Long-term outcome of transcatheter embolization of renal angiomyolipomas due to tuberous sclerosis complex.
OBJECTIVE
Complications from renal angiomyolipomas (AMLs) are common in patients with tuberous sclerosis complex (TSC) and tumors greater than 4 cm are more likely to cause symptoms. AMLs are the most common cause of death in adults with TSC. We present our long-term experience with transcatheter tumor embolization as a definitive treatment for AMLs due to TSC.


METHODS
A total of 16 patients with TSC between 7.5 and 47.2 years old with symptomatic or large (4 to 21 cm) AMLs underwent embolization. Followup consisted of periodic physician visits or telephone contacts and renal imaging.


RESULTS
The 16 patients underwent 18 treatment sessions to embolize 27 tumors. There were no intraoperative complications. The post-embolization syndrome occurred in 11 individuals but all responded to medical management. Two individuals had an arterial aneurysm within a tumor. The AML size decreased in the 13 patients who were imaged 3 months after treatment, and the 7 patients who were imaged 3 to 9 years after treatment have shown no tumor regrowth. No renal failure or hemorrhage has developed in patients following embolization.


CONCLUSIONS
Transcatheter embolization of symptomatic or large AMLs due to TSC prevents hemorrhage and renal loss. The treatment is minimally invasive, preserves renal function, and can be performed multiple times. All of the patients who underwent followup renal imaging after embolization showed decreased AML size, and none of the 16 patients has developed renal loss or renal insufficiency in these individuals. Embolization should be considered the initial treatment of choice for large or symptomatic AMLs.
Ewalt
David H
DH
Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas, USA. dhewalt@pol.net
Diamond
Norman
N
Rees
Chet
C
Sparagana
Steven P
SP
Delgado
Mauricio
M
Batchelor
Lori
L
Roach
E Steve
ES
D000293:Adolescent; D000328:Adult; D018206:Angiolipoma / Q000000981:diagnostic imaging / Q000209:etiology / Q000473:pathology* / Q000628:therapy*; D002648:Child; D015331:Cohort Studies; D004621:Embolization, Therapeutic / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007680:Kidney Neoplasms / Q000000981:diagnostic imaging / Q000209:etiology / Q000473:pathology* / Q000628:therapy*; D018810:Magnetic Resonance Angiography; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000379:methods; D015641:Radiography, Interventional; D012189:Retrospective Studies; D018570:Risk Assessment; D013997:Time Factors; D016896:Treatment Outcome; D014402:Tuberous Sclerosis / Q000150:complications* / Q000175:diagnosis