Renal Artery Embolization-indications, Technical Approaches and Outcomes

Overview

Journal Nat Rev Nephrol

Specialty Nephrology

Date 2014 Dec 24

PMID 25536394

Citations 37

Authors

Arnaud Muller

Olivier Rouviere

Affiliations

Soon will be listed here.

Abstract

Owing to improvements in catheters and embolic agents, renal artery embolization (RAE) is increasingly used to treat nephrological and urological disease. RAE has become a useful adjunct to medical resuscitation in severe penetrating, iatrogenic or blunt renal traumatisms with active bleeding, and might avoid surgical intervention, particularly among patients that are haemodynamically stable. The role of RAE in pre-operative or palliative management of advanced malignant renal tumours remains debated; however, RAE is recommended as a first-line therapy for bleeding angiomyolipomas and can be used as a preventative treatment for angiomyolipomas at risk of bleeding. RAE represents an alternative to nephrectomy in various medical conditions, including severe uncontrolled hypertension among patients with end-stage renal disease, renal graft intolerance syndrome or autosomal dominant polycystic kidney disease. RAE is increasingly used to treat renal artery aneurysms or symptomatic renal arteriovenous malformations, with a low complication rate as compared with surgical alternatives. This Review highlights the potential use of RAE as an adjunct in the management of renal disease. We first compare and contrast the technical approaches of RAE associated with the various available embolization agents and then discuss the complications associated with RAE and alternative procedures.

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References

Krueger D, Northrup H . Tuberous sclerosis complex surveillance and management: recommendations of the 2012 International Tuberous Sclerosis Complex Consensus Conference. Pediatr Neurol. 2013; 49(4):255-65. PMC: 4058297. DOI: 10.1016/j.pediatrneurol.2013.08.002. View

Breyer B, McAninch J, Elliott S, Master V . Minimally invasive endovascular techniques to treat acute renal hemorrhage. J Urol. 2008; 179(6):2248-52. DOI: 10.1016/j.juro.2008.01.104. View

van Poppel H . Efficacy and safety of nephron-sparing surgery. Int J Urol. 2010; 17(4):314-26. DOI: 10.1111/j.1442-2042.2010.02482.x. View

Arima K, Yamakado K, Kinbara H, Nakatsuka A, Takeda K, Sugimura Y . Percutaneous radiofrequency ablation with transarterial embolization is useful for treatment of stage 1 renal cell carcinoma with surgical risk: results at 2-year mean follow up. Int J Urol. 2007; 14(7):585-90. DOI: 10.1111/j.1442-2042.2007.01740.x. View

Maleux G, Messiaen T, Stockx L, Vanrenterghem Y, Wilms G . Transcatheter embolization of biopsy-related vascular injuries in renal allografts. Long-term technical, clinical and biochemical results. Acta Radiol. 2003; 44(1):13-7. View

Lorenzen J, Schneider A, Korner K, Regier M, Adam G, Nolte-Ernsting C . Post-biopsy arteriovenous fistula in transplant kidney: treatment with superselective transcatheter embolisation. Eur J Radiol. 2012; 81(5):e721-6. DOI: 10.1016/j.ejrad.2012.01.037. View

Buckley J, McAninch J . Revision of current American Association for the Surgery of Trauma Renal Injury grading system. J Trauma. 2011; 70(1):35-7. DOI: 10.1097/TA.0b013e318207ad5a. View

Takebayashi S, Hosaka M, Kubota Y, Ishizuka E, Iwasaki A, Matsubara S . Transarterial embolization and ablation of renal arteriovenous malformations: efficacy and damages in 30 patients with long-term followup. J Urol. 1998; 159(3):696-701. DOI: 10.1016/s0022-5347(01)63703-0. View

Belville J, Morgentaler A, Loughlin K, Tumeh S . Spontaneous perinephric and subcapsular renal hemorrhage: evaluation with CT, US, and angiography. Radiology. 1989; 172(3):733-8. DOI: 10.1148/radiology.172.3.2672096. View

10.

Venkatesan A, Wood B, Gervais D . Percutaneous ablation in the kidney. Radiology. 2011; 261(2):375-91. PMC: 3198222. DOI: 10.1148/radiol.11091207. View

11.

Eskandari M, Resnick S . Aneurysms of the renal artery. Semin Vasc Surg. 2005; 18(4):202-8. DOI: 10.1053/j.semvascsurg.2005.09.006. View

12.

Torres V, Harris P, Pirson Y . Autosomal dominant polycystic kidney disease. Lancet. 2007; 369(9569):1287-1301. DOI: 10.1016/S0140-6736(07)60601-1. View

13.

Ramon J, Rimon U, Garniek A, Golan G, BenSaid P, Kitrey N . Renal angiomyolipoma: long-term results following selective arterial embolization. Eur Urol. 2008; 55(5):1155-61. DOI: 10.1016/j.eururo.2008.04.025. View

14.

Shoma A, Eraky I, El-Kappany H . Pretransplant native nephrectomy in patients with end-stage renal failure: assessment of the role of laparoscopy. Urology. 2003; 61(5):915-20. DOI: 10.1016/s0090-4295(02)02556-6. View

15.

Zielinski H, Szmigielski S, Petrovich Z . Comparison of preoperative embolization followed by radical nephrectomy with radical nephrectomy alone for renal cell carcinoma. Am J Clin Oncol. 2000; 23(1):6-12. DOI: 10.1097/00000421-200002000-00002. View

16.

Yamakoshi S, Ubara Y, Suwabe T, Hiramatsu R, Yamanouchi M, Hayami N . Transcatheter renal artery embolization improves lung function in patients with autosomal dominant polycystic kidney disease on hemodialysis. Clin Exp Nephrol. 2012; 16(5):773-8. DOI: 10.1007/s10157-012-0619-1. View

17.

Wszolek M, Wotkowicz C, Libertino J . Surgical management of large renal tumors. Nat Clin Pract Urol. 2008; 5(1):35-46. DOI: 10.1038/ncpuro0963. View

18.

Aranzulla T, Colombo A, Sangiorgi G . Successful endovascular renal artery aneurysm exclusion using the Venture catheter and covered stent implantation: a case report and review of the literature. J Invasive Cardiol. 2007; 19(8):E246-53. View

19.

Zeng G, Zhao Z, Wan S, Khadgi S, Long Y, Zhang Y . Failure of initial renal arterial embolization for severe post-percutaneous nephrolithotomy hemorrhage: a multicenter study of risk factors. J Urol. 2013; 190(6):2133-8. DOI: 10.1016/j.juro.2013.06.085. View

20.

Tondel C, Vikse B, Bostad L, Svarstad E . Safety and complications of percutaneous kidney biopsies in 715 children and 8573 adults in Norway 1988-2010. Clin J Am Soc Nephrol. 2012; 7(10):1591-7. PMC: 3463204. DOI: 10.2215/CJN.02150212. View