Pre-operative renal artery embolization and suprarenal IVC filter placement for prevention of fat embolization in renal angiomyolipoma with venous extension.
Though generally considered benign, angiomyolipomas can invade through the renal vein into the inferior vena cava, putting patients at risk of catastrophic pulmonary fat embolization. Venous invasion is thus an indication for surgical resection but is thought to increase the risk of adverse operative outcomes including intraoperative hemorrhage and embolization of fat and/or tumor thrombus. We report a novel approach to mitigating these complications illustrated in the case of a 43-year-old woman with IVC-invasive renal AML who underwent successful radical nephrectomy after concurrent pre-operative renal artery embolization and placement of a retrievable suprarenal IVC filter.
Department of Radiology, New York-Presbyterian Hospital, Weill Cornell Medical Center, 525 East 68th Street, Box 141, New York, NY 10065, USA. Electronic address: joc9246@nyp.org.
Joshua
J
Cornman-Homonoff
Division of Interventional Radiology, New York-Presbyterian Hospital, Weill Cornell Medical Center, 525 East 68th Street, Box 141, New York, NY 10065, USA. Electronic address: dal9039@med.cornell.edu.
David
D
Li
Division of Interventional Radiology, New York-Presbyterian Hospital, Weill Cornell Medical Center, 525 East 68th Street, Box 141, New York, NY 10065, USA. Electronic address: mas9252@med.cornell.edu.
Marc
M
Schiffman
D000328:Adult; D018207:Angiomyolipoma / Q000473:pathology*; D004621:Embolization, Therapeutic; D005260:Female; D006801:Humans; D007668:Kidney / Q000098:blood supply / Q000473:pathology / Q000601:surgery; D007680:Kidney Neoplasms / Q000473:pathology* / Q000601:surgery; D008067:Lipoma / Q000473:pathology; D009392:Nephrectomy; D011183:Postoperative Complications / Q000209:etiology / Q000517:prevention & control; D011300:Preoperative Care; D011655:Pulmonary Embolism / Q000209:etiology / Q000517:prevention & control*; D012077:Renal Artery / Q000473:pathology; D012082:Renal Veins / Q000473:pathology; D013927:Thrombosis / Q000209:etiology / Q000517:prevention & control; D019043:Vascular Neoplasms / Q000150:complications / Q000556:secondary / Q000628:therapy; D016306:Vena Cava Filters; D014682:Vena Cava, Inferior / Q000473:pathology*
Angiomyolipoma; IVC filter; Pulmonary embolus; Renal artery embolization; Tumor thrombus