Department of Urology, University of California, San Francisco, San Francisco, California 94143, USA.
J Urol. 2011 Sep;186(3):921-7. doi: 10.1016/j.juro.2011.04.082. Epub 2011 Jul 24.
Selective transarterial embolization for renal angiomyolipomas is effective in preventing or limiting hemorrhage and preserving normal parenchyma. Data are insufficient regarding the safety and efficacy of embolic agents. We compared transarterial embolization of angiomyolipomas using embolic agents of different sizes.
We performed a retrospective review of all transarterial angiomyolipoma embolizations from 1999 to 2010, and evaluated demographics, procedural data, embolization response and outcomes comparing smaller (less than 150 microns) and larger (more than 150 microns) embolic agents.
Overall 48 patients underwent 66 embolization procedures for 72 angiomyolipomas. Smaller agents were used more commonly (58%). Age, gender, indications, pre-embolization angiomyolipoma size and prevalence of tuberous sclerosis were similar between the groups. Angiomyolipomas decreased a mean±SD 25%±18% after embolization with no differences between the groups (p=0.24). There were 10 angiomyolipomas that required 14 repeat embolizations (median 14 months). Repeat embolization of the same mass was almost sixfold more likely in those embolized with smaller agents (OR 5.88, 95% CI 1.64-20.8, p=0.002). Complications were similar between the groups, although 2 of 3 patients with acute respiratory distress underwent embolization with smaller agents. Patients with tuberous sclerosis had similar angiomyolipoma size, decrease in angiomyolipoma size, followup, complications and need for repeat embolization. Practice patterns changed regarding embolization agent size during the study period.
Angioembolization with larger embolic agents is associated with higher long-term efficacy compared to smaller agents. Due to concerns for serious pulmonary complications, we no longer use agents smaller than 150 microns. Prospective studies are necessary to evaluate the optimal embolization technique to achieve durable outcomes without increasing patient morbidity.
选择性经动脉栓塞治疗肾血管平滑肌脂肪瘤可有效预防或限制出血并保留正常组织。关于栓塞剂的安全性和疗效的数据还不够充分。我们比较了使用不同大小的栓塞剂进行的血管平滑肌脂肪瘤的经动脉栓塞。
我们回顾了 1999 年至 2010 年所有的经动脉血管平滑肌脂肪瘤栓塞治疗，并评估了人口统计学、程序数据、栓塞反应和结果，比较了较小（小于 150 微米）和较大（大于 150 微米）的栓塞剂。
共有 48 例患者接受了 66 次栓塞治疗，共 72 个血管平滑肌脂肪瘤。较小的栓塞剂更常用（58%）。年龄、性别、适应证、栓塞前血管平滑肌脂肪瘤大小和结节性硬化症的发生率在两组之间相似。栓塞后血管平滑肌脂肪瘤平均减少 25%±18%，两组之间无差异（p=0.24）。有 10 个血管平滑肌脂肪瘤需要 14 次重复栓塞（中位数 14 个月）。用较小的栓塞剂进行栓塞的患者，再次栓塞同一肿块的可能性几乎是前者的六倍（OR 5.88，95%CI 1.64-20.8，p=0.002）。两组之间的并发症相似，尽管有 3 例急性呼吸窘迫患者中，有 2 例使用了较小的栓塞剂。结节性硬化症患者的血管平滑肌脂肪瘤大小、血管平滑肌脂肪瘤缩小程度、随访、并发症和重复栓塞的需求相似。在研究期间，栓塞剂大小的实践模式发生了变化。
与使用较小的栓塞剂相比，使用较大的栓塞剂进行血管内栓塞与长期疗效更高相关。由于对严重肺部并发症的担忧，我们不再使用小于 150 微米的栓塞剂。需要进行前瞻性研究，以评估实现持久疗效而不增加患者发病率的最佳栓塞技术。
