Renal angiomyolipoma: long-term results after arterial embolization.

Abstract

PURPOSE:

Selective arterial embolization of renal angiomyolipomas (AMLs) was performed to prevent hemorrhage in patients with AMLs larger than 4 cm. This study was conducted to evaluate the long-term efficacy of AML embolization.

MATERIALS AND METHODS:

Nineteen patients underwent embolization for 30 renal AMLs between July 1991 and June 2002. Of these, 10 patients had tuberous sclerosis (TS) with multiple AMLs and nine patients had a solitary sporadic AML. Embolization was performed with use of ethanol mixed with iodized oil (Ethiodol) in 29 tumors; coils were used in addition to the ethanol/Ethiodol mixture in one case. All tumors were completely embolized according to angiographic criteria including vascular stasis and absence of arterial feeders. The efficacy of embolization was determined over a mean follow-up period of 51.5 months (range, 6-132 months). Recurrence was defined as an increase in tumor size of greater than 2 cm on follow-up imaging and/or recurrent symptoms that required repeat embolization. An institutional review board exemption was obtained to perform this retrospective study.

RESULTS:

Embolization of the renal AMLs was technically successful in all 19 patients and for all 30 lesions. AML recurrence was noted in 31.6% of patients (n = 19) and for 30% of lesions overall (n = 9). Six of 10 patients in the TS group had AML recurrences. No recurrences occurred in the patients with sporadic AML. In the TS group of 10 patients, there was a total of 21 AMLs and the overall tumor recurrence rate was 42.9% (nine of 21). Six lesions in four patients had to be reembolized because of recurrent symptoms, including one hemorrhage, and three lesions in two patients required repeat embolization because of a greater than 2 cm increase in size. The median time interval from embolization to recurrence was 78.7 months (range, 13-132 months). Statistical testing with use of the Fisher exact test demonstrated that patients with TS were significantly more likely to develop recurrence than those without TS (P = .01).

CONCLUSIONS:

Transarterial embolization is effective in preventing hemorrhage in patients with renal AMLs. However, long-term follow-up revealed a high AML recurrence rate in patients with TS. Lifelong surveillance for recurrence after AML embolization is essential in patients with TS.

• Authors: Nishita Kothary, Michael C Soulen, Timothy W I Clark, A J Wein, Richard D Shlansky-Goldberg, Peter B Crino, S William Stavropoulos
• Journal: Journal of vascular and interventional radiology : JVIR (J Vasc Interv Radiol) Vol. 16 Issue 1 Pg. 45-50 (Jan 2005) ISSN: 1051-0443 [Print] United States
• PMID: 15640409 (Publication Type: Journal Article)

Topics

• Adult
• Aged
• Angiomyolipoma (blood supply, therapy)
• Embolization, Therapeutic
• Female
• Follow-Up Studies
• Hemorrhage (prevention & control)
• Humans
• Kidney Neoplasms (blood supply, therapy)
• Male
• Middle Aged
• Neoplasm Recurrence, Local
• Treatment Outcome
• Tuberous Sclerosis (complications)