Semin intervent Radiol 2020; 37(04): 420-425
DOI: 10.1055/s-0040-1715884
How I Do It

Renal Artery Embolization for Neoplastic Conditions

Alex Lionberg
1   Department of Radiology, The University of Chicago, Chicago, Illinois
,
James Jeffries
1   Department of Radiology, The University of Chicago, Chicago, Illinois
,
Thuong G. Van Ha
1   Department of Radiology, The University of Chicago, Chicago, Illinois
› Author Affiliations

Renal artery embolization (RAE) is a versatile tool for the management of both acute renal hemorrhage and nonemergent renal conditions. Acute bleeds may be encountered in the setting of trauma, iatrogenic injury, renal tumors, or aneurysms. Since its development in the 1970s–1980s, the use of RAE for acute hemorrhage has been shown to be both safe and efficacious, with reported success rates between 85 and 95%.[1] [2] [3] Improvements in technology such as the coaxial catheter system have allowed for the use of superselective embolization, which minimizes the risk of irreversible renal function loss. With superselective technique, the infarcted portion of the kidney is typically less than 15%, and there is often no significant loss of renal function.[4] For this reason, along with fewer complications and more rapid recovery compared with surgical management, RAE is considered the treatment of choice for acute renal hemorrhage when possible.[5] [6]

RAE can also be performed for a wide variety of nonemergent renal conditions. Patients with end-stage renal disease and consequent drug-resistant hypertension may be appropriate for RAE as a means of functional exclusion of the kidney, particularly those who are poor surgical candidates. For this indication, proximal embolization is performed with the goal of achieving complete necrosis of the kidney. This obviates the need to perform open or laparoscopic nephrectomy, which otherwise carries significant morbidity and mortality.[7] [8] Similarly, functional exclusion with RAE can be used to treat nephrotic syndrome and cases of graft intolerance syndrome associated with failed renal transplants.[9] [10] [11] Less frequent indications include arteriovenous malformations, renal artery aneurysms, and autosomal dominant polycystic kidney disease. Benign and malignant neoplasms together comprise the most common indications for RAE, which will be reviewed in detail in this article.



Publication History

Article published online:
01 October 2020

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  • References

  • 1 Richstone L, Reggio E, Ost MC. , et al. First prize (tie): hemorrhage following percutaneous renal surgery: characterization of angiographic findings. J Endourol 2008; 22 (06) 1129-1135
  • 2 Jain V, Ganpule A, Vyas J. , et al. Management of non-neoplastic renal hemorrhage by transarterial embolization. Urology 2009; 74 (03) 522-526
  • 3 Wang HL, Xu CY, Wang HH, Xu W. Emergency transcatheter arterial embolization for acute renal hemorrhage. Medicine (Baltimore) 2015; 94 (42) e1667
  • 4 Mohsen T, El-Assmy A, El-Diasty T. Long-term functional and morphological effects of transcatheter arterial embolization of traumatic renal vascular injury. BJU Int 2008; 101 (04) 473-477
  • 5 Ramaswamy RS, Akinwande O, Tiwari T. Renal embolization: current recommendations and rationale for clinical practice. Curr Urol Rep 2018; 19 (03) 5
  • 6 Sedhai YR, Basnyat S, Dar T, Acharya D. Endovascular treatment of ruptured renal artery aneurysm: a case-based literature review. Case Rep Med 2019; 2019: 3738910
  • 7 Alhamid N, Alterky H, Othman MI. Renal artery embolization for managing uncontrolled hypertension in a kidney transplant candidate. Avicenna J Med 2013; 3 (01) 23-25
  • 8 Mao Z, Ye C, Mei C. , et al. Comparison of unilateral renal artery embolization versus bilateral for treatment of severe refractory hypertension in hemodialysis patients. World J Urol 2009; 27 (05) 679-685
  • 9 Solak Y, Koc O, Ucar R. , et al. Renal artery embolization in severe nephrotic syndrome. Hemodial Int 2016; 20 (03) 407-413
  • 10 Dogan N, Nas OF, Canver B, Ozturk K, Gokalp G. Selective bilateral renal artery embolization with tris-acryl microspheres in focal segmental glomerulosclerosis. Diagn Interv Imaging 2017; 98 (03) 277-278
  • 11 Cofan F, Real MI, Vilardell J. , et al. Percutaneous renal artery embolisation of non-functioning renal allografts with clinical intolerance. Transpl Int 2002; 15 (04) 149-155
  • 12 Venkatesan AM, Kundu S, Sacks D. , et al. Society of Interventional Radiology Standards of Practice Committee.. Practice guidelines for adult antibiotic prophylaxis during vascular and interventional radiology procedures. [corrected] J Vasc Interv Radiol 2010; 21 (11) 1611-1630, quiz 1631
  • 13 Nelson CP, Sanda MG. Contemporary diagnosis and management of renal angiomyolipoma. J Urol 2002; 168 (04) , Pt 1 1315-1325
  • 14 Rouvière O, Nivet H, Grenier N, Zini L, Lechevallier E. Kidney damage due to tuberous sclerosis complex: management recommendations. Diagn Interv Imaging 2013; 94 (03) 225-237
  • 15 Kothary N, Soulen MC, Clark TW. , et al. Renal angiomyolipoma: long-term results after arterial embolization. J Vasc Interv Radiol 2005; 16 (01) 45-50
  • 16 Chan CK, Yu S, Yip S, Lee P. The efficacy, safety and durability of selective renal arterial embolization in treating symptomatic and asymptomatic renal angiomyolipoma. Urology 2011; 77 (03) 642-648
  • 17 Ramon J, Rimon U, Garniek A. , et al. Renal angiomyolipoma: long-term results following selective arterial embolization. Eur Urol 2009; 55 (05) 1155-1161
  • 18 Mourikis D, Chatziioannou A, Antoniou A, Kehagias D, Gikas D, Vlahos L. Selective arterial embolization in the management of symptomatic renal angiomyolipomas. Eur J Radiol 1999; 32 (03) 153-159
  • 19 Sooriakumaran P, Gibbs P, Coughlin G. , et al. Angiomyolipomata: challenges, solutions, and future prospects based on over 100 cases treated. BJU Int 2010; 105 (01) 101-106
  • 20 Halpenny D, Snow A, McNeill G, Torreggiani WC. The radiological diagnosis and treatment of renal angiomyolipoma-current status. Clin Radiol 2010; 65 (02) 99-108
  • 21 Rimon U, Duvdevani M, Garniek A. , et al. Large renal angiomyolipomas: digital subtraction angiographic grading and presentation with bleeding. Clin Radiol 2006; 61 (06) 520-526
  • 22 Steiner MS, Goldman SM, Fishman EK, Marshall FF. The natural history of renal angiomyolipoma. J Urol 1993; 150 (06) 1782-1786
  • 23 Yanai H, Sasagawa I, Kubota Y. , et al. Spontaneous hemorrhage during pregnancy secondary to renal angiomyolipoma. Urol Int 1996; 56 (03) 188-191
  • 24 Yamakado K, Tanaka N, Nakagawa T, Kobayashi S, Yanagawa M, Takeda K. Renal angiomyolipoma: relationships between tumor size, aneurysm formation, and rupture. Radiology 2002; 225 (01) 78-82
  • 25 Davies DM, de Vries PJ, Johnson SR. , et al. Sirolimus therapy for angiomyolipoma in tuberous sclerosis and sporadic lymphangioleiomyomatosis: a phase 2 trial. Clin Cancer Res 2011; 17 (12) 4071-4081
  • 26 Hocquelet A, Cornelis F, Le Bras Y. , et al. Long-term results of preventive embolization of renal angiomyolipomas: evaluation of predictive factors of volume decrease. Eur Radiol 2014; 24 (08) 1785-1793
  • 27 Rilling WS, Chen GW. Preoperative embolization. Semin Intervent Radiol 2004; 21 (01) 3-9
  • 28 Kalman D, Varenhorst E. The role of arterial embolization in renal cell carcinoma. Scand J Urol Nephrol 1999; 33 (03) 162-170
  • 29 Wszolek MF, Wotkowicz C, Libertino JA. Surgical management of large renal tumors. Nat Clin Pract Urol 2008; 5 (01) 35-46
  • 30 Bakke A, Göthlin JH, Haukaas SA, Kalland T. Augmentation of natural killer cell activity after arterial embolization of renal carcinomas. Cancer Res 1982; 42 (09) 3880-3883
  • 31 Nakano H, Nihira H, Toge T. Treatment of renal cancer patients by transcatheter embolization and its effects on lymphocyte proliferative responses. J Urol 1983; 130 (01) 24-27
  • 32 Zielinski H, Szmigielski S, Petrovich Z. Comparison of preoperative embolization followed by radical nephrectomy with radical nephrectomy alone for renal cell carcinoma. Am J Clin Oncol 2000; 23 (01) 6-12
  • 33 May M, Brookman-Amissah S, Pflanz S, Roigas J, Hoschke B, Kendel F. Pre-operative renal arterial embolisation does not provide survival benefit in patients with radical nephrectomy for renal cell carcinoma. Br J Radiol 2009; 82 (981) 724-731
  • 34 Bakke A, Göthlin JH, Haukaas SA, Kalland T. Augmentation of natural killer cell activity after arterial embolization of renal carcinomas. Cancer Res 1982; 42 (09) 3880-3883
  • 35 Reinhart HA, Ghaleb M, Davis BR. Transarterial embolization of renal tumors improves surgical outcomes: a case series. Int J Surg Case Rep 2015; 15: 116-118
  • 36 Bigot P, Bouvier A, Panayotopoulos P, Aubé C, Azzouzi AR. Partial nephrectomy after selective embolization of tumor vessels in a hybrid operating room: a new approach of zero ischemia in renal surgery. J Surg Oncol 2016; 113 (02) 135-137
  • 37 Hall WH, McGahan JP, Link DP, deVere White RW. Combined embolization and percutaneous radiofrequency ablation of a solid renal tumor. AJR Am J Roentgenol 2000; 174 (06) 1592-1594
  • 38 Yamakado K, Nakatsuka A, Kobayashi S. , et al. Radiofrequency ablation combined with renal arterial embolization for the treatment of unresectable renal cell carcinoma larger than 3.5 cm: initial experience. Cardiovasc Intervent Radiol 2006; 29 (03) 389-394
  • 39 Nakasone Y, Kawanaka K, Ikeda O, Tamura Y, Yamashita Y. Sequential combination treatment (arterial embolization and percutaneous radiofrequency ablation) of inoperable renal cell carcinoma: single-center pilot study. Acta Radiol 2012; 53 (04) 410-414
  • 40 Goldberg SN, Hahn PF, Tanabe KK. , et al. Percutaneous radiofrequency tissue ablation: does perfusion-mediated tissue cooling limit coagulation necrosis?. J Vasc Interv Radiol 1998; 9 (01) , Pt 1 101-111
  • 41 Harmon TS, Matteo J, Meyer TE, Kee-Sampson J. Pre-cryoablation embolization of renal tumors: decreasing probes and saving loads. Cureus 2018; 10 (12) e3676
  • 42 Gunn AJ, Mullenbach BJ, Poundstone MM, Gordetsky JB, Underwood ES, Rais-Bahrami S. Trans-arterial embolization of renal cell carcinoma prior to percutaneous ablation: technical aspects, institutional experience, and brief review of the literature. Curr Urol 2018; 12 (01) 43-49
  • 43 Arima K, Yamakado K, Kinbara H, Nakatsuka A, Takeda K, Sugimura Y. Percutaneous radiofrequency ablation with transarterial embolization is useful for treatment of stage 1 renal cell carcinoma with surgical risk: results at 2-year mean follow up. Int J Urol 2007; 14 (07) 585-590 , discussion 590
  • 44 Maxwell NJ, Amer NS, Rogers E, Kiely D, Sweeney P, Brady AP. Renal artery embolization in the palliative treatment of renal carcinoma. Br J Radiol 2007; 80 (950) 96-102
  • 45 Karalli A, Ghaffarpour R, Axelsson R. , et al. Transarterial chemoembolization of renal cell carcinoma: a prospective controlled trial. J Vasc Interv Radiol 2017; 28 (12) 1664-1672
  • 46 Schwartz MJ, Smith EB, Trost DW, Vaughan Jr ED. Renal artery embolization: clinical indications and experience from over 100 cases. BJU Int 2007; 99 (04) 881-886
  • 47 Vora A, Brodsky R, Nolan J. , et al. Incidence of postembolization syndrome after complete renal angioinfarction: a single-institution experience over four years. Scand J Urol 2014; 48 (03) 245-251
  • 48 Bissler JJ, Racadio J, Donnelly LF, Johnson ND. Reduction of postembolization syndrome after ablation of renal angiomyolipoma. Am J Kidney Dis 2002; 39 (05) 966-971