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Alexander Combes,1 Simon McQueen,2 Catalina Alejandra Palma,1 David Benz,2 Scott Leslie,1,3– 5 Paul Sved,1,5 John Boulas,1,5 Arthur Vasilaras,1,5 Chris Rogan,2,5 Ilias Drivas,2 David Robert Eisinger,1 Richard Waugh2 1Department of Urology, Royal Prince Alfred Hospital, Camperdown, NSW, 2050, Australia; 2Department of Radiology, Royal Prince Alfred Hospital, Camperdown, NSW, 2050, Australia; 3RPA Institute of Academic Surgery, Sydney, NSW, Australia; 4Faculty of Medicine, University of Sydney, Sydney, NSW, Australia; 5Department of Urology, Chris O’Brien Lifehouse, Sydney, NSW, AustraliaCorrespondence: Alexander Combes, Department of Urology, Royal Prince Alfred Hospital, 50 Missenden Road, Camperdown, NSW, 2050, Australia, Tel +612 9515 7773, Fax +612 9515 7774, Email combes_08@hotmail.comPurpose: Renal angiomyolipoma (AML) is the most common benign renal tumor. Whilst generally asymptomatic, they can cause life-threatening bleeding. Selective angioembolization (SAE) may be used to treat large symptomatic and asymptomatic AMLs. We aimed to evaluate the efficacy of SAE for symptomatic and asymptomatic renal AMLs and determine characteristics that predict spontaneous bleeding.Patients and Methods: Data were retrospectively collected from a prospectively maintained database from July 2011 to April 2022. Patients were included if AML was > 4cm and they underwent subsequent SAE. Follow-up imaging was analyzed to calculate mean reduction in AML size. Clinical notes were reviewed to analyze lesion characteristics including vascularity, fat content and presence of aneurysm as well as post-procedural complications.Results: 26 patients with 30 AMLs were identified. Interval of follow-up imaging ranged from 1 to 60 months. 25 AMLs were embolized electively with 5 emergency embolizations performed for bleeding. Mean reduction in AML volume was 41% at 3 months (p=0.013) and 63% at 12 months (p=0.007). All 5 bleeding AMLs had a rich vascularity with 60% also having either aneurysms or a low fat content. Complications included post-embolic syndrome (n=9), segmental renal parenchyma devascularization (n=3), acute bleeding requiring re-embolization (n=2), nephrectomy for ongoing bleeding (n=1) and delayed bleeding managed conservatively (n=1). No deterioration in renal function was observed.Conclusion: SAE is an effective procedure for managing symptomatic and asymptomatic renal AML, with minimal significant complications. AML vascularity, fat content and aneurysms may be useful characteristics to assess future risk of bleeding in patients with renal AML.Keywords: selective angioembolization, aneurysm, fat content, tuberosclerosis complex |
