Department of Medical Imaging, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia.
Department of Urology, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia.
J Med Imaging Radiat Oncol. 2024 Aug;68(5):577-585. doi: 10.1111/1754-9485.13665. Epub 2024 May 2.
The purpose of this study is to evaluate the patient selection methods, treatment outcomes, complications, clinical and radiological follow-up after renal angiomyolipoma (AML) treatment with selective arterial embolization (SAE) in an Australian metropolitan tertiary centre.
This study presents a retrospective single-centre review of patients' medical records who underwent SAE for renal AML during the period of 1st January 2012 and 1st January 2023.
A total of 32 SAE procedures for renal AML occurred during the study period. Three episodes were classified as emergency cases [9.38%] and the remaining 29 were treated electively. Mean AML size pre-treatment was 69.45 mm (range = 33-177; SD = 31.69). All AMLs demonstrated hyper-vascularity on contrast-enhanced cross-sectional imaging (arterial-phase enhancement characteristics and/or prominent tortuous feeding vessels) [n = 32; 100%] or an intralesional aneurysm or pseudoaneurysm [n = 12; 42.85%]. Periprocedural complications [n = 3; 9.38%] included: one intralesional haemorrhage after embolization, one vascular access site complication, and one lipiduria-associated urinary tract infection. No patients suffered a life-threatening complication, non-target embolization, deterioration in renal function or death following SAE. Re-treatment with SAE was performed in only three patients [10.71%]. Hospital mean length of stay was 1.58 days. Median durations of clinical and radiological follow-up post-treatment were 493 days (range = 104-1645) and 501 days (range = 35-1774), respectively. Follow-up imaging revealed AML total size reduction in all cases [mean = -17.17 mm; -26.51%] and 50% had obliteration of lesion hyper-vascularity after one episode of SAE. Outpatient clinical follow-up signifies that none of the patients included in the study have re-presented with lesion haemorrhage after successful SAE.
In this study, renal AMLs were treated safely with a high degree of success by using SAE, and there were very low rates of periprocedural complications. Follow-up of patients after SAE treatment of renal AML should include both radiological (assessment for reduction in lesion vascularity and size) and clinical review in an outpatient clinic setting (either by an interventional radiologist or urologist).
本研究旨在评估在澳大利亚大都市三级中心，通过选择性动脉栓塞（SAE）治疗肾血管平滑肌脂肪瘤（AML）的患者选择方法、治疗结果、并发症、临床和放射学随访情况。
本研究回顾性分析了 2012 年 1 月 1 日至 2023 年 1 月 1 日期间在本中心接受 SAE 治疗的肾 AML 患者的病历。
在研究期间，共进行了 32 例 SAE 治疗肾 AML。3 例为急症（9.38%），其余 29 例为择期治疗。治疗前 AML 平均大小为 69.45mm（范围 33-177；SD 31.69）。所有 AML 在对比增强横断面成像（动脉期增强特征和/或突出的迂曲供血血管）上均显示高血管性[32 例；100%]或瘤内动脉瘤或假性动脉瘤[12 例；42.85%]。围手术期并发症[3 例；9.38%]包括：栓塞后 1 例瘤内出血，1 例血管入路并发症，1 例脂尿相关尿路感染。没有患者发生危及生命的并发症、非目标栓塞、肾功能恶化或 SAE 后死亡。仅 3 例（10.71%）患者需要再次 SAE 治疗。住院平均住院时间为 1.58 天。治疗后临床和放射学随访的中位时间分别为 493 天（范围 104-1645）和 501 天（范围 35-1774）。随访影像学显示所有病例 AML 总大小均有缩小（平均 -17.17mm；-26.51%），50%的病例在单次 SAE 后瘤内高血管性消失。门诊临床随访显示，所有成功接受 SAE 治疗的患者均未再出现病变出血。
在这项研究中，肾 AML 采用 SAE 治疗安全有效，成功率高，围手术期并发症发生率很低。肾 AML 患者 SAE 治疗后的随访应包括影像学（评估病变血管性和大小的减少）和临床评估（由介入放射科医生或泌尿科医生在门诊进行）。
