Selective Arterial Embolization of Renal Angiomyolipomas with a N-Butyl Cyanoacrylate-Lipiodol Mixture: Efficacy, Safety, Short- and Mid-Term Outcomes

Prigent, François-Victor; Guillen, Kévin; Comby, Pierre-Olivier; Pellegrinelli, Julie; Falvo, Nicolas; Midulla, Marco; Majbri, Nabil; Chevallier, Olivier; Loffroy, Romaric

doi:10.3390/jcm10184062

Cited by 10 publications

(20 citation statements)

References 46 publications

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“…Our cohort did have complications with post-embolization syndrome (PES) presenting in 27% of our cohort. This is in line with similar reviews with a mean incidence ranging between 33 and 60% 5,11,12 and is an expected sequalae of embolization. Major complications were present in five patients.…”

Section: Discussionsupporting

confidence: 92%

Is Size All That Matters? New Predictors of Complications and Bleeding in Renal Angiomyolipoma

Combes¹,

McQueen²,

Palma³

et al. 2023

RRU

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Renal angiomyolipoma (AML) is the most common benign renal tumor. Whilst generally asymptomatic, they can cause life-threatening bleeding. Selective angioembolization (SAE) may be used to treat large symptomatic and asymptomatic AMLs. We aimed to evaluate the efficacy of SAE for symptomatic and asymptomatic renal AMLs and determine characteristics that predict spontaneous bleeding. Patients and Methods: Data were retrospectively collected from a prospectively maintained database from July 2011 to April 2022. Patients were included if AML was >4cm and they underwent subsequent SAE. Follow-up imaging was analyzed to calculate mean reduction in AML size. Clinical notes were reviewed to analyze lesion characteristics including vascularity, fat content and presence of aneurysm as well as post-procedural complications. Results: 26 patients with 30 AMLs were identified. Interval of follow-up imaging ranged from 1 to 60 months. 25 AMLs were embolized electively with 5 emergency embolizations performed for bleeding. Mean reduction in AML volume was 41% at 3 months (p=0.013) and 63% at 12 months (p=0.007). All 5 bleeding AMLs had a rich vascularity with 60% also having either aneurysms or a low fat content. Complications included post-embolic syndrome (n=9), segmental renal parenchyma devascularization (n=3), acute bleeding requiring re-embolization (n=2), nephrectomy for ongoing bleeding (n=1) and delayed bleeding managed conservatively (n=1). No deterioration in renal function was observed. Conclusion: SAE is an effective procedure for managing symptomatic and asymptomatic renal AML, with minimal significant complications. AML vascularity, fat content and aneurysms may be useful characteristics to assess future risk of bleeding in patients with renal AML.

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Section: Discussionsupporting

confidence: 92%

Is Size All That Matters? New Predictors of Complications and Bleeding in Renal Angiomyolipoma

Combes¹,

McQueen²,

Palma³

et al. 2023

RRU

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“…Previous studies have shown that the extent of AML shrinkage induced by TAE is affected by several AML characteristics, including tumor composition and initial tumor size. AMLs with a lower fat content are reported to undergo greater decreases in tumor volume after TAE (1,9,15,16), as are smaller AMLs (1,8). Differences in these parameters between AMLs included in this pilot study may underlie the differences in initial LDH elevation and subsequent tumor volume reduction.…”

Section: Discussionmentioning

confidence: 99%

Serum lactate dehydrogenase concentration after transcatheter renal artery embolization correlates with reduction in renal angiomyolipoma volume

et al. 2023

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Background The extent of renal angiomyolipoma (AML) volume reduction after renal transcatheter arterial embolization (TAE) varies between patients, with no predictive measure available. Purpose To determine whether the serum lactate dehydrogenase (LDH) concentration shortly after TAE correlates with the extent of tumor shrinkage. Material and Methods In a cohort of 36 patients undergoing prophylactic renal TAE for unruptured renal AML, we retrospectively acquired data from patient medical records, including serum LDH before and within 7 days after TAE and the tumor volume before and 12–36 months after TAE. The relationship between the serum level of LDH and reduction in tumor volume was evaluated using Spearman correlation analysis. Results The median LDH concentration was significantly higher after TAE than before (909.0 U/L vs. 186.5 U/L). This early post-TAE serum LDH level and LDH index (post-TAE LDH / pre-TAE LDH) correlated significantly and positively with the absolute decrease in tumor volume (both P < 0.0001). We observed no significant correlation between the relative tumor volume reduction and serum LDH level or LDH index. Conclusion Serum LDH elevation occurs shortly after TAE and correlates with the extent of absolute decrease in AML volume at 12–36 months after TAE. Further large-scale studies are warranted to confirm the predictive role of post-TAE serum LDH level and LDH index in tumor shrinkage in patients with unruptured renal AML.

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“…Instead of nephrectomy, superselective arterial embolization (SAE) is a minimally invasive technique that can treat dysplastic vessels and reduce tumor size ( 9 , 10 ). By superselecting the arteries, SAE can preserve renal function and decrease severe complications ( 8 , 11 ). Because of the effectiveness and safety, SAE is also gradually used as a prophylactic treatment option to avoid RAML rupture or enlargement ( 12 ).…”

Section: Introductionmentioning

confidence: 99%

The radiomics-clinical nomogram for predicting the response to initial superselective arterial embolization in renal angiomyolipoma, a preliminary study

Zechuan,

Tianshi,

Tiantian

et al. 2024

Front. Oncol.

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PurposeThe aim of this study was to explore a radiomics-clinical model for predicting the response to initial superselective arterial embolization (SAE) in renal angiomyolipoma (RAML).Materials and methodsA total of 78 patients with RAML were retrospectively enrolled. Clinical data were recorded and evaluated. Radiomic features were extracted from preoperative contrast-enhanced CT (CECT). Least absolute shrinkage and selection operator (LASSO) and intra- and inter-class correlation coefficients (ICCs) were used in feature selection. Logistic regression analysis was performed to develop the radiomics, clinical, and combined models where the fivefold cross-validation method was used. The predictive performance and calibration were evaluated by the receiver operating characteristic (ROC) curve and calibration curve. Decision curve analysis (DCA) was used to measure clinical usefulness.ResultsThe tumor shrinkage rate was 29.7% in total, and both fat and angiomyogenic components were significantly reduced. In the radiomics model, 12 significant features were selected. In the clinical model, maximum diameter (p = 0.001), angiomyogenic tissue ratio (p = 0.032), aneurysms (p = 0.048), and post-SAE time (p = 0.002) were significantly associated with greater volume reduction after SAE. Because of the severe linear dependence between radiomics signature and some clinical parameters, the combined model eventually included Rad-score, aneurysm, and post-SAE time. The radiomics-clinical model showed better discrimination (mean AUC = 0.83) than the radiomics model (mean AUC = 0.60) and the clinical model (mean AUC = 0.82). Calibration curve and DCA showed the goodness of fit and clinical usefulness of the radiomics-clinical model.ConclusionsThe radiomics-clinical model incorporating radiomics features and clinical parameters can potentially predict the positive response to initial SAE in RAML and provide support for clinical treatment decisions.

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Selective Arterial Embolization of Renal Angiomyolipomas with a N-Butyl Cyanoacrylate-Lipiodol Mixture: Efficacy, Safety, Short- and Mid-Term Outcomes

Cited by 10 publications

References 46 publications

Is Size All That Matters? New Predictors of Complications and Bleeding in Renal Angiomyolipoma

Is Size All That Matters? New Predictors of Complications and Bleeding in Renal Angiomyolipoma

Serum lactate dehydrogenase concentration after transcatheter renal artery embolization correlates with reduction in renal angiomyolipoma volume

The radiomics-clinical nomogram for predicting the response to initial superselective arterial embolization in renal angiomyolipoma, a preliminary study

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