Selective arterial embolization of symptomatic and asymptomatic renal angiomyolipomas: a retrospective study of safety, outcomes and tumor size reduction

Florian Bardin (1) , Olivier Chevallier (1) , Aurélie Bertaut (2) , Emmanuel Delorme (3) , Morgan Moulin (4) , Pierre Pottecher (1) , Marco Marco (1) , Sophie Gehin (1) , Eric Mourey , Luc Cormier (4) , Christiane Mousson (5) , Marco Midulla (1) , Romaric Loffroy (6, 1)

1 Department vascular, oncologic ans interventional radiology (CHU de Dijon)
2 Unité de biostatistiques [Centre Georges-François Leclerc]
3 Département d'Urologie, Hôpital privé Ste Marie, Chalon sur Saône
4 Service d'Urologie [CHU de Dijon]
5 Service de néphrologie (CHU de Dijon)
6 Le2i - Laboratoire Electronique, Informatique et Image [UMR6306]

BACKGROUND: Angiomyolipoma (AML) is the most common renal benign tumor. Treatment should be considered for symptomatic patients or for those at risk for complications, especially retroperitoneal bleeding which is correlated to tumor size, grade of the angiogenic component and to the presence of tuberous sclerosis complex (TSC). This study reports our single-center experience with the use of selective arterial embolization (SAE) in the management of symptomatic and asymptomatic renal AMLs. METHODS: In this retrospective mono-centric study, all demographic and imaging data, medical records, angiographic features, outpatient charts and follow-up visits of patients who underwent prophylactic or emergency SAE for AMLs between January 2005 and July 2016 were reviewed. Tumor size and treatment outcomes were assessed at baseline and after the procedure during follow-up. Computed tomography (CT), magnetic resonance imaging (MRI) or ultrasonography was used to evaluate AML shrinkage. Renal function was measured pre- and post-procedure. RESULTS: Twenty-three patients (18 females, 5 males; median age, 45 years; range, 19-85 years) who underwent SAE either to treat bleeding AML (n=6) or as a prophylactic treatment (n=17) were included. Overall, 34 AMLs were embolized. TSC status was confirmed for 6 patients. Immediate technical success rate was 96% and 4 patients benefitted from an additional procedure. Major complications occurred in 3 patients and minor post-embolization syndrome (PES) in 14 patients. The mean AML size reduction rate was 26.2% after a mean follow-up was 20.5 months (range, 0.5-56 months), and only non-TSC status was significantly associated with better shrinkage of tumor (P=0.022). Intralesional aneurysms were significantly more frequent in patients with hemorrhagic presentation (P=0.008). There was no change in mean creatinine level after SAE. CONCLUSIONS: SAE is a safe and effective technique to manage renal AMLs as a preventive treatment as well as in emergency setting, with significant reduction in tumor size during follow-up. A multidisciplinary approach remains fundamental, especially for TSC patients. In addition to size, the presence of intralesional aneurysms should be considered in any prophylactic treatment decision.

Mots clés: Renal tumor; angiomyolipoma (AML); bleeding patient; arterial embolization; outcomes; therapeutic response; Tuberous Sclerosis Complex; Monotypic Epithelioid Angiomyolipoma; Of-The-Literature; Term-Follow-Up; Clinicopathological Analysis; Transcatheter Embolization; Radiofrequency Ablation; Preventive Embolization; Active Surveillance; Controlled-Trial

Domaines: Imagerie; Médecine nucléaire; Ingénierie biomédicale

Florian Bardin, Olivier Chevallier, Aurélie Bertaut, Emmanuel Delorme, Morgan Moulin, et al.. Selective arterial embolization of symptomatic and asymptomatic renal angiomyolipomas: a retrospective study of safety, outcomes and tumor size reduction. Quantitative Imaging in Medicine and Surgery, 2017, 7 (1), pp.8 - 23. ⟨10.21037/qims.2017.01.02⟩. ⟨hal-01515641⟩