Combes Alexander, McQueen Simon, Palma Catalina Alejandra, Benz David, Leslie Scott, Sved Paul, Boulas John, Vasilaras Arthur, Rogan Chris, Drivas Ilias, Eisinger David Robert, Waugh Richard
Department of Urology, Royal Prince Alfred Hospital, Camperdown, NSW, 2050, Australia.
Department of Radiology, Royal Prince Alfred Hospital, Camperdown, NSW, 2050, Australia.
Res Rep Urol. 2023 Mar 20;15:113-121. doi: 10.2147/RRU.S400730. eCollection 2023.
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.
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.
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.
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.
肾血管平滑肌脂肪瘤（AML）是最常见的肾良性肿瘤。虽然通常无症状，但它们可导致危及生命的出血。选择性血管栓塞术（SAE）可用于治疗大型有症状和无症状的AML。我们旨在评估SAE治疗有症状和无症状肾AML的疗效，并确定预测自发性出血的特征。
回顾性收集2011年7月至2022年4月前瞻性维护数据库中的数据。如果AML大于4cm且患者随后接受了SAE，则纳入研究。分析随访影像以计算AML大小的平均缩小情况。查阅临床记录以分析病变特征，包括血管情况、脂肪含量和动脉瘤的存在以及术后并发症。
确定了26例患者的30个AML。随访影像的间隔时间为1至60个月。25个AML被选择性栓塞，5个因出血进行了急诊栓塞。AML体积在3个月时平均缩小41%（p = 0.013），在12个月时平均缩小63%（p = 0.007）。所有5个出血性AML都有丰富的血管，其中60%还伴有动脉瘤或脂肪含量低。并发症包括栓塞后综合征（n = 9）、节段性肾实质缺血（n = 3）、急性出血需要再次栓塞（n = 2）、因持续出血行肾切除术（n = 1）和保守治疗的延迟出血（n = 1）。未观察到肾功能恶化。
SAE是治疗有症状和无症状肾AML的有效方法，严重并发症极少。AML的血管情况、脂肪含量和动脉瘤可能是评估肾AML患者未来出血风险的有用特征。
