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Semin intervent Radiol 2020; 37(04): 420-425
DOI: 10.1055/s-0040-1715884
How I Do It

Renal Artery Embolization for Neoplastic Conditions

Alex Lionberg
1   Department of Radiology, The University of Chicago, Chicago, Illinois
,
James Jeffries
1   Department of Radiology, The University of Chicago, Chicago, Illinois
,
Thuong G. Van Ha
1   Department of Radiology, The University of Chicago, Chicago, Illinois
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Renal artery embolization (RAE) is a versatile tool for the management of both acute renal hemorrhage and nonemergent renal conditions. Acute bleeds may be encountered in the setting of trauma, iatrogenic injury, renal tumors, or aneurysms. Since its development in the 1970s–1980s, the use of RAE for acute hemorrhage has been shown to be both safe and efficacious, with reported success rates between 85 and 95%.[1] [2] [3] Improvements in technology such as the coaxial catheter system have allowed for the use of superselective embolization, which minimizes the risk of irreversible renal function loss. With superselective technique, the infarcted portion of the kidney is typically less than 15%, and there is often no significant loss of renal function.[4] For this reason, along with fewer complications and more rapid recovery compared with surgical management, RAE is considered the treatment of choice for acute renal hemorrhage when possible.[5] [6]

RAE can also be performed for a wide variety of nonemergent renal conditions. Patients with end-stage renal disease and consequent drug-resistant hypertension may be appropriate for RAE as a means of functional exclusion of the kidney, particularly those who are poor surgical candidates. For this indication, proximal embolization is performed with the goal of achieving complete necrosis of the kidney. This obviates the need to perform open or laparoscopic nephrectomy, which otherwise carries significant morbidity and mortality.[7] [8] Similarly, functional exclusion with RAE can be used to treat nephrotic syndrome and cases of graft intolerance syndrome associated with failed renal transplants.[9] [10] [11] Less frequent indications include arteriovenous malformations, renal artery aneurysms, and autosomal dominant polycystic kidney disease. Benign and malignant neoplasms together comprise the most common indications for RAE, which will be reviewed in detail in this article.



Publication History

Article published online:
01 October 2020

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