Advances in Clinical and Experimental Medicine
2015, vol. 24, nr 5, September-October, p. 837–843
Publication type: original article
The Role of Transarterial Embolization in the Treatment of Renal Tumors
1 Department of General and Interventional Radiology and Neuroradiology, Chair of Radiology, Wroclaw Medical University, Poland
2 Department of Urology and Oncological Urology, Wroclaw Medical University, Poland
Background. Renal arterial embolization (RAE) is one of the adjunctive methods in the treatment of renal tumors. Embolization is performed in patients prior to nephrectomy, in patients with inoperable renal tumors as palliative treatment.
Objectives. The purpose of the study was to present and to analyze our own experiences in the embolization of renal tumors.
Material and Methods. A retrospective analysis of 33 patients treated using RAE between 2011 and 2013 was carried out. In 30 cases (91%), embolization was performed due to renal carcinoma and in 3 cases (9%) due to angiomyolipoma. In 11 patients intervention was performed as a palliative procedure because of advanced disease. Histoacrylic glue, polyvinyl alcohol, sponge pledgets and embolization coils were used for embolization.
Results. In 20 patients (61%), selective RAE was performed, whereas superselective RAE was carried out in 13 patients (39%). The technical success rate of RAE was 100%. In one case the procedure was complicated by reflux of the histoacrylic glue into the common femoral artery with its embolization that required surgical embolectomy. We used histoacrylic glue in 26 embolizations (79%), in 19 procedures (58%) as the only embolization agent. Polyvinyl alcohol was used in 10 procedures (30%), gelatin sponge pledgets and absolute ethanol in 6 patients (18%). In 4 cases (12%), coils were implemented. In 22 patients (67%), one or more components of postembolization syndrome (PES) developed. In all 22 patients with PES (100%), severe lumbar pain was observed and administration of analgesics proved necessary. In 10 patients treated by palliative embolization, both a regression of macrohaematuria and an increase in hemoglobin level were observed. In 10 further patients, the creatinine level decreased following RAE.
Conclusion. RAE is an effective and minimally-invasive intervention burdened with low risk of major complications. PES occurs in about two-third of patients. In the majority of patients after palliative embolization, haematuria decreases and the quality of life improves.
kidney neoplasms, embolization, endovascular procedures, cyanoacrylate glue, coils
- Chatziioannou AN, Johnson ME, Pneumaticos SG, Lawrence DD, Carrasco CH: Preoperative embolization of bone metastases from renal cell carcinoma. Eur Radiol 2000, 10, 593–596.
- Basile A, Rand T, Lomoschitz F, Toma C, Lupattelli T, Kettenbach J, Lammer J: Trisacryl gelatin microspheres versus polyvinyl alcohol particles in the preoperative embolization of bone neoplasms. Cardiovasc Intervent Radiol 2004, 27, 495–502.
- Ljungberg B, Cowan NC, Hanbury DC, Hora M, Kuczyk MA, Merseburger AS, Patard JJ, Mulders PF, Sinescu IC: European Association of Urology Guideline Group. EAU Guidelines on renal cell carcinoma: The 2010 Update. Eur Urol 2010, 58, 398–406.
- Ward JF, Velling TE: Transcatheter therapeutic embolization of genitourinary pathology. Rev Urol 2000, 2, 236–252.
- Lalli AF, Peterson N, Bookstein JJ: Roentgen-guided infarctions of kidney and lungs: a potential therapeutic technique. Radiology 1969, 93, 434–435.
- Almgard LE, Fernström I, Haverling M, Ljungqvist A: Treatment of renal adenocarcinoma by embolic occlusion of the renal circulation. Br J Urol 1973, 45, 474–479.
- 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, 724–731.
- Vaicekavicius E, Pranculis A: Transcatheter renal arterial embolization in malignant renal neoplasms: clinical results and indications for use of the method in multi-profile hospitals. Medicina (Kaunas) 2002, 38, 888–891.
- Schwartz MJ, Smith EB, Trost DW, Vaughan Jr. ED: Renal artery embolization: clinical indications and experience from over 100 cases. BJU Int 2007, 99, 881–886.
- Munro NP, Woodhams S, Nawrocki JD, Fletcher MS, Thomas PJ: The role of transarterial embolization in the treatment of renal cell carcinoma. BJU Int 2003, 92, 240–244.
- Gallucci M, Guaglianone S, Carpanese L, Papalia R, Simone G, Forestiere E, Leonardo C: Superselective embolization as first step of laparoscopic partial nephrectomy. Urology 2007, 69, 642–645.
- Maxwell NJ, Saleem Amer N, Rogers E, Kiely D, Sweeney P, Brady AP: Renal artery embolisation in the palliative treatment of renal carcinoma. Br J Radiol 2007, 80, 96–102. Erratum in: Br J Radiol 2007, 80, 853.
- Guy L, Alfidja AT, Chabrot P, Ravel A, Boiteux JP, Boyer L: Palliative transarterial embolization of renal tumors in 20 patients. Int Urol Nephrol 2007, 39, 47–50.
- Onishi T, Oishi Y, Suzuki Y, Asano K: Prognostic evaluation of transcatheter arterial embolization for unresectable renal cell carcinoma with distant metastasis. BJU Int 2001, 87, 312–315.
- Kurcz J, Nienartowicz E, Słonina J, Garcarek J, Moroń K: The usefulness of CT-angiography in detecting anatomical variants of arteries arising from the abdominal aorta and aortic arch. Adv Clin Exp Med 2007, 16, 751–760.
- Jae Hyung P, Woo Sun K, Man Chung H, Chong W: Renal Arterial Embolization with Absolute Ethanol. J Korean Med Sci 1987, 2, 13–18.
- Davis C, Boyett T, Caridi J: Renal Artery Embolization: Application and Success in Patients with Renal Cell Carcinoma and Angiomyolipoma. Semin Intervent Radiol 2007, 24, 111–116.
- Bakke A, Gothlin JH, Haukaas SA, Kalland T: Augmentation of natural killer cell activity after arterial embolization of renal carcinomas. Cancer Res 1982, 42, 3880–3883.
- 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, 24–27.
- Kalman D, Varenhorst E: The role of arterial embolization in renal cell carcinoma. Scand J Urol Nephrol 1999, 33, 162–170.
- Subramanian VS, Stephenson AJ, Goldfarb DA, Fergany AF, Novick AC, Krishnamurthi V: Utility of preoperative renal artery embolization for management of renal tumors with inferior vena cava thrombi. Urology 2009, 74, 154–159.