Skip to main content

Prophylactic selective arterial embolization for renal angiomyolipomas: efficacy and evaluation of predictive factors of significant shrinkage

International Urology and Nephrology volume 50, pages 1765–1770 (2018)Cite this article

Abstract

Purpose

To evaluate the efficacy of prophylactic selective arterial embolization (SAE) of angiomyolipomas (AMLs) and to find out predictive factors of significant shrinkage of AMLs after SAE.

Methods

Patients receiving prophylactic SAE for renal AMLs with complete medical records were included. The changes of the size, urine erythrocyte counts, and serum creatinine of all patients pre- and post-embolization were assessed. Demographic data, symptoms, the background of tuberous sclerosis complex (TSC), aneurysms, enhancement features, initial tumor sizes, and serum creatinine pre-embolization were estimated as predictive factors of significant shrinkage in size.

Results

Forty-five patients receiving prophylactic SAE for AMLs successfully in our center were included with median follow-up of 14.0 months (interquartile range 6.5–40.5). Mean size of AMLs decreased from 10.7 ± 6.2 to 8.3 ± 5.9 cm by 23.4% ± 20.6% at the latest follow-up (P < 0.001). Urine erythrocytes decreased significantly after SAE (11.1 [interquartile range 5.7–23.2] vs. 6.4 [interquartile range 2.7–13.4], P < 0.001). In addition, there was no significant change between the serum creatinine before and after embolization (81.8 ± 14.9 mmol/L vs. 83.6 ± 17.1 mmol/L, P = 0.224). Of the variables mentioned above, only the enhanced area of AMLs before SAE was statistically significant between the groups with and without significant shrinkage (P < 0.001). In multiv-ariate analysis, enhanced area < 25% (AOR = 0.015, 95% CI 0.001–0.367) and having the background of TSC (AOR = 0.056, 95% CI 0.004–0.799) were identified as predictive factors of significant shrinkage of the tumors.

Conclusions

Prophylactic SAE is effective in reducing the size of renal AMLs and decreasing urine erythrocytes with preservation of renal function. Significant shrinkage of AMLs after SAE is modulated by the enhanced area and the background of TSC.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

USD 39.95

Price includes VAT (USA)
Tax calculation will be finalised during checkout.

Fig. 1

References

  1. Steiner MS, Goldman SM, Fishman EK, Marshall FF (1993) The natural history of renal angiomyolipoma. J Urol 150:1782–1786

    CAS  Article  PubMed  Google Scholar 

  2. Kontos S, Politis V, Fokitis I, Lefakis G, Koritsiadis G, Simaioforidis V, Kachrilas S, Chatziplis E, Koritsiadis S (2008) Rapture of renal angiomyolipoma during pregnancy: a case report. Cases J 1:245. https://doi.org/10.1186/1757-1626-1-245

    Article  PubMed  PubMed Central  Google Scholar 

  3. Konosu-Fukaya S, Nakamura Y, Fujishima F, Kasajima A, Takahashi Y, Joh K, Ikeda Y, Ioritani N, Watanabe M, Sasano H (2013) Bilateral papillary renal cell carcinoma and angiomyolipoma in the patients with autosomal dominant polycystic kidney disease: case report of two cases and literature review. Pol J Pathol 64:303–307

    CAS  Article  PubMed  Google Scholar 

  4. Radhakrishnan R, Verma S (2011) Clinically relevant imaging in tuberous sclerosis. J Clin Imaging Sci 1:39. https://doi.org/10.4103/2156-7514.83230

    Article  PubMed  PubMed Central  Google Scholar 

  5. Murray TE, Doyle F, Lee M (2015) Transarterial embolization of angiomyolipoma: a systematic review. J Urol 194:635–639. https://doi.org/10.1016/j.juro.2015.04.081

    Article  PubMed  Google Scholar 

  6. Sun P, Liu J, Charles H, Hulbert J, Bissler J (2017) Outcomes of angioembolization and nephrectomy for renal angiomyolipoma associated with tuberous sclerosis complex: a real-world US national study. Curr Med Res Opin 33:821–827. https://doi.org/10.1080/03007995.2017.1286307

    Article  PubMed  Google Scholar 

  7. Kato H, Kuwatsuru R, Inoue T, Okada S, Aida M, Yamashiro Y (2018) Superselective transcatheter arterial embolization for large unruptured renal angiomyolipoma in lymphangioleiomyomatosis. J Vasc Interv Radiol. https://doi.org/10.1016/j.jvir.2017.11.003

    Article  PubMed  Google Scholar 

  8. Hocquelet A, Cornelis F, Le Bras Y, Meyer M, Tricaud E, Lasserre AS, Ferriere JM, Robert G, Grenier N (2014) Long-term results of preventive embolization of renal angiomyolipomas: evaluation of predictive factors of volume decrease. Eur Radiol 24:1785–1793. https://doi.org/10.1007/s00330-014-3244-4

    CAS  Article  PubMed  Google Scholar 

  9. Han YM, Kim JK, Roh BS, Song HY, Lee JM, Lee YH, Lee SY, Chung GH, Kim CS, Sohn MH, Choi KC (1997) Renal angiomyolipoma: selective arterial embolization–effectiveness and changes in angiomyogenic components in long-term follow-up. Radiology 204:65–70. https://doi.org/10.1148/radiology.204.1.9205224

    CAS  Article  PubMed  Google Scholar 

  10. Ramon J, Rimon U, Garniek A, Golan G, Bensaid P, Kitrey ND, Nadu A, Dotan ZA (2009) Renal angiomyolipoma: long-term results following selective arterial embolization. Eur Urol 55:1155–1161. https://doi.org/10.1016/j.eururo.2008.04.025

    Article  PubMed  Google Scholar 

  11. Eisenhauer EA, Therasse P, Bogaerts J, Schwartz LH, Sargent D, Ford R, Dancey J, Arbuck S, Gwyther S, Mooney M, Rubinstein L, Shankar L, Dodd L, Kaplan R, Lacombe D, Verweij J (2009) New response evaluation criteria in solid tumours: revised RECIST guideline (version 1.1). Eur J Cancer 45:228–247. https://doi.org/10.1016/j.ejca.2008.10.026

    CAS  Article  PubMed  Google Scholar 

  12. Diaz DLA, Pedrosa I (2017) Imaging and screening of kidney cancer. Radiol Clin North Am 55:1235–1250. https://doi.org/10.1016/j.rcl.2017.06.007

    Article  Google Scholar 

  13. Kiefer RM, Stavropoulos SW (2017) The role of interventional radiology techniques in the management of renal angiomyolipomas. Curr Urol Rep 18:36. https://doi.org/10.1007/s11934-017-0687-6

    Article  PubMed  Google Scholar 

  14. Wang C, Yang M, Tong X, Wang J, Guan H, Niu G, Yan Z, Zhang B, Zou Y (2017) Transarterial embolization for renal angiomyolipomas: a single centre experience in 79 patients. J Int Med Res 45:706–713. https://doi.org/10.1177/0300060516684251

    Article  PubMed  PubMed Central  Google Scholar 

  15. Bardin F, Chevallier O, Bertaut A, Delorme E, Moulin M, Pottecher P, Di Marco L, Gehin S, Mourey E, Cormier L, Mousson C, Midulla M, Loffroy R (2017) Selective arterial embolization of symptomatic and asymptomatic renal angiomyolipomas: a retrospective study of safety, outcomes and tumor size reduction. Quant Imaging Med Surg 7:8–23. https://doi.org/10.21037/qims.2017.01.02

    Article  PubMed  PubMed Central  Google Scholar 

  16. Lee SY, Hsu HH, Chen YC, Huang CC, Wong YC, Wang LJ, Chuang CK, Yang CW (2009) Evaluation of renal function of angiomyolipoma patients after selective transcatheter arterial embolization. Am J Med Sci 337:103–108. https://doi.org/10.1097/MAJ.0b013e31817f6dd9

    Article  PubMed  Google Scholar 

  17. Williams JM, Racadio JM, Johnson ND, Donnelly LF, Bissler JJ (2006) Embolization of renal angiomyolipomata in patients with tuberous sclerosis complex. Am J Kidney Dis 47:95–102. https://doi.org/10.1053/j.ajkd.2005.09.028

    Article  PubMed  Google Scholar 

  18. Planche O, Correas JM, Mader B, Joly D, Mejean A, Helenon O (2011) Prophylactic embolization of renal angiomyolipomas: evaluation of therapeutic response using CT 3D volume calculation and density histograms. J Vasc Interv Radiol 22:1388–1395. https://doi.org/10.1016/j.jvir.2011.05.016

    Article  PubMed  Google Scholar 

  19. Villalta JD, Sorensen MD, Durack JC, Kerlan RK, Stoller ML (2011) Selective arterial embolization of angiomyolipomas: a comparison of smaller and larger embolic agents. J Urol 186:921–927. https://doi.org/10.1016/j.juro.2011.04.082

    Article  PubMed  Google Scholar 

Download references

Author information

Author notes

  1. Letao Lin, Chengen Wang and Renguang Pei contributed equally to this study and therefore share first authorship.

Authors and Affiliations

  1. Department of Interventional Radiology and Vascular Surgery, Peking University First Hospital, 8 Xishiku St, Beijing, 100034, People’s Republic of China

    Letao Lin, Chengen Wang, Renguang Pei, Haitao Guan, Jian Wang, Min Yang, Xiaoqiang Tong & Yinghua Zou

Authors
  1. Letao Lin
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Chengen Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Renguang Pei
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Haitao Guan
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Jian Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Min Yang
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Xiaoqiang Tong
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Yinghua Zou
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Yinghua Zou.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

For this retrospective study, formal consent is not required.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Lin, L., Wang, C., Pei, R. et al. Prophylactic selective arterial embolization for renal angiomyolipomas: efficacy and evaluation of predictive factors of significant shrinkage. Int Urol Nephrol 50, 1765–1770 (2018). https://doi.org/10.1007/s11255-018-1953-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11255-018-1953-3

Keywords

  • Angiomyolipoma
  • Selective arterial embolization
  • Kidney neoplasms
  • Tuberous sclerosis