Renal Artery Embolization: Application and Success in Patients with Renal Cell Carcinoma and Angiomyolipoma

ABSTRACT

Renal artery embolization is a procedure primarily performed by interventional radiologists that can be utilized for treatment of renal tumors, both malignant and benign. It has many applications, including pretreatment of renal cell carcinomas prior to planned resection to decrease hemorrhagic complications intraoperatively, treatment of malignant renal tumor in patients who are not deemed suitable surgical candidates, as well as treatment of benign renal tumors and their potential hemorrhagic complications. There are many different techniques. We describe how the procedure is approached at the University of Florida-Gainesville and provide examples of two cases, a renal cell carcinoma and an angiomyolipoma, treated at our institution with transcatheter embolotherapy.

KEYWORDS

Renal artery embolization - renal cell carcinoma - angiomyolipoma

REFERENCES

• 1 Valji K. Vascular and Interventional Radiology. 2nd ed. Philadelphia; WB Sanders 2006: 171-174
• 2 Watanabe S, Hama Y, Kaji T, Kimura F, Kosuda S. Pre-operative embolization for spontaneous rupture of renal cell carcinoma.  Ulster Med J. 2005;  74 66-67
• 3 Zielinski H, Szmigielski S, Petrovich Z. Comparison of preoperative embolization followed by radical nephrectomy with radical nephrectomy alone for renal cell carcinoma.  Am J Clin Oncol. 2000;  23 6-12
• 4 Kier R, Taylor K J, Feyock A L, Ramos I M. Renal masses: characterization with Doppler US.  Radiology. 1990;  176 703-707
• 5 Sheth S, Scatarige J, Horton K, Corl F, Fishman E. Current concepts in the diagnosis and management of renal cell carcinoma: role of multidetector CT and three-dimensional CT.  Radiographics. 2001;  21 S237-S254
• 6 Davidson A J, Hartman D S, Choyke P L, Wagner B J. Radiologic assessment of renal masses: implications for patient care.  Radiology. 1997;  202 297-305
• 7 Silverman S G, Lee B Y, Seltzer S E, Bloom D A, Corless C L, Adams D F. Small (< or = 3 cm) renal masses: correlation of spiral CT features and pathologic findings.  AJR Am J Roentgenol. 1994;  163 597-605
• 8 Han Y M, Kim J K, Roh B S et al.. Renal angiomyolipoma: selective arterial embolization-effectiveness and changes in angiomyogenic components in long-term follow-up.  Radiology. 1997;  204 65-70
• 9 Logue L G, Acker R E, Sienko A E. Best cases from the AFIP: angiomyolipomas in tuberous sclerosis.  Radiographics. 2003;  23 241-246
• 10 Steiner M S, Goldman S M, Fishman E K, Marshall F F. The natural history of renal angiomyolipoma.  J Urol. 1993;  150 1782-1786
• 11 Bennett W F, Bova J G, Vaswani K. Case 2: angiomyolipoma with minimal fat content.  AJR Am J Roentgenol. 2000;  175 883-884
• 12 Martin J, Puig J, Falco J et al.. Hyperechoic liver nodules: characterization with proton fat-water chemical shift MR imaging.  Radiology. 1998;  207 325-330
• 13 Paivansalo M, Lahde S, Hyvarinen S, Kallioinen M, Jalovaara P. Renal angiomyolipoma: ultrasonographic, CT, angiographic, and histologic correlation.  Acta Radiol. 1991;  32 239-243
• 14 Baum S, Pentecost M J. Abrams Angiography: Interventional Radiology. 2nd ed. Baltimore; Lippincott, Wilkins, and Williams 2005: 1060-1066
• 15 Thomsen H S. Gadolinium-based contrast media may be nephrotoxic even at approved doses.  Eur Radiol. 2004;  14 1654-1656
• 16 Thomsen H S, Almen T, Morcos S K. Contrast Media Safety Committee of the European Society of Urogenital Radiology (ESUR) . Gadolinium containing contrast media for radiographic examinations: a position paper.  Eur Radiol. 2002;  12 2600-2605
• 17 Nyman U, Elmstahl B, Leander P, Nilsson M, Golman K, Almen T. Are gadolinium-based contrast media really safer than iodinated media for digital subtraction angiography in patients with azotemia?.  Radiology. 2002;  223 311-318
• 18 Bakal C W, Cynamon J, Lakritz P S, Sprayregen S. Value of preoperative renal artery embolization in reducing blood transfusion requirements during nephrectomy for renal cell carcinoma.  J Vasc Interv Radiol. 1993;  4 727-731
• 19 Park J H, Kim S H, Han J K, Chung J W, Han M C. Transcatheter arterial embolization of unresectable renal cell carcinoma with a mixture of ethanol and iodized oil.  Cardiovasc Intervent Radiol. 1994;  17 323-327
• 20 Kothary N, Soulen M C, Clark T W et al.. Renal angiomyolipoma: long-term results after arterial embolization.  J Vasc Interv Radiol. 2005;  16 45-50
• 21 Lee W, Kim T S, Chung J W, Han J K, Kim S H, Park J H. Renal angiomyolipoma: embolization with a mixture of alcohol and iodized oil.  J Vasc Interv Radiol. 1998;  9 255-261
• 22 Rimon U, Duvdevani M, Garniek A et al.. Ethanol and polyvinyl alcohol mixture for transcatheter embolization of renal angiomyolipoma.  AJR Am J Roentgenol. 2006;  187 762-768
• 23 Choyke P L, Filling-Katz M R, Shawker T K et al.. von Hippel-Lindau disease: radiologic screening for visceral manifestations.  Radiology. 1990;  174 815-820
• 24 Choyke P L, Glenn G M, Walther M M, Patronas N J, Linehan W M, von Zbar B. Hippel-Lindau disease: genetic, clinical, and imaging features.  Radiology. 1995;  194 629-642