Superselective Transcatheter Arterial Embolization for Large Unruptured Renal Angiomyolipoma in Lymphangioleiomyomatosis

Kato, Hitomi; Kuwatsuru, Ryohei; Inoue, Tatsuro; Okada, Shingo; Aida, Mari; Yamashiro, Y

doi:10.1016/j.jvir.2017.11.003

Cited by 17 publications

(19 citation statements)

References 26 publications

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“…The quality of the articles included was high. Among the 30 studies, 18 studies scored 11 points 11–28 in the Agency for Healthcare Research and Quality Cross-Sectional/Prevalence Study Quality checklists, six studies scored 10 points, 29–34 three studies scored 9 points, 35–37 and the other three studies scored 8 points. 38–40…”

Section: Resultsmentioning

confidence: 99%

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Renal function, complications, and outcomes of a reduction in tumor size after transarterial embolization for renal angiomyolipomas: a meta-analysis

Lin

Guan

et al. 2019

J Int Med Res

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Objective The present study aimed to evaluate renal function, complications, and changes in tumor size after transarterial embolization for patients with renal angiomyolipomas. Methods We performed a meta-analysis of transarterial embolization in patients with renal angiomyolipomas from January 1994 to April 2018. Endpoints of interest were the estimated glomerular filtration rate, serum creatinine levels, blood urea nitrogen levels, complications, and reduction of tumors. Results A total of 30 studies comprising 653 patients were included. A total of 32.0% of patients were treated by urgent transarterial embolization for spontaneous ruptured renal angiomyolipomas. Other patients sought to relieve symptoms or received embolism prophylactically. The estimated glomerular filtration rate showed no significant difference between before and after embolization. In 363 patients with data on complications, post-embolization syndrome occurred most frequently (54.0%). Only 16 (4.4%) patients had major complications. The diameter of sporadic angiomyolipomas was reduced by a mean of 2.09 cm (95% confidence interval [CI], 0.73–3.45 cm; I2 = 29.3%) and they were reduced in size by 30.0% (95% CI, 16.0%–44.0%; I2 = 27.9%). Conclusions Transarterial embolization of renal angiomyolipomas affects renal function preservation, with a low complication rate. Transarterial embolization is useful for sporadic and tuberous sclerosis complex-related angiomyolipomas.

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Section: Resultsmentioning

confidence: 99%

“…PES was reported in 16 (363 patients) studies, 11–14,17,21,22,28–32,36,37,40 in which researchers adopted different approaches to PES. As a result, the rate of PES was 54.0% (95.0% CI, 36.6%–70.4%; I 2 = 91.0%; p < 0.001) (Figure 4), with a significant difference between studies.…”

Section: Resultsmentioning

confidence: 99%

Renal function, complications, and outcomes of a reduction in tumor size after transarterial embolization for renal angiomyolipomas: a meta-analysis

Lin

Guan

et al. 2019

J Int Med Res

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“…Because of the different proportions of blood vessels, smooth muscles, and fat in different tumors, the degree of tumor shrinkage after SAE treatment also differs; in particular, tumors with high fat content do not show significantly reduced volume (19,20). We therefore decided to combine SAE therapy with RFA because our experience and published data (1,(17)(18)(19)(20) suggest that treatment with SAE alone may not result in rapid tumor shrinkage. We did not apply SAE and RFA sequentially, but used both immediately, as sequential therapy may risk the disappearance of lipiodol or the granular embolic agent, the formation of newly-developed collateral vessels, and the recanalization of the embolized blood vessels.…”

Section: A B C Dmentioning

confidence: 99%

A new management strategy for renal angiomyolipomas: superselective arterial embolization in combination with radiofrequency ablation

Liu

Tang

et al. 2019

Ann Transl Med

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Background: The present study analyzed the safety and efficacy of superselective arterial embolization (SAE) combined with radiofrequency ablation (RFA) to treat renal angiomyolipoma (RAML).Methods: This retrospective study included the clinical data of 6 patients with RAML treated between March 2016 and October 2017. All patients underwent RFA treatment immediately after SAE guided by angio-computed tomography (angio-CT). The tumor size, renal function and complications, and time to recurrence were compared before and after treatment. Results:The success rate of the SAE + RFA technique was 100%, and no serious complications were found during or after surgery. After treatment, the patients' symptoms, including low back pain and hematuria, were relieved. The pre-treatment creatinine level (55.6±11.0 μmol/L) did not differ significantly from the post-treatment creatinine level (68.2±13.7 μmol/L), which was measured 1 day after surgery (t=1.75, P=0.109). The mean follow-up time was 29.5±6.1 months. By the end of the follow-up period, the maximum diameter of the tumor was 3.1±0.6 cm, which was significantly smaller than the pre-treatment diameter of 5.9±1.01 cm (t=5.83, P<0.001). At 3 months after surgery, the maximum diameter of the tumor was reduced by 22-38% in all 6 patients. At the last follow-up examination, the maximum diameter of the tumor was reduced by 36-61%. Contrast-enhanced CT or magnetic resonance imaging scans showed that the enhanced part of the original lesion had disappeared, the renal parenchyma was full of even fat signals, and only one patient had new enhanced lesions at the site of the original lesions.Conclusions: SAE combined with RFA is a safe and effective treatment for RAML, and its strengths qualify it to become a new treatment strategy for RAML.

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“…Regarding reductions in tumor volume, Hocquelet et al 21 reported a mean volume reduction of 72% at a median follow-up duration of 28 months, and Planche et al 22 found mean volume reductions of 43% for AMLs followed for 1 to 6 months and 81% for those followed for more than 1 year. Kato et al 23 assessed the regression of LAM-associated AMLs after superselective TAE and reported a mean reduction in tumor volume of 69% at a mean follow-up of 11 months. Furthermore, 1 year after embolization, sporadic AMLs had a median reduction in tumor diameter of 29.8% and a median reduction in tumor volume of 67.9%; TSC-AMLs yielded equivalent values of 23.6% and 47.7%, respectively.…”

Section: Declaration Of Conflicting Interestmentioning

confidence: 99%

“…Superselective TAE is an important but technique-challenging treatment for renal hilar AMLs. However, although several studies have assessed the post-embolization regression of renal AMLs in general, [18][19][20][21][22][23][24] no studies have evaluated the effectiveness of superselective TAE for treating renal hilar AMLs. Therefore, we investigated the efficacy of prophylactic, superselective TAE for renal hilar AMLs for reducing tumor volume, preventing bleeding, and protecting renal function.…”

Section: Introductionmentioning

confidence: 99%

Efficacy and safety of prophylactic superselective embolization for angiomyolipoma at the renal hilum

et al. 2021

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Objective This study investigated the efficacy and safety of superselective transcatheter arterial embolization for angiomyolipoma at the renal hilum. Methods Between August 2012 and January 2015, 13 patients with 16 angiomyolipomas at the renal hilum underwent initial, prophylactic, superselective transcatheter arterial embolization. The patients were followed by computed tomography or magnetic resonance imaging, and volume-reduction ratios after embolization were measured. Results The mean or median post-embolization volume reduction ratios were 23% (follow-up duration, 1–2 months), 55% (3–6 months), 55% (7–12 months), 66% (1–2 years), 67% (2–3 years), and 54% (>3 years). After initial embolization, none of the 16 tumors bled or required surgery; two (13%) tumors recurred; and three (19%) tumors received repeat embolization. Estimated glomerular filtration rates were not decreased at medians of 7 days (near the time of discharge) and 39 days (first clinical follow-up) post-procedure, compared with baseline. Except for post-embolization syndrome, no procedure-related complications occurred. Conclusions Superselective embolization for renal hilar angiomyolipoma is safe and kidney-preserving, with good tumor volume reduction and bleeding prevention.

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Superselective Transcatheter Arterial Embolization for Large Unruptured Renal Angiomyolipoma in Lymphangioleiomyomatosis

Cited by 17 publications

References 26 publications

Renal function, complications, and outcomes of a reduction in tumor size after transarterial embolization for renal angiomyolipomas: a meta-analysis

Renal function, complications, and outcomes of a reduction in tumor size after transarterial embolization for renal angiomyolipomas: a meta-analysis

A new management strategy for renal angiomyolipomas: superselective arterial embolization in combination with radiofrequency ablation

Efficacy and safety of prophylactic superselective embolization for angiomyolipoma at the renal hilum

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