Renal angiomyolipoma: long-term results after arterial embolization.
OBJECTIVE
Selective arterial embolization of renal angiomyolipomas (AMLs) was performed to prevent hemorrhage in patients with AMLs larger than 4 cm. This study was conducted to evaluate the long-term efficacy of AML embolization.


METHODS
Nineteen patients underwent embolization for 30 renal AMLs between July 1991 and June 2002. Of these, 10 patients had tuberous sclerosis (TS) with multiple AMLs and nine patients had a solitary sporadic AML. Embolization was performed with use of ethanol mixed with iodized oil (Ethiodol) in 29 tumors; coils were used in addition to the ethanol/Ethiodol mixture in one case. All tumors were completely embolized according to angiographic criteria including vascular stasis and absence of arterial feeders. The efficacy of embolization was determined over a mean follow-up period of 51.5 months (range, 6-132 months). Recurrence was defined as an increase in tumor size of greater than 2 cm on follow-up imaging and/or recurrent symptoms that required repeat embolization. An institutional review board exemption was obtained to perform this retrospective study.


RESULTS
Embolization of the renal AMLs was technically successful in all 19 patients and for all 30 lesions. AML recurrence was noted in 31.6% of patients (n = 19) and for 30% of lesions overall (n = 9). Six of 10 patients in the TS group had AML recurrences. No recurrences occurred in the patients with sporadic AML. In the TS group of 10 patients, there was a total of 21 AMLs and the overall tumor recurrence rate was 42.9% (nine of 21). Six lesions in four patients had to be reembolized because of recurrent symptoms, including one hemorrhage, and three lesions in two patients required repeat embolization because of a greater than 2 cm increase in size. The median time interval from embolization to recurrence was 78.7 months (range, 13-132 months). Statistical testing with use of the Fisher exact test demonstrated that patients with TS were significantly more likely to develop recurrence than those without TS (P = .01).


CONCLUSIONS
Transarterial embolization is effective in preventing hemorrhage in patients with renal AMLs. However, long-term follow-up revealed a high AML recurrence rate in patients with TS. Lifelong surveillance for recurrence after AML embolization is essential in patients with TS.
Kothary
Nishita
N
Department of Radiology, New York Presbyterian/Columbia Hospital, 177 Fort Washington Avenue, MHB 4-100, New York, New York, USA. nk2125@columbia.edu
Soulen
Michael C
MC
Clark
Timothy W I
TW
Wein
A J
AJ
Shlansky-Goldberg
Richard D
RD
Crino
Peter B
PB
Stavropoulos
S William
SW
D000328:Adult; D000368:Aged; D018207:Angiomyolipoma / Q000098:blood supply / Q000628:therapy*; D004621:Embolization, Therapeutic; D005260:Female; D005500:Follow-Up Studies; D006470:Hemorrhage / Q000517:prevention & control; D006801:Humans; D007680:Kidney Neoplasms / Q000098:blood supply / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D016896:Treatment Outcome; D014402:Tuberous Sclerosis / Q000150:complications