Role of Embolization in the Treatment of Renal Masses

Abstract

Renal arterial embolization (RAE) performed for the treatment of renal masses has been proven to be a safe and effective technique, with several decades of experience. RAE is well tolerated with few complications, particularly if the time interval from embolization to surgery is reduced to less than 48 hours. Review of the literature suggests that RAE is also extremely effective for palliation of symptoms in the setting of nonoperative advanced stage renal cell carcinoma. In addition, this technique plays a large role in the management of angiomyolipomas that are symptomatic or at risk of spontaneous rupture. To date, RAE has not been evaluated in a randomized controlled setting, which has contributed to its underutilization. All of these potential benefits warrant the need for prospective studies for further validation.

Suitability of Patients with Autosomal Dominant Polycystic Kidney Disease for Renal Transcatheter Arterial Embolization

“…It was reported that performing renal TAE before nephrectomy reduces surgical complications. 34 Although it is possible to perform renal TAE in patients with renal cell carcinoma, TAE can induce tumor lysis syndrome in patients with metastatic renal cancer, and therefore, suspected renal metastasis is a contraindication. Renal cyst infection can progress rapidly after renal TAE, and it should not be performed in patients with active cyst infection, although we previously reported that the incidence of renal cyst infection decreases if adequate RV reduction is achieved by renal TAE.…”

Effect of renal embolization in patients with synchronous metastatic renal cell carcinoma: A retrospective comparison of cytoreductive nephrectomy and systemic medical therapy

“…RE can be used to treat patients with large unresectable smRCC, intravenocaval thrombosis or extensive lymphadenopathy, with outcomes expected to be comparable to those obtained with CN [7,9]. The RE procedure can be performed either preoperatively to facilitate surgery or as palliative treatment to control symptoms, such as pain and hematuria [6,10].…”

“…RE is also indicated for patients with a short life expectancy, due to major comorbidities or poor general condition, and for those unsuitable for general anesthesia [11,12]. RE has the advantage over CN of being associated with a lower rate of major morbidity, as well as decreasing the delay between the procedure and initiation of TT [7,9,11,13]. The lower morbidity rate with RE is clinically significant, with previous studies having reported that systemic therapy cannot be provided to 5.4-21.4% of patients after nephrectomy due to procedure-related morbidity [14,15].…”

The role of interventional oncology in the palliative care of cancer patients

“…Common primary tumors which result in gastrointestinal hemorrhage include adenocarcinoma, lymphoma and GI stromal tumors (GISTs); metastatic tumors including melanoma and renal-cell carcinoma (RCC) [78]. Active hemorrhage into the urinary tract resulting in hematuria can also occur as a result from involvement of the urinary tract from RCC [79].…”

“…Renal artery embolization in the setting of palliation is well-tolerated, with the most common complication being postembolization syndrome characterized by pain, leukocytosis and low grade fevers. Post-embolization syndrome is well controlled with anti-pyretics, analgesics, and anti-emetics, usually resolving in 3 days [79].…”