Abstract
Introduction:
Transarterial embolization is increasingly used in the management of renal angiomyolipoma. The level of evidence establishing the safety and efficacy of transarterial embolization has not increased in parallel.
Materials and Methods:
Using the MOOSE (Meta-analysis Of Observational Studies in Epidemiology) criteria a systematic review of transarterial embolization of angiomyolipoma was performed to establish procedural safety and efficacy. A MEDLINE® PubMed® search revealed 1,739 publications, of which 31 studies met eligibility criteria.
Results:
A total of 524 cases of transarterial embolization of angiomyolipoma were included in analysis. Self-limiting post-embolization syndrome developed following 35.9% of embolizations and further morbidity developed in 6.9%. No procedural mortality was reported. At a mean followup of 39 months the mean size reduction was 3.4 cm (−38.3% of angiomyolipoma diameter). Unplanned repeat embolization or surgery was required in 20.9% of cases during this period. The most frequent indications for repeat procedures included angiomyolipoma revascularization in 30.0% of cases, unchanged or increasing size in 22.6%, refractory or recurring symptoms in 16.7% and representation with acute retroperitoneal hemorrhage in 14.3%. Treatment included a combination of 2 or more embolic agents in 46.8% of cases, ethanol monotherapy in 41.7%, coil monotherapy in 6.2% and foam or microparticle monotherapy in 5.2%.
Conclusions:
Transarterial embolization of angiomyolipoma demonstrates low rates of mortality and serious complications. Re-treatment rates and size reduction at a mean followup of 39 months are presented. Longitudinal data assessing long-term size reduction and re-treatment rates are lacking. Recommendations guiding the indications for transarterial embolization and clear followup require further longitudinal data.
References
- 1 : Elective embolization for prevention of hemorrhage from renal angiomyolipomas. J Vasc Interv Radiol1994; 5: 587. Google Scholar
- 2 : Trends of presentation and clinical outcome of treated renal angiomyolipoma. Yonsei Med J2010; 51: 728. Google Scholar
- 3 : Angiomyolipoma of the kidney. J Urol1951; 65: 525. Link, Google Scholar
- 4 : Contemporary experience in the management of angiomyolipoma. J Endourol2010; 24: 1883. Google Scholar
- 5 : Changing trends in presentation, diagnosis and management of renal angiomyolipoma: comparison of sporadic and tuberous sclerosis complex-associated forms. Urology2008; 72: 1077. Google Scholar
- 6 : The management of renal angiomyolipoma. J Urol1986; 135: 1121. Link, Google Scholar
- 7 : Benign renal tumors detected among healthy adults by abdominal ultrasonography. Eur Urol1995; 27: 124. Crossref, Medline, Google Scholar
- 8 : Angiomyolipoma of the kidney: report of 27 cases and review of the literature. J Urol1969; 102: 396. Link, Google Scholar
- 9 : Contemporary diagnosis and management of renal angiomyolipoma. J Urol2002; 168: 1315. Link, Google Scholar
- 10 : Renal angiomyolipoma. BJU Int2012; 110: 25. Google Scholar
- 11 : Small (<4 cm) renal mass: differentiation of angiomyolipoma without visible fat from renal cell carcinoma utilizing MR imaging. Radiology2012; 263: 160. Google Scholar
- 12 : Treatment of angiomyolipoma at a tertiary care centre: the decision between surgery and angioembolization. Can Urol Assoc J2011; 5: E138. Google Scholar
- 13 : Sirolimus therapy for angiomyolipoma in tuberous sclerosis and sporadic lymphangioleiomyomatosis: a phase 2 trial. Clin Cancer Res2011; 17: 4071. Google Scholar
- 14 : Assessing the effectiveness of rapamycin on angiomyolipoma in tuberous sclerosis: a two years trial. Orphanet J Rare Dis2012; 7: 87. Google Scholar
- 15 : Hormone receptor expression in renal angiomyolipoma: clinicopathologic correlation. Urology2008; 72: 927. Google Scholar
- 16 : Radiofrequency ablation (RFA) therapy for renal angiomyolipoma (AML): an alternative to angio-embolization and nephron-sparing surgery. BJU Int2012; 109: 384. Google Scholar
- 17 : Angiomyolipomata: challenges, solutions, and future prospects based on over 100 cases treated. BJU Int2010; 105: 101. Google Scholar
- 18 : Selective arterial embolization in the management of symptomatic renal angiomyolipomas. Eur J Radiol1999; 32: 153. Crossref, Medline, Google Scholar
- 19 : Apparent renal cell carcinomas in tuberous sclerosis are heterogeneous: the identification of malignant epithelioid angiomyolipoma. Am J Surg Pathol1998; 22: 180. Crossref, Medline, Google Scholar
- 20 : Meta-analysis of observational studies in epidemiology: a proposal for reporting. Meta-analysis Of Observational Studies in Epidemiology (MOOSE) group. JAMA2000; 283: 2008. Google Scholar
- 21 : Ethanol and polyvinyl alcohol mixture for transcatheter embolization of renal angiomyolipoma. AJR Am J Roentgenol2006; 187: 762. Google Scholar
- 22 : Transcatheter embolisation of renal angiomyolipoma. Ir J Med Sci2010; 179: 211. Google Scholar
- 23 : Renal angiomyolipoma: long-term results following selective arterial embolization. Eur Urol2009; 55: 1155. Google Scholar
- 24 : Thirty-day mortality after nephrectomy: clinical implications for informed consent. Eur Urol2009; 56: 998. Google Scholar
- 25 : Embolization of renal angiomyolipomata in patients with tuberous sclerosis complex. Am J Kidney Dis2006; 47: 95. Google Scholar
- 26 : The role of partial nephrectomy for the management of sporadic renal angiomyolipoma. Urology2007; 70: 1064. Google Scholar
- 27 : Embolization of renal angiomyolipoma: immediate complications and long-term outcomes. Clin Radiol2008; 63: 864. Google Scholar
- 28 : Selective arterial embolization of angiomyolipomas: a comparison of smaller and larger embolic agents. J Urol2011; 186: 921. Link, Google Scholar
- 29 : Renal angiomyolipoma: optimal treatment based on size and symptoms. Clin Nephrol1998; 49: 281. Medline, Google Scholar
- 30 : Renal angiomyolipoma: relationships between tumor size, aneurysm formation, and rupture. Radiology2002; 225: 78. Google Scholar
