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Tomita K, Matsumoto T, Kamei S, Yamamoto S, Suda S, Zakoji H, Hasebe T. Transcatheter arterial embolization for unruptured renal angiomyolipoma using a 1.8-Fr tip microballoon catheter with a mixture of ethanol and Lipiodol. CVIR Endovasc 2020; 3:3. [PMID: 32027014 PMCID: PMC6966394 DOI: 10.1186/s42155-019-0095-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Accepted: 12/30/2019] [Indexed: 12/18/2022] Open
Abstract
Background To evaluate the efficacy and safety of transcatheter arterial embolization for renal angiomyolipoma using a 1.8-French tip microballoon catheter and a mixture of ethanol and Lipiodol. Methods Seven consecutive patients with total of eight angiomyolipomas underwent this procedure between June 2014 and June 2017. A 1.8-French tip microballoon catheter was advanced to the feeding artery of the angiomyolipoma, and transcatheter arterial embolization was performed with a mixture of ethanol and Lipiodol under microballoon inflation. We retrospectively evaluated the characteristics of angiomyolipomas, technical success rate, clinical success rate, renal function, and adverse events. Technical success and clinical success were defined as complete embolization of all feeding arteries and reduction of tumor size, respectively. Results The median size of the angiomyolipomas was 46 mm (range, 40–64 mm). Transcatheter arterial embolization was successful in all eight angiomyolipomas. The median volume of the mixture of ethanol and Lipiodol was 6.0 ml (range, 2.0–14 ml). The median ratio of ethanol to Lipiodol was 71% (range, 71–75%). All eight angiomyolipomas shrank with a median shrinkage rate of 34% in diameter (range, 9–63%) and 77% in volume (range, 48–94%). The median follow-up period was 13 months (range, 9–54 months). Clinical success was achieved in all cases. Serum creatinine concentrations and the pre- and post-procedural estimated glomerular filtration rates did not change notably, and there were no major complications. Conclusion Transcatheter arterial embolization for renal angiomyolipoma using a 1.8-French tip microballoon catheter with a mixture of ethanol and Lipiodol is effective and safe.
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Affiliation(s)
- Kosuke Tomita
- Department of Radiology, Tokai University Hachioji Hospital, Tokai University School of Medicine, 1838 Ishikawa-machi, Hachioji, Tokyo, 192-0032, Japan
| | - Tomohiro Matsumoto
- Department of Radiology, Tokai University Hachioji Hospital, Tokai University School of Medicine, 1838 Ishikawa-machi, Hachioji, Tokyo, 192-0032, Japan
| | - Shunsuke Kamei
- Department of Radiology, Tokai University Hachioji Hospital, Tokai University School of Medicine, 1838 Ishikawa-machi, Hachioji, Tokyo, 192-0032, Japan
| | - Shota Yamamoto
- Department of Radiology, Tokai University Hachioji Hospital, Tokai University School of Medicine, 1838 Ishikawa-machi, Hachioji, Tokyo, 192-0032, Japan
| | - Satoshi Suda
- Department of Radiology, Tokai University Hachioji Hospital, Tokai University School of Medicine, 1838 Ishikawa-machi, Hachioji, Tokyo, 192-0032, Japan
| | - Hidenori Zakoji
- Department of Urology, Tokai University Hachioji Hospital, Tokai University School of Medicine, 1838 Ishikawa-machi, Hachioji, Tokyo, 192-0032, Japan
| | - Terumitsu Hasebe
- Department of Radiology, Tokai University Hachioji Hospital, Tokai University School of Medicine, 1838 Ishikawa-machi, Hachioji, Tokyo, 192-0032, Japan.
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Kato H, Kuwatsuru R, Inoue T, Okada S, Aida M, Yamashiro Y. Superselective Transcatheter Arterial Embolization for Large Unruptured Renal Angiomyolipoma in Lymphangioleiomyomatosis. J Vasc Interv Radiol 2018; 29:958-965. [PMID: 29398412 DOI: 10.1016/j.jvir.2017.11.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Revised: 11/05/2017] [Accepted: 11/05/2017] [Indexed: 10/18/2022] Open
Abstract
PURPOSE To retrospectively evaluate therapeutic performance and complications of superselective transcatheter arterial embolization (TAE) for unruptured renal angiomyolipoma (AML) in patients with lymphangioleiomyomatosis (LAM) and to investigate the correlation between percentage reduction in tumor volume and intratumoral fat content. MATERIALS AND METHODS Superselective TAE was performed in 14 consecutive patients with 15 large unruptured renal AMLs associated with LAM (mean age, 38 y; range, 21-57 y). Patients had renal AML with aneurysms ≥ 5 mm in diameter, tumor-related abdominal symptoms, or both. In all cases, embolization of 1 tumor was achieved in a single session by using multiporous gelatin sponge particles (GSPs) with additional metallic coils in all but 1 case. Tumor volume and fat content percentage were measured on CT or MR imaging before and after superselective TAE (median, 11 months; range, 6-14 months). RESULTS Residual tumor staining declined by > 90% after all TAE sessions except 2, with embolization of all treated aneurysms. No nontarget embolization or severe complications were encountered. Mean percentage reduction in tumor volume after superselective TAE was 69% (range, 21%-95%). Percentage tumor volume reduction was negatively correlated with fat content before embolization (P < .01). CONCLUSIONS Superselective TAE with multiporous GSPs and metallic coils for large unruptured renal AML in patients with LAM is useful for reducing tumor volume and treating intratumoral aneurysms without major pulmonary or renal complications. Extent of tumor reduction may be influenced by fat content before embolization.
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Affiliation(s)
- Hitomi Kato
- Department of Radiology, School of Medicine, Juntendo University, 2-1-1 Hongo Bunkyo-ku, Tokyo 113-8421, Japan
| | - Ryohei Kuwatsuru
- Department of Radiology, School of Medicine, Juntendo University, 2-1-1 Hongo Bunkyo-ku, Tokyo 113-8421, Japan; Department of Radiology, Graduate School of Medicine, Juntendo University, 2-1-1 Hongo Bunkyo-ku, Tokyo 113-8421, Japan.
| | - Tatsuro Inoue
- Department of Radiology, School of Medicine, Juntendo University, 2-1-1 Hongo Bunkyo-ku, Tokyo 113-8421, Japan
| | - Shingo Okada
- Department of Radiology, School of Medicine, Juntendo University, 2-1-1 Hongo Bunkyo-ku, Tokyo 113-8421, Japan
| | - Mari Aida
- Department of Radiology, School of Medicine, Juntendo University, 2-1-1 Hongo Bunkyo-ku, Tokyo 113-8421, Japan
| | - Yuki Yamashiro
- Department of Radiology, School of Medicine, Juntendo University, 2-1-1 Hongo Bunkyo-ku, Tokyo 113-8421, Japan
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Kikuchi N, Kuwatsuru R, Kyogoku S, Shiraishi A, Okada S, Tsuge D, Yamashiro Y. Embolization of spontaneous intratumoral hemorrhage with the hemodynamic characteristics of arteriovenous fistula in renal angiomyolipoma. Case Rep Nephrol Dial 2015; 5:54-9. [PMID: 25789276 PMCID: PMC4360528 DOI: 10.1159/000371844] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Aneurysms within renal angiomyolipomas (AML) may rupture into the tumor or pararenal space. Transcatheter arterial embolization is the first-choice treatment to control bleeding. Here, we describe the use of coil embolization in two cases of spontaneous intratumoral hemorrhage with the hemodynamic characteristics of renal arteriovenous (AV) fistula in renal AML. In case 1, renal angiography showed several intratumoral aneurysms, one of which had ruptured into the tumor, resulting in the formation of an intratumoral hematoma. Blood flow within the hematoma was rapid and the blood was immediately returned to the systemic circulation through the left renal vein. In case 2, renal angiography showed that the rupture of an intratumoral aneurysm of a tumor-feeding artery had resulted in formation of an intratumoral hematoma and direct renal vein communication. No extratumoral hemorrhage was observed in either case. The hemodynamics of both hematomas resembled those of a high-flow renal AV fistula. The ruptured aneurysms were embolized with detachable and pushable coils (case 1) or pushable coils only (case 2). To our knowledge, this is the first report of successful embolization of AV fistula-like intratumoral hemorrhage in renal AML.
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Affiliation(s)
- Nao Kikuchi
- Department of Radiology, Faculty of Medicine, Juntendo University, Tokyo, Japan
| | - Ryohei Kuwatsuru
- Department of Radiology, Faculty of Medicine, Juntendo University, Tokyo, Japan
| | - Shinsuke Kyogoku
- Department of Radiology, Faculty of Medicine, Juntendo University, Tokyo, Japan
| | - Akihiko Shiraishi
- Department of Radiology, Faculty of Medicine, Juntendo University, Tokyo, Japan
| | - Shingo Okada
- Department of Radiology, Faculty of Medicine, Juntendo University, Tokyo, Japan
| | - Daisuke Tsuge
- Department of Radiology, Faculty of Medicine, Juntendo University, Tokyo, Japan
| | - Yuki Yamashiro
- Department of Radiology, Faculty of Medicine, Juntendo University, Tokyo, Japan
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Transcatheter ablation of an iatrogenic renal artery pseudoaneurysm with absolute alcohol: a rare case report. Indian Heart J 2014; 66:719-22. [PMID: 25634415 DOI: 10.1016/j.ihj.2014.10.402] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2014] [Accepted: 10/09/2014] [Indexed: 11/21/2022] Open
Abstract
A 25 year old male was admitted with features of life threatening renal haemorrhage after undergoing open nephrolithotomy for a staghorn calculus of the right kidney. CECT abdomen and selective renal angiography revealed a 2.5 × 3.0 cm pseudoaneurysm arising from the lower segmental branch of right renal artery, leaking into retroperitoneal space. After an initial failed attempt of transcatheter embolization with N-butyl cyanoacrylate (NBCA) and 10% lipiodol mixture, the pseudoaneurysm was successfully ablated with absolute alcohol. Our case demonstrates that absolute alcohol ablation is a safe and effective modality for controlling haemorrhage from an iatrogenic renal artery pseudoaneurysm.
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Loffroy R, Rao P, Kwak BK, Ota S, De Lin M, Liapi E, Geschwind JF. Transcatheter arterial embolization in patients with kidney diseases: an overview of the technical aspects and clinical indications. Korean J Radiol 2010; 11:257-68. [PMID: 20461179 PMCID: PMC2864852 DOI: 10.3348/kjr.2010.11.3.257] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2009] [Accepted: 01/18/2010] [Indexed: 01/31/2023] Open
Abstract
Therapeutic embolization is defined as the voluntary occlusion of one or several vessels, and this is achieved by inserting material into the lumen to obtain transient or permanent thrombosis in the downstream vascular bed. There are a number of indications for this approach in urological practice, in particular for the patients with parenchymatous or vascular kidney disease. In this review, we present the different embolization techniques and the principally employed occluding agents, and then we present the principal clinical indications and we discuss other pathologies that may benefit from this non-invasive therapy. The complications, side effects and main precautions associated with this approach are also described.
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Affiliation(s)
- Romaric Loffroy
- Russell H. Morgan Department of Radiology and Radiological Sciences, Division of Cardiovascular and Interventional Radiology, Johns Hopkins University School of Medicine, Johns Hopkins Hospital, Baltimore, Maryland 21287, USA.
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Current World Literature. Curr Opin Neurol 2010; 23:194-201. [DOI: 10.1097/wco.0b013e328338cade] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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