title: Tumor necrosis after preventive embolization of large renal angiomyolipomas.
abstract: OBJECTIVE
  The purpose of this study was to retrospectively evaluate tumor necrosis following preventive embolization in patients with renal angiomyolipoma (RAML) at high risk of bleeding.
  
  
  METHODS
  Arterial embolization was performed in 24 patients (22 women, 2 men; mean age, 43±13 years) with a total of 30 RAMLs (mean volume, 137 cm(3)±163) between 1996 and 2012. Two sub-groups of patients were identified and further compared based on the presence or not of necrosis following arterial embolization.
  
  
  RESULTS
  The technical and clinical success rates of arterial embolization of RAMLs were 97% and 87%, respectively. The mean initial volume of RAMLs differed between the two sub-groups with 331 cm(3) in the group with tumor necrosis and 88 cm(3) in the group without tumor necrosis (P=0.0047). High-fat content RAMLs were predominantly observed in the necrosis group and the mean volume reduction observed for high-fat RAMLs was 65% whereas it was 36% for low-fat content RAMLs. The six patients who developed RAML necrosis had arterial embolization using microspheres (one patient with microspheres alone and five with a combination of microspheres and metallic coils). All necrotic RAMLs displayed arterial dysplasia.
  
  
  CONCLUSIONS
  The risk of tumor necrosis is higher for larger RAMLs. The role of distal arterial embolization with microspheres in tumor necrosis in RAML is suggested by the results of our study but could not be definitely demonstrated statistically due to the limited sample size.
authors.affiliation: Service d'imagerie néphro-urologique et ORL, université Lille, hôpital Claude-Huriez, CHRU de Lille, 1, rue Michel-Polonovski, 59037 Lille cedex, France.
authors.forename: M
authors.initials: M
authors.lastname: El Rafei
authors.affiliation: Service d'imagerie néphro-urologique et ORL, université Lille, hôpital Claude-Huriez, CHRU de Lille, 1, rue Michel-Polonovski, 59037 Lille cedex, France.
authors.forename: B
authors.initials: B
authors.lastname: Renard
authors.affiliation: Service d'imagerie néphro-urologique et ORL, université Lille, hôpital Claude-Huriez, CHRU de Lille, 1, rue Michel-Polonovski, 59037 Lille cedex, France; Inserm U703, université Lille Nord de France, CHRU de Lille, 59120 Loos, France.
authors.forename: P
authors.initials: P
authors.lastname: Puech
authors.affiliation: Délégation à recherche clinique et à l'innovation, université Lille Nord de France, CHRU de Lille, 59000 Lille, France.
authors.forename: P
authors.initials: P
authors.lastname: Devos
authors.affiliation: Service d'imagerie néphro-urologique et ORL, université Lille, hôpital Claude-Huriez, CHRU de Lille, 1, rue Michel-Polonovski, 59037 Lille cedex, France.
authors.forename: V
authors.initials: V
authors.lastname: Gaillard
authors.affiliation: Service d'imagerie néphro-urologique et ORL, université Lille, hôpital Claude-Huriez, CHRU de Lille, 1, rue Michel-Polonovski, 59037 Lille cedex, France; Inserm U703, université Lille Nord de France, CHRU de Lille, 59120 Loos, France. Electronic address: laurent.lemaitre@chru-lille.fr.
authors.forename: L
authors.initials: L
authors.lastname: Lemaître
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D018207:Angiomyolipoma / Q000473:pathology* / Q000517:prevention & control / Q000628:therapy*; D004621:Embolization, Therapeutic / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000473:pathology* / Q000517:prevention & control / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009336:Necrosis / Q000209:etiology; D012189:Retrospective Studies; D018570:Risk Assessment; D055815:Young Adult
keywords: Angiomyolipoma; Embolization; Necrosis; Preventive