Transcatheter Arterial Embolization with Ethanol Injection in Symptomatic Patients with Enlarged Polycystic Kidneys.
OBJECTIVE
To evaluate the safety and effectiveness of transcatheter arterial embolization (TAE) with ethanol in symptomatic patients with enlarged polycystic kidney disease.


METHODS
This prospective study was institutional review board approved and was planned for patients with symptoms related to enlarged polycystic kidney disease, such as a markedly distended abdomen, gastroesophageal reflux, and abdominal pain. At the time of TAE, all patients were undergoing dialysis therapy for chronic renal failure, and their urinary volume had decreased to less than 500 mL per day. Bilateral renal TAE with absolute ethanol was performed, and changes in kidney volume, clinical symptoms, laboratory data, and complications were evaluated after TAE. The differences in patients' kidney volumes, clinical symptoms, abdominal circumference, and dry weights before and after TAE were analyzed with a mixed effect model.


RESULTS
Fifteen patients (seven men and eight women; mean age, 57.7 years ± 5.3 [standard deviation]) were treated. Among the 15 patients, the follow-up period was 24 months in 13 patients, 6 months in one patient, and 3 months in one patient. The mean kidney volume was 3380 mL before renal TAE, and at 3, 12, and 24 months after TAE, it significantly decreased to 60.9%, 39.8%, and 32.1% of the pretherapeutic value, respectively (P < .001). All patients reported improved clinical symptoms within 3 months after TAE (P < .001). Abdominal circumferences were significantly decreased after TAE (P < .001). The dry weights also continued to significantly decreased until 6 months after TAE (P < .001), at which point they began to slightly increase until 24 months after TAE. Abdominal pain, nausea, and inflammatory response developed in all patients after TAE, but these symptoms improved with conservative treatment. Abscess formation was found in one kidney, and drainage catheter placement was performed. No major complications related to TAE occurred in the remaining patients.


CONCLUSIONS
Renal contraction therapy by TAE with ethanol injection appears to be a safe and effective treatment in patients with symptomatic enlarged polycystic kidney disease.
From the Department of Diagnostic and Interventional Radiology (Y.S., D.A., T.S., K.K.), Department of Medicine II (S.N.), Department of Urology (K.M.), and Translational Research and Clinical Trial Center (K.O.), Hokkaido University Hospital, N-14, W-5, Kita-ku, Sapporo, Hokkaido 060-0848, Japan; Department of Diagnostic Radiology, Sapporo City General Hospital, Sapporo, Japan (Y.H.); Department of Radiology, Steel Memorial Muroran Hospital, Murofan, Japan (N.Y.); Department of Medicine IV, Tokyo Women's Medical University, Tokyo, Japan (T.M.); and Department of Radiation Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Japan (H.S.).
Yusuke
Y
Sakuhara
From the Department of Diagnostic and Interventional Radiology (Y.S., D.A., T.S., K.K.), Department of Medicine II (S.N.), Department of Urology (K.M.), and Translational Research and Clinical Trial Center (K.O.), Hokkaido University Hospital, N-14, W-5, Kita-ku, Sapporo, Hokkaido 060-0848, Japan; Department of Diagnostic Radiology, Sapporo City General Hospital, Sapporo, Japan (Y.H.); Department of Radiology, Steel Memorial Muroran Hospital, Murofan, Japan (N.Y.); Department of Medicine IV, Tokyo Women's Medical University, Tokyo, Japan (T.M.); and Department of Radiation Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Japan (H.S.).
Saori
S
Nishio
From the Department of Diagnostic and Interventional Radiology (Y.S., D.A., T.S., K.K.), Department of Medicine II (S.N.), Department of Urology (K.M.), and Translational Research and Clinical Trial Center (K.O.), Hokkaido University Hospital, N-14, W-5, Kita-ku, Sapporo, Hokkaido 060-0848, Japan; Department of Diagnostic Radiology, Sapporo City General Hospital, Sapporo, Japan (Y.H.); Department of Radiology, Steel Memorial Muroran Hospital, Murofan, Japan (N.Y.); Department of Medicine IV, Tokyo Women's Medical University, Tokyo, Japan (T.M.); and Department of Radiation Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Japan (H.S.).
Ken
K
Morita
From the Department of Diagnostic and Interventional Radiology (Y.S., D.A., T.S., K.K.), Department of Medicine II (S.N.), Department of Urology (K.M.), and Translational Research and Clinical Trial Center (K.O.), Hokkaido University Hospital, N-14, W-5, Kita-ku, Sapporo, Hokkaido 060-0848, Japan; Department of Diagnostic Radiology, Sapporo City General Hospital, Sapporo, Japan (Y.H.); Department of Radiology, Steel Memorial Muroran Hospital, Murofan, Japan (N.Y.); Department of Medicine IV, Tokyo Women's Medical University, Tokyo, Japan (T.M.); and Department of Radiation Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Japan (H.S.).
Daisuke
D
Abo
From the Department of Diagnostic and Interventional Radiology (Y.S., D.A., T.S., K.K.), Department of Medicine II (S.N.), Department of Urology (K.M.), and Translational Research and Clinical Trial Center (K.O.), Hokkaido University Hospital, N-14, W-5, Kita-ku, Sapporo, Hokkaido 060-0848, Japan; Department of Diagnostic Radiology, Sapporo City General Hospital, Sapporo, Japan (Y.H.); Department of Radiology, Steel Memorial Muroran Hospital, Murofan, Japan (N.Y.); Department of Medicine IV, Tokyo Women's Medical University, Tokyo, Japan (T.M.); and Department of Radiation Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Japan (H.S.).
Yu
Y
Hasegawa
From the Department of Diagnostic and Interventional Radiology (Y.S., D.A., T.S., K.K.), Department of Medicine II (S.N.), Department of Urology (K.M.), and Translational Research and Clinical Trial Center (K.O.), Hokkaido University Hospital, N-14, W-5, Kita-ku, Sapporo, Hokkaido 060-0848, Japan; Department of Diagnostic Radiology, Sapporo City General Hospital, Sapporo, Japan (Y.H.); Department of Radiology, Steel Memorial Muroran Hospital, Murofan, Japan (N.Y.); Department of Medicine IV, Tokyo Women's Medical University, Tokyo, Japan (T.M.); and Department of Radiation Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Japan (H.S.).
Noriaki
N
Yuasa
From the Department of Diagnostic and Interventional Radiology (Y.S., D.A., T.S., K.K.), Department of Medicine II (S.N.), Department of Urology (K.M.), and Translational Research and Clinical Trial Center (K.O.), Hokkaido University Hospital, N-14, W-5, Kita-ku, Sapporo, Hokkaido 060-0848, Japan; Department of Diagnostic Radiology, Sapporo City General Hospital, Sapporo, Japan (Y.H.); Department of Radiology, Steel Memorial Muroran Hospital, Murofan, Japan (N.Y.); Department of Medicine IV, Tokyo Women's Medical University, Tokyo, Japan (T.M.); and Department of Radiation Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Japan (H.S.).
Toshio
T
Mochizuki
From the Department of Diagnostic and Interventional Radiology (Y.S., D.A., T.S., K.K.), Department of Medicine II (S.N.), Department of Urology (K.M.), and Translational Research and Clinical Trial Center (K.O.), Hokkaido University Hospital, N-14, W-5, Kita-ku, Sapporo, Hokkaido 060-0848, Japan; Department of Diagnostic Radiology, Sapporo City General Hospital, Sapporo, Japan (Y.H.); Department of Radiology, Steel Memorial Muroran Hospital, Murofan, Japan (N.Y.); Department of Medicine IV, Tokyo Women's Medical University, Tokyo, Japan (T.M.); and Department of Radiation Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Japan (H.S.).
Takeshi
T
Soyama
From the Department of Diagnostic and Interventional Radiology (Y.S., D.A., T.S., K.K.), Department of Medicine II (S.N.), Department of Urology (K.M.), and Translational Research and Clinical Trial Center (K.O.), Hokkaido University Hospital, N-14, W-5, Kita-ku, Sapporo, Hokkaido 060-0848, Japan; Department of Diagnostic Radiology, Sapporo City General Hospital, Sapporo, Japan (Y.H.); Department of Radiology, Steel Memorial Muroran Hospital, Murofan, Japan (N.Y.); Department of Medicine IV, Tokyo Women's Medical University, Tokyo, Japan (T.M.); and Department of Radiation Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Japan (H.S.).
Koji
K
Oba
From the Department of Diagnostic and Interventional Radiology (Y.S., D.A., T.S., K.K.), Department of Medicine II (S.N.), Department of Urology (K.M.), and Translational Research and Clinical Trial Center (K.O.), Hokkaido University Hospital, N-14, W-5, Kita-ku, Sapporo, Hokkaido 060-0848, Japan; Department of Diagnostic Radiology, Sapporo City General Hospital, Sapporo, Japan (Y.H.); Department of Radiology, Steel Memorial Muroran Hospital, Murofan, Japan (N.Y.); Department of Medicine IV, Tokyo Women's Medical University, Tokyo, Japan (T.M.); and Department of Radiation Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Japan (H.S.).
Hiroki
H
Shirato
From the Department of Diagnostic and Interventional Radiology (Y.S., D.A., T.S., K.K.), Department of Medicine II (S.N.), Department of Urology (K.M.), and Translational Research and Clinical Trial Center (K.O.), Hokkaido University Hospital, N-14, W-5, Kita-ku, Sapporo, Hokkaido 060-0848, Japan; Department of Diagnostic Radiology, Sapporo City General Hospital, Sapporo, Japan (Y.H.); Department of Radiology, Steel Memorial Muroran Hospital, Murofan, Japan (N.Y.); Department of Medicine IV, Tokyo Women's Medical University, Tokyo, Japan (T.M.); and Department of Radiation Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Japan (H.S.).
Kohsuke
K
Kudo
D000368:Aged; D002404:Catheterization; D004621:Embolization, Therapeutic / Q000379:methods*; D000431:Ethanol / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D007267:Injections; D008297:Male; D008875:Middle Aged; D007690:Polycystic Kidney Diseases / Q000628:therapy*; D011446:Prospective Studies; D012077:Renal Artery
D000431:Ethanol