Renal artery embolization: application and success in patients with renal cell carcinoma and angiomyolipoma

A systematic review and meta-analysis on the efficacy of preoperative renal artery embolization prior to radical nephrectomy for renal cell carcinoma: Is it necessary?

INTRODUCTION

Radical nephrectomy for Renal Cell Carcinoma (RCC) is still the treatment of choice for all stages except for stage I and IV, which need patient selectivity. The purpose of Renal Artery Embolization (RAE) pre-operative before radical nephrectomy is to facilitate resection, reduce bleeding, and reduce the time to surgery, but the necessity of this procedure is still debatable. This study investigates the efficacy of pre-operative Renal Artery Embolization (PRAE) before radical nephrectomy for RCC patients.

METHODS

The systematic searches based on PRISMA guidelines were conducted in Pubmed, Scopus, Web of Science, Medrxiv, and ScienceDirect databases with pre-defined keywords. Both analyses, quantitative and qualitative, were performed to assess blood loss, transfusion rate, surgical time, Intensive Care Unit (ICU) stay, and hospital stay.

RESULTS

A total of 921 patients from 8 eligible studies were included. The blood loss was significantly lower in the PRAE group compared to the control group (p = < 0.00001; SMD -20 mL; 95%CI -0.29, -0.12). There is no statistically significant difference between RAE and without RAE in the transfusion rate nephrectomy (p = 0.53, OR 0.65; 95% CI 0.16, 2.57), mean operative time (p = 0.69; SMD 5.91; 95% CI -23.25, 35.07), mean length of hospital stay (p = 0.05; SMD 0.56; 95% CI 0.00, 1.12), and mean length of stay in the ICU (p = 0.45; SMD 11.61; 95% CI -18.35, 41.57) Conclusions: PRAE before radical nephrectomy significantly reduces blood loss in RCC patients but is similar in the surgical time, transfusion rate, and length of hospital stay and ICU stay.

Spectrum of Presentations and Management Strategies in Renal Angiomyolipoma

Renal angiomyolipoma (rAML) occurs rarely sporadically but is commonly encountered in patients with tuberous sclerosis complex and lymphangioleiomyomatosis. rAML is a rare entity, not seen regularly in daily practice; however, is commonly encountered and diagnosed by clinicians who approach and treat kidney masses. Basic knowledge of this entity is necessary to recognize that despite being benign, these tumors can rarely cause deadly complications such as hemorrhage or severe renal dysfunction or may have malignant components associated with them.

Renal Arteries Embolization in Unresectable Clear Cell Renal Carcinoma: First Time Experience at Haji Adam Malik Hospital

OBJECTIVE

To report a case of renal arterial embolisation (RAE) in unresectable renal tumour before nephrectomy.

CASE REPORT

On presentation, the clinical features of this patient, including medical history, signs and symptoms, imaging examinations were recorded. After diagnosis and initial treatment, the result and histopathological examination were performed and discussed. We performed RAE in the unresectable renal tumour in the 28-year-old male that was complaining a palpable pain right flank mass and intermittent hematuria that had been observed five months earlier. A month after RAE, the tumour shrinks and become resectable. The parameter used was tumour volume, propulsion and component, with subjective value VAS, hematuria symptom and Quality Of Life Score EORTC-QLQ C30. The next step we performed nephrectomy with histopathology results in Clear Cell Renal Carcinoma (CCRC).

CONCLUSION

RAE is an effective therapeutic and adjuvant tool because it facilitates the dissection of unresectable large renal tumours and tumours with extensive involvement around the renal hilum; it leading to lower overall morbidity. However, the lack of randomised prospective studies is the primary reason that RAE is not used often before surgery.

Arterial embolization of retained kidney remnant following blunt traumatic injury: A case report

INTRODUCTION

There has been a recent trend toward nonoperative management of solid organ injuries with arteriography and embolization as alternatives to surgical exploration. We examine the use of arterial embolization in the management of a post-subtotal nephrectomy urinoma in a patient with severe renal injury secondary to blunt trauma.

METHODS

This case report has been reported in line with the CARE criteria [13].

PRESENTATION OF CASE

A 35-year-old female patient presented with a persistent urinoma after an incomplete nephrectomy for blunt renal trauma. Computed tomography scan of the abdomen demonstrated a 47×68×101 mm³ collection superior to the remnant of the resected right kidney. With persistence of the urinoma after placement of an 8 French drainage catheter, the patient was taken for arterial embolization of the lower renal artery for ablation of the kidney remnant.

DISCUSSION

Most kidney injuries with urinoma formation are treated successfully with supportive measures, however refractory cases require intervention. Arterial embolization has been used successfully in the treatment of traumatic pseudoaneurysms, arteriovenous fistulas, and some renal tumors. In this patient, we extended the use of embolization to infarct vessels of the functioning kidney remnant as an alternative to surgery. Post-embolization the patient recovered well with permanent resolution of the urinoma and short-term side effects limited to short-lived fever and lumbar pain.

CONCLUSION

Arterial embolization should be considered as an alternative to surgery in cases of persistent urinoma following renal trauma with retained remnants.

Renal artery embolization-indications, technical approaches and outcomes

Owing to improvements in catheters and embolic agents, renal artery embolization (RAE) is increasingly used to treat nephrological and urological disease. RAE has become a useful adjunct to medical resuscitation in severe penetrating, iatrogenic or blunt renal traumatisms with active bleeding, and might avoid surgical intervention, particularly among patients that are haemodynamically stable. The role of RAE in pre-operative or palliative management of advanced malignant renal tumours remains debated; however, RAE is recommended as a first-line therapy for bleeding angiomyolipomas and can be used as a preventative treatment for angiomyolipomas at risk of bleeding. RAE represents an alternative to nephrectomy in various medical conditions, including severe uncontrolled hypertension among patients with end-stage renal disease, renal graft intolerance syndrome or autosomal dominant polycystic kidney disease. RAE is increasingly used to treat renal artery aneurysms or symptomatic renal arteriovenous malformations, with a low complication rate as compared with surgical alternatives. This Review highlights the potential use of RAE as an adjunct in the management of renal disease. We first compare and contrast the technical approaches of RAE associated with the various available embolization agents and then discuss the complications associated with RAE and alternative procedures.

A case-based approach to common embolization agents used in vascular interventional radiology. AJR Am J Roentgenol. 2014;203:699-708. [PMID: 25247933 DOI: 10.2214/ajr.14.12480]

OBJECTIVE

The objective of this article is to familiarize the reader with the most commonly used embolic agents in interventional radiology and discuss an approach for selecting among the different embolic agents. This article reviews their properties and uses a case-based approach to explain how to select one.

CONCLUSION

A wide variety of embolic agents are available. Familiarity with the available embolic agents and selection of the most appropriate embolic agent is critical in interventional radiology to achieve optimum therapeutic response and avoid undesired, potentially disastrous complications such as nontarget embolization.

Endovascular intervention in renovascular disease: a pictorial review

Interventional radiologic procedures offer a significant and expanding role in the management of various renovascular diseases including renal artery stenosis, renal artery aneurysm and pseudoaneurysm, renal vascular malformations, renal tumours, trauma, and resistant hypertension. In this article, we discuss these entities in the context of currently accepted definitions, incidence, modes of diagnosis, and management as they pertain to the practice of interventional radiology. Particular emphasis is placed on current interventional procedures for managing and treating these diseases as well as emerging procedures and technologies.

• Highlights the literature on renovascular diseases

• Reviewing the role of various interventional procedures in the management of renovascular disease

• Review of imaging techniques in the identification and characterisation of renovascular disease