Schwartz Michael J, Smith Eric B, Trost David W, Vaughan E Darracott
Department of Urology, The New York-Presbyterian Hospital, Weill Medical College of Cornell University, NY, USA.
BJU Int. 2007 Apr;99(4):881-6. doi: 10.1111/j.1464-410X.2006.06653.x. Epub 2006 Dec 13.
To review current indications and techniques for renal artery embolization (RAE) and more specifically to review cases of RAE before nephrectomy for treating patients with a large renal mass.
All RAEs done at our institution between May 1993 and December 2005 were reviewed. Patients were identified using a database assembled by the Division of Cardiovascular Interventional Radiology. Indications, techniques and RAE-related complications were then obtained from a retrospective review of medical records. Additional data for patients undergoing preoperative infarction were acquired, including estimated blood loss (EBL), transfusion requirement, pathological size, subtype, grade, stage, and level of tumour thrombus if present.
In all, there were 121 RAEs, 69 in males and 52 in females (mean age 57.6 years, range 11-89). Metallic microcoils were the most often used embolization agent, followed by acrylic microspheres (embospheres), polyvinyl alcohol particles, absolute ethanol, and Gelfoam (Pharmacia & Upjohn, USA). The most common indication for RAE was infarction before nephrectomy (54.5%). Other indications included symptomatic angiomyolipomas, palliation of unresectable renal cancer, haemorrhage, perinephric bleeding in end-stage renal disease, vascular lesions, malignant hypertension, and sequelae of end-stage renal disease. RAE-associated complications including coil migration, incomplete embolization, and groin haematoma (in 5.0%). Symptoms of post-infarction syndrome were common, with 74.4% of patients having flank pain, nausea, or vomiting; the vast majority of these symptoms were mild and self-limited. In patients having nephrectomy after RAE the median (range) interval from RAE was 2 (0-78) days. The mean tumour size was 11.2 (3.5-25) cm and 46% of patients had tumour thrombus present in either the renal vein or inferior vena cava (IVC). The mean (median) overall EBL in patients having nephrectomy after RAE was 1048 (725) mL. The mean transfusion requirement over the course of hospitalization was 3.9 units of packed red blood cells.
RAE is a safe and effective therapeutic tool for many urological, renal and vascular conditions. Its use has increased at our institution due to improved techniques, embolization materials, and our increasing use of RAE as an adjuvant procedure for patients requiring nephrectomy with or without IVC thrombectomy. There are many potential operative advantages for patients having RAE before surgery, with minimal morbidity. It is likely that the lack of prospective randomized trials is the primary reason why it is underutilized in the preoperative setting.
回顾肾动脉栓塞术（RAE）的当前适应证和技术，更具体地回顾在肾切除术前行RAE治疗巨大肾肿块患者的病例。
回顾了1993年5月至2005年12月在本机构进行的所有RAE。通过心血管介入放射科建立的数据库识别患者。然后通过对病历的回顾性分析获得适应证、技术及与RAE相关的并发症。获取了接受术前梗死患者的其他数据，包括估计失血量（EBL）、输血需求、病理大小、亚型、分级、分期以及是否存在肿瘤血栓及其水平。
总共进行了121次RAE，男性69例，女性52例（平均年龄57.6岁，范围11 - 89岁）。金属微线圈是最常用的栓塞剂，其次是丙烯酸微球（栓塞球）、聚乙烯醇颗粒、无水乙醇和明胶海绵（美国法玛西亚公司）。RAE最常见的适应证是肾切除术前梗死（54.5%）。其他适应证包括有症状的肾血管平滑肌脂肪瘤、不可切除肾癌的姑息治疗、出血、终末期肾病的肾周出血、血管病变、恶性高血压以及终末期肾病的后遗症。与RAE相关的并发症包括线圈移位、栓塞不完全和腹股沟血肿（5.0%）。梗死综合征的症状很常见，74.4%的患者有胁腹痛、恶心或呕吐；这些症状绝大多数轻微且为自限性。在RAE后接受肾切除术的患者中，从RAE到手术的中位（范围）间隔时间为2（0 - 78）天。平均肿瘤大小为11.2（3.5 - 25）cm，46%的患者肾静脉或下腔静脉（IVC）存在肿瘤血栓。RAE后接受肾切除术患者的平均（中位）总EBL为1048（725）mL。住院期间平均输血需求为3.9单位浓缩红细胞。
RAE是用于许多泌尿外科、肾脏和血管疾病的一种安全有效的治疗工具。由于技术改进、栓塞材料以及我们越来越多地将RAE作为需要肾切除术（无论是否行IVC血栓切除术）患者的辅助手术，其在本机构的应用有所增加。对于术前接受RAE的患者有许多潜在的手术优势，且发病率极低。缺乏前瞻性随机试验可能是其在术前未得到充分利用的主要原因。
