title: Selective arterial embolization of symptomatic and asymptomatic renal angiomyolipomas: a retrospective study of safety, outcomes and tumor size reduction.
abstract: BACKGROUND
  Angiomyolipoma (AML) is the most common renal benign tumor. Treatment should be considered for symptomatic patients or for those at risk for complications, especially retroperitoneal bleeding which is correlated to tumor size, grade of the angiogenic component and to the presence of tuberous sclerosis complex (TSC). This study reports our single-center experience with the use of selective arterial embolization (SAE) in the management of symptomatic and asymptomatic renal AMLs.
  
  
  METHODS
  In this retrospective mono-centric study, all demographic and imaging data, medical records, angiographic features, outpatient charts and follow-up visits of patients who underwent prophylactic or emergency SAE for AMLs between January 2005 and July 2016 were reviewed. Tumor size and treatment outcomes were assessed at baseline and after the procedure during follow-up. Computed tomography (CT), magnetic resonance imaging (MRI) or ultrasonography was used to evaluate AML shrinkage. Renal function was measured pre- and post-procedure.
  
  
  RESULTS
  Twenty-three patients (18 females, 5 males; median age, 45 years; range, 19-85 years) who underwent SAE either to treat bleeding AML (n=6) or as a prophylactic treatment (n=17) were included. Overall, 34 AMLs were embolized. TSC status was confirmed for 6 patients. Immediate technical success rate was 96% and 4 patients benefitted from an additional procedure. Major complications occurred in 3 patients and minor post-embolization syndrome (PES) in 14 patients. The mean AML size reduction rate was 26.2% after a mean follow-up was 20.5 months (range, 0.5-56 months), and only non-TSC status was significantly associated with better shrinkage of tumor (P=0.022). Intralesional aneurysms were significantly more frequent in patients with hemorrhagic presentation (P=0.008). There was no change in mean creatinine level after SAE.
  
  
  CONCLUSIONS
  SAE is a safe and effective technique to manage renal AMLs as a preventive treatment as well as in emergency setting, with significant reduction in tumor size during follow-up. A multidisciplinary approach remains fundamental, especially for TSC patients. In addition to size, the presence of intralesional aneurysms should be considered in any prophylactic treatment decision.
authors.affiliation: Department of Vascular and Interventional Radiology, François-Mitterrand Teaching Hospital, University of Dijon School of Medicine, Dijon, France.
authors.forename: Florian
authors.initials: F
authors.lastname: Bardin
authors.affiliation: Department of Vascular and Interventional Radiology, François-Mitterrand Teaching Hospital, University of Dijon School of Medicine, Dijon, France.
authors.forename: Olivier
authors.initials: O
authors.lastname: Chevallier
authors.affiliation: Department of Epidemiology and Biostatistics, Georges François Leclerc Center, Dijon, France.
authors.forename: Aurélie
authors.initials: A
authors.lastname: Bertaut
authors.affiliation: Department of Urology, Sainte Marie Private Hospital, Chalon-sur-Saône, France.
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Delorme
authors.affiliation: Department of Urology and Andrology, François-Mitterrand Teaching Hospital, University of Dijon School of Medicine, Dijon, France.
authors.forename: Morgan
authors.initials: M
authors.lastname: Moulin
authors.affiliation: Department of Vascular and Interventional Radiology, François-Mitterrand Teaching Hospital, University of Dijon School of Medicine, Dijon, France.
authors.forename: Pierre
authors.initials: P
authors.lastname: Pottecher
authors.affiliation: Department of Vascular and Interventional Radiology, François-Mitterrand Teaching Hospital, University of Dijon School of Medicine, Dijon, France.
authors.forename: Lucy
authors.initials: L
authors.lastname: Di Marco
authors.affiliation: Department of Vascular and Interventional Radiology, François-Mitterrand Teaching Hospital, University of Dijon School of Medicine, Dijon, France.
authors.forename: Sophie
authors.initials: S
authors.lastname: Gehin
authors.affiliation: Department of Urology and Andrology, François-Mitterrand Teaching Hospital, University of Dijon School of Medicine, Dijon, France.
authors.forename: Eric
authors.initials: E
authors.lastname: Mourey
authors.affiliation: Department of Urology and Andrology, François-Mitterrand Teaching Hospital, University of Dijon School of Medicine, Dijon, France.
authors.forename: Luc
authors.initials: L
authors.lastname: Cormier
authors.affiliation: Department of Nephrology and Renal Transplantation, François-Mitterrand Teaching Hospital, University of Dijon School of Medicine, Dijon, France.
authors.forename: Christiane
authors.initials: C
authors.lastname: Mousson
authors.affiliation: Department of Vascular and Interventional Radiology, François-Mitterrand Teaching Hospital, University of Dijon School of Medicine, Dijon, France.
authors.forename: Marco
authors.initials: M
authors.lastname: Midulla
authors.affiliation: Department of Vascular and Interventional Radiology, François-Mitterrand Teaching Hospital, University of Dijon School of Medicine, Dijon, France;; LE2I UMR CNRS 6306, Arts et Métiers, University of Bourgogne Franche-Comté, Dijon, France.
authors.forename: Romaric
authors.initials: R
authors.lastname: Loffroy
keywords: Renal tumor; angiomyolipoma (AML); arterial embolization; bleeding patient; outcomes; therapeutic response