Embolization of giant renal angiomyolipomas: technique and results.
OBJECTIVE
To evaluate the efficacy and safety of prophylactic embolization of angiomyolipomas (AMLs) larger than 10 cm.


METHODS
Sixteen patients (mean age, 41.2 years; 14 women and two men) underwent embolization for 23 AMLs larger than 10 cm. All lesions were embolized by using microcatheters with ethanol and ethiodized oil mixed to a ratio of 7(ethanol) to 3(ethiodized oil). Data collected included pre- and posttreatment AML size, creatinine level, technical success, volume of embolic material used, clinical success, and complications.


RESULTS
The mean AML size before treatment was 15 cm (range, 10-25 cm). Ten of the 16 patients (62%) had all their AMLs treated in one session, whereas six (38%) required multiple sessions. A mean volume of 8.6 mL of the ethanol-ethiodized oil mixture (range, 2-20 mL) was administered per lesion. Patients were followed up for a mean of 29 months (range, 1-80 months). No patient had an increase of 0.2 mg/dL (17.7 mumol/L) or greater in mean serum creatinine level during the follow-up period. Two of the 16 patients (12%) required repeat embolization due to AML regrowth (n = 1) or reperfusion (n = 1) seen at surveillance imaging. One of the 16 patients (6.2%) had an AML hemorrhage 59 months after AML embolization.


CONCLUSIONS
Embolization of giant renal AMLs to decrease the risk of bleeding can be done safely without loss of renal function. Although recurrence was infrequent, additional treatment may be necessary and giant renal AMLs should be followed up with serial imaging studies.
Bishay
Vivian L
VL
Division of Interventional Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Crino
Peter B
PB
Wein
Alan J
AJ
Malkowicz
Stanley B
SB
Trerotola
Scott O
SO
Soulen
Michael C
MC
Stavropoulos
S William
SW
D000328:Adult; D018207:Angiomyolipoma / Q000000981:diagnostic imaging / Q000628:therapy*; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D016461:Chemoembolization, Therapeutic / Q000379:methods; D000431:Ethanol / Q000627:therapeutic use*; D004998:Ethiodized Oil / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000000981:diagnostic imaging / Q000628:therapy*; D008297:Male; D011859:Radiography; D019275:Radiopharmaceuticals / Q000627:therapeutic use; D016896:Treatment Outcome
D000970:Antineoplastic Agents; D019275:Radiopharmaceuticals; D000431:Ethanol; D004998:Ethiodized Oil