The Role of Interventional Radiology Techniques in the Management of Renal Angiomyolipomas

Abstract

For patients with renal masses and non-diagnostic imaging studies, image-guided percutaneous biopsy is found to be highly accurate and useful in directing patient management. Once the diagnosis of AML has been made based on either imaging or biopsy, arterial embolization of tumors that are symptomatic or >4 cm has been demonstrated to reduce the risk of hemorrhage as well as tumor size. Percutaneous ablation devices have been proposed as alternative strategies but remain investigational. The utility of interventional radiology techniques including percutaneous core needle biopsy and prophylactic super-selective arterial embolization is safe and effective management strategies for patients presenting with AML tumors.

Renal Angiomyolipoma: The Good, the Bad, and the Ugly

“…However, in select cases, the use of imaging alone is insufficient and percutaneous renal biopsy may be necessary for correctly diagnosing the renal mass, thus avoiding unnecessary treatment. Nowadays, percutaneous biopsy is increasingly used to differentiate between benign and malignant renal lesions [1819]. …”

“…The use of a 4 cm tumour size as a criterion for treatment comes from a frequently quoted review published in 1986 [21119]. The authors of this review reported that 82% of patients with renal AMLs larger than 4 cm experienced symptoms and 51% of them presented with active retroperitoneal haemorrhage.…”

“…For hereditary AML, the International Tuberous Sclerosis Complex Consensus recommends the use of MRI, because of its increased sensitivity in the detection of adipose tissue. Annual clinical evaluation of renal function and blood pressure is also required in these cases [192830]. …”

“…Many clinicians favour embolization and reserve surgery for patients with uncontrollable symptoms, vascular malformations, failure of embolization, and rare diagnostic uncertainty. When surgery needs to be performed, preoperative embolization of the lesion may be taken into consideration in reducing the difficulty and complications of tumourectomy or nephrectomy [11192732]. …”

“…Routine prophylaxis, including antipyretics, antiemetics and analgesia, may play a role in periprocedural management [227]. Other complications, including non-target embolization of normal parenchyma or renal infarction with abscess forming, are uncommon [111932]. In general though, arterial embolization is a well-tolerated procedure.…”