.7143
Additional Files
Published
How to Cite
Issue
Section
License
Copyright (c) 2023 Jesper Swärd, Karl Bohlin, Olof Henrikson, Sven Lundstam, Ralph Peeker, Anna Grenabo Bergdahl
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
As from Volume 59 (2024) all published articles, unless otherwise specified, are published under CC-BY license, allowing third parties to copy and redistribute the material in any medium or format and to remix, transform, and build upon the material, with the condition of proper attribution to the original work.
