Evidence-based protocol-led management of renal angiomyolipoma: A review of literature

Vaggers, Sophie; Rice, Patrick; Somani, Bhaskar; Veeratterapillay, Rajan; Prasad, Bhavan

doi:10.5152/tud.2020.20343

Cited by 12 publications

(18 citation statements)

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“…Arterial embolisation therapy is considered the first line of therapy for patients with AML presenting with acute haemorrhage. Selective arterial embolisation has been shown to be safe and effective therapy for actively haemorrhaging AMLs 14–16. Arterial embolisation therapy has success rates emergently controlling haemorrhage reported over 95% 17.…”

Section: Discussionmentioning

confidence: 99%

“…It can reach most AMLs including some involving the renal hilum. It limits blood loss, and has been shown to decrease the need for surgery, as well as improve outcomes of subsequent nephron-sparing surgery should it be necessary 14–16. There are concerns that patients who are treated with embolisation therapy may need reintervention for further bleeding or growth of the AML.…”

Section: Discussionmentioning

confidence: 99%

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Ruptured angiomyolipoma, a novel entity for emergency physicians in the differential diagnosis of haemorrhagic shock in a female patient of reproductive age

Sapadin

Girzadas²,

Chhabra³

et al. 2022

BMJ Case Rep

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A woman in her 30s presented to the emergency department with acute onset, progressively worsening left-sided abdominal pain after exercise. She was found to be hypotensive and diaphoretic, with free intraperitoneal fluid detected on bedside point-of-care ultrasound. Resuscitation was initiated, a presumptive diagnosis of ruptured ectopic pregnancy was made, and obstetrics and gynaecology were consulted. Point-of-care urine pregnancy testing, however, was negative, and subsequent CT angiography of the patient’s abdomen revealed an angiomyolipoma (AML) with active haemorrhage. Ultimately, embolisation was performed in the interventional radiology suite, with improvement of patient haemodynamics. Ruptured AML is a rare, life-threatening condition that needs to be included in the differential diagnosis of haemorrhagic shock in female patients of reproductive age presenting to the emergency department.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Ruptured angiomyolipoma, a novel entity for emergency physicians in the differential diagnosis of haemorrhagic shock in a female patient of reproductive age

Sapadin

Girzadas²,

Chhabra³

et al. 2022

BMJ Case Rep

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“…Systemic treatments are currently recommended as the first-line treatment for asymptomatic TSC patients to preserve renal parenchyma, reduce rate of secondary complications, and/or reduce the need for continued interventions that may further compromise renal function. [15][16][17] While four study participants (patients 3, 4, 12, 19) managed their AMLs through localized therapy, they were not candidates for everolimus therapy or active surveillance, as they had either symptomatic AMLs and/or extremely high-risk AMLs.…”

Section: Tsc-related Angiomyolipomamentioning

confidence: 99%

“…These findings suggest that active surveillance in low-risk, asymptomatic AML patients is a viable option, which aligns with the current strategy recommendations. 15,16 Refer to Figure 2 for a management algorithm for TSCassociated AMLs.…”

Section: Tsc-related Angiomyolipomamentioning

confidence: 99%

“…For example, a recent literature review of renal AML research proposed a larger AML cutoff size to prevent overtreatment of AMLs. 16 Other papers have also suggested that AML size is not the only factor that needs to be considered. 6,7,15 At our center, multiple variables (AML size, size of aneurysms, disease burden, functional kidney reserves, AML location, growth rate, etc.)…”

Section: Tsc-related Angiomyolipomamentioning

confidence: 99%

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Management of adult tuberous sclerosis complex-related angiomyolipoma: A single-center experience

Siddoji

Hoogenes

et al. 2021

CUAJ

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Introduction: Tuberous sclerosis complex (TSC) is a rare, multisystem, genetic disease. A significant cause of TSC-related morbidity is potential bleeding from renal angiomyolipoma (AML). To pre-emptively decrease AML bleeding, mTOR inhibitors can be used; however, thresholds for initiating and maintaining everolimus therapy remain uncertain. Recent literature suggests not triggering active treatment of AMLs based on size thresholds alone. We evaluated the appropriateness of initiating everolimus therapy in asymptomatic patients after considering AML size, rate of growth, and other factors. Methods: Diagnostic criteria developed by the 2012 International TSC Consensus Group and presence of AML were used as inclusion criteria. Medical and imaging reports of 20 TSC patients from a single center were reviewed. Results: Mean age was 40.55 (±16.27) and 11 patients were female. Eight asymptomatic patients at high risk for complications underwent everolimus therapy, of which seven (88%) demonstrated decreased AML size but multiple side effects were reported. Four high-risk asymptomatic patients did not undergo therapy due to side effect concerns, while four low-risk asymptomatic patients had stable AMLs under active surveillance. Four patients had reduced AMLs through local therapy. Conclusions: Everolimus treatment was effective for managing AML size in most high-risk asymptomatic patients with tolerable side effects. AML size can remain relatively stable for asymptomatic low-risk patients despite not receiving intervention(s). Patients with TSC-related AML can be safely managed with mTOR inhibitors like everolimus, with shared decision-making including factors such as bleeding risk, AML growth rate, and number and absolute size of AMLs.

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Multiple Cervicomediastinal Hamartomas Associated with Lymphangioleiomyomatosis

Ayyildiz

Aydın

Oğul

2022

Archivos de Bronconeumología

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Evidence-based protocol-led management of renal angiomyolipoma: A review of literature

Abstract: Ali Serdar Gözen, et al.; Robot-assisted vasovasostomy and vasoepididymostomy: Current status and review of the literature.

Cited by 12 publications

References 0 publications

Ruptured angiomyolipoma, a novel entity for emergency physicians in the differential diagnosis of haemorrhagic shock in a female patient of reproductive age

Ruptured angiomyolipoma, a novel entity for emergency physicians in the differential diagnosis of haemorrhagic shock in a female patient of reproductive age

Management of adult tuberous sclerosis complex-related angiomyolipoma: A single-center experience

Multiple Cervicomediastinal Hamartomas Associated with Lymphangioleiomyomatosis

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