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Multimodal approach to the endovascular treatment of embolisation or exclusion of the renal arteries and their distal and/or polar branches: personal experience

Approccio multimodale al trattamento endovascolare di embolizzazione o esclusione delle arterie renali e dei suoi rami distali e/o polari: esperienza personale

  • Vascular and Interventional Radiology / Radiologia Vascolare e Interventistica
  • Published:
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Abstract

Purpose

This study reviews our experience over the last 10 years with procedures of embolisation and/or exclusion of the renal arteries, their parenchymal branches and the polar arteries [renal artery embolisation (RAE)].

Materials and methods

Twenty-seven patients (19 men and eight women; age range 37–93 years; mean 74 years) underwent RAE. The indications were: symptomatic gross haematuria in nine patients (33.3%) (tumour-related in seven and iatrogenic in two), symptomatic inoperable renal tumour in five (18.5%), large subcapsular or perirenal haematoma in three (11.1%) and aneurysm of the main renal artery in two (7.4%). Eight patients (29.6%) scheduled for endovascular aneurysm repair (EVAR) of the abdominal aorta underwent prophylactic embolisation of the renal polar branch arising from the aneurysmal sac or the subrenal aortic neck to prevent the possible revascularisation of the sac. Different embolisation agents were used: coils (17 cases), embolisation particles (14 cases), glue (one case), coated stent (two cases) and mechanical occlusion devices (two cases). In 11 cases, two to three different embolisation agents were used together.

Results

Technical success was achieved in 26/27 patients (96.3%); in one case, embolisation of a polar artery arising from the aneurysmal sac was not possible. One case of gross haematuria recurred 13 months after the procedure and was re-treated with success. There were no cases of major or minor complications.

Conclusions

RAE is an effective and minimally invasive procedure in the treatment of neoplastic/iatrogenic symptomatic gross haematuria and in the palliative treatment of inoperable renal tumours. One possible new indication is the prophylactic exclusion of the polar artery arising from the neck or the sac of an abdominal aortic aneurysm in patients who are candidates for EVAR. In our experience, we observed very low morbidity and a short hospital stay. This procedure requires the availability of various materials for performing embolisation and experience in their use.

Riassunto

Obiettivo

Scopo di questo lavoro è rivalutare la nostra esperienza degli ultimi 10 anni nelle procedure di embolizzazione o esclusione delle arterie renali (EAR), dei suoi rami parenchimali e delle arterie polari.

Materiali e metodi

Ventisette pazienti (19 maschi e 8 femmine; età 37–93 anni, media 74 anni) sono stati sottoposti a procedura di EAR. Le indicazioni sono state: macroematuria sintomatica in 9 pazienti (33,3%) (tumorale in 7 casi e iatrogena in 2), tumore renale sintomatico inoperabile in 5 pazienti (18,5%), voluminoso ematoma sottocapsulare o perirenale in 3 casi (11,1%) ed aneurisma dell’arteria renale principale in 2 casi (7,4%). In 8 pazienti (29,6%) candidati a posizionamento di endoprotesi aortica addominale (EVAR) si è proceduto alla preventiva embolizzazione del ramo renale polare originantesi dalla sacca aneurismatica o dal colletto sottorenale aortico per prevenire la possibile rivascolarizzazione della sacca. Sono stati utilizzati diversi agenti embolizzanti: spirali (17 casi), particelle embolizzanti (14 casi), colla (1 caso), stent ricoperto (2 casi), occlusore meccanico (2 casi). In 11 casi sono stati utilizzati insieme 2–3 diversi agenti embolizzanti.

Risultati

Il successo tecnico è stato ottenuto in 26/27 pazienti (96,3%); in un caso non è stato possibile embolizzare un’arteria polare originante dalla sacca aneurismatica. Un caso di macroematuria ha recidivato a distanza di 13 mesi ed è stato ritrattato con successo. Non si sono verificate complicanze maggiori o minori.

Conclusioni

L’EAR è una terapia efficace e minimamente invasiva nel trattamento della macroematuria sintomatica neoplastica/iatrogena e nella palliazione di tumori renali inoperabili. Una possibile nuova indicazione è l’esclusione preventiva dell’arteria polare originantesi dal colletto o dalla sacca di un aneurisma dell’aorta addominale in pazienti candidati ad EVAR. Nella nostra esperienza abbiamo osservato scarsa morbilità e breve degenza intraospedaliera. Questa procedura richiede la disponibilità di diversi materiali per effettuare l’embolizzazione ed esperienza nel loro utilizzo.

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Authors and Affiliations

  1. Unità Clinico Operativa di Radiologia, Università degli Studi di Trieste, Ospedale di Cattinara, Strada di Fiume 447, 34149, Trieste, Italy

    F. Pozzi-Mucelli, A. Medeot, S. Cernic, A. Calgaro, M. Braini & M. Cova

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  1. F. Pozzi-Mucelli
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  2. A. Medeot
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  3. S. Cernic
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  4. A. Calgaro
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  5. M. Braini
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  6. M. Cova
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Correspondence to F. Pozzi-Mucelli.

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Pozzi-Mucelli, F., Medeot, A., Cernic, S. et al. Multimodal approach to the endovascular treatment of embolisation or exclusion of the renal arteries and their distal and/or polar branches: personal experience. Radiol med 116, 945–959 (2011). https://doi.org/10.1007/s11547-011-0684-7

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