Arterial embolisation of renal tumours with foreign particles is described. This involves occlusion of the arteries supplying the tumour through a catheter introduced by the trans-femoral route. Pre-operative and therapeutic embolisation should be distinguished. During pre-operative embolisation, the kidney should be totally occluded by the foreign particles in order to obtain a bloodless operation zone and in order to avoid the much feared production of tumour emboli. Because of the clinical consequences of renal artery emboli, this procedure should be carried out immediately before the operation. During therapeutic embolisation, which is not followed by an operation, only those vessels supplying the tumour should be occluded in order to avoid the complications of a renal embolus. Ischemia of the tumour and less rapid growth may then be excluded.

We report on a radio opaque substance for the embolization of kidney tumours which consists of amino acids mixed up with a contrast medium. It is relatively easy to be injected and can be well directed because of its radio-opacity. Past and recent histological examinations of embolized pig kidneys show that this material provides a durable closure of the vessels and that there is no essential tendency of intravasal dissolution. It is therefore also suitable for palliative embolizations. The first results in clinical trial have proved to be encouraging.

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The results of computed angiography in 12 patients with renal transplants are described. In five patients with normal function of the transplant and normal appearances on a conventional angiogram, under-perfusion averaging 36% was demonstrated. In two out of three patients with a stenosis at the anastomosis, the effect of the stenosis on function could be shown. In two patients with acute rejection of the graft and hypoxia of the tubules, the differential diagnosis could be clarified by means of computer angiography. Computer angiography can therefore be regarded as a valuable addition to conventional angiography for the differentiation between tubular hypoxia and acute rejection and for underperfusion of a renal transplant.

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