Embolization of Spontaneous Intratumoral Hemorrhage with the Hemodynamic Characteristics of Arteriovenous Fistula in Renal Angiomyolipoma

Abstract

Aneurysms within renal angiomyolipomas (AML) may rupture into the tumor or pararenal space. Transcatheter arterial embolization is the first-choice treatment to control bleeding. Here, we describe the use of coil embolization in two cases of spontaneous intratumoral hemorrhage with the hemodynamic characteristics of renal arteriovenous (AV) fistula in renal AML. In case 1, renal angiography showed several intratumoral aneurysms, one of which had ruptured into the tumor, resulting in the formation of an intratumoral hematoma. Blood flow within the hematoma was rapid and the blood was immediately returned to the systemic circulation through the left renal vein. In case 2, renal angiography showed that the rupture of an intratumoral aneurysm of a tumor-feeding artery had resulted in formation of an intratumoral hematoma and direct renal vein communication. No extratumoral hemorrhage was observed in either case. The hemodynamics of both hematomas resembled those of a high-flow renal AV fistula. The ruptured aneurysms were embolized with detachable and pushable coils (case 1) or pushable coils only (case 2). To our knowledge, this is the first report of successful embolization of AV fistula-like intratumoral hemorrhage in renal AML.

Embolization of hemorrhagic renal angiomyolipoma complicated by arteriovenous shunting: A case report

“…Such cases can be technically challenging, with an increased risk of embolizing adjoining normal renal parenchyma, resulting in functional compromise [5] , [12] . Embolization options that have been successfully used to treat renal AML include polyvinyl alcohol foam powder with coils, polyvinyl alcohol with alcohol, alcohol with ethiodized oil, and sterile compressed sponge [13] .…”

“…However, the use of particle- or liquid-based embolization materials is not suitable in the presence of AV shunt hemodynamics [13] . Gelatin foam with metallic coils has been demonstrated as a suitable option allowing embolization with reduced risk of nontarget embolization through the AV shunt [13] , [14] . A disadvantage to this approach is the high frequency of collateral vessel recruitment, which we encountered in this case [13] .…”

“…Gelatin foam with metallic coils has been demonstrated as a suitable option allowing embolization with reduced risk of nontarget embolization through the AV shunt [13] , [14] . A disadvantage to this approach is the high frequency of collateral vessel recruitment, which we encountered in this case [13] . We employed a 2-step approach in which proximal embolization using large gelatin foam and metallic coils was performed, resulting in stabilization of hemorrhage and reduction in AV shunt flow.…”

An update on recent developments in rupture of renal angiomyolipoma

“…[ 47 ] Choices of embolization agents and methods significantly determine the outcome of embolization and should be guided by the hemodynamics of patients. [ 48 ] Development and application of new embolization agents may help interventionist better cope with clinical practice. [ 49 ]…”

Wünderlich sindrom kao prva manifestacija karcinoma bubrega – prikaz slučaja

“…U literaturi se također najčešće preporučuje operacija, bila to potpuna ili parcijalna nefrektomija ili eventualno samo evakuacija hematoma u blažim slučajevima [11][12] . U određenim slučajevima, pogotovo kada je uzrok dobroćudna tvorevina, može se napraviti embolizacija grane renalne arterije, s tim da je tu primijećena povećana vjerojatnost ponovnog nastanka krvarenja [13][14][15] .…”