Elective and emergency selective renal artery angio-graphy and embolization of angiomyolipoma: a report of two cases and review of the literature

Abstract

Objectives: With developments in interventional radiology, selective renal artery angiography and super-selective embolization is gradually being used as an alternative treatment modality for angiomyolipoma of the kidney instead of nephrectomy or partial nephrectomy. It has been suggested that the use of steroids around the time of embolization may reduce or avoid post-embolization syndrome. Our aim is to report two cases of angiomyolipoma of kidney that were treated electively and as an emergency procedure with a review of the literature.

Methods: Detailed clinical records of the two patients were obtained from their case notes, ALS records of clinic letters and discharge summaries, PACS system for records of all radiological procedures, computerized results of all laboratory tests in order to document the presentation, investigation, management and outcome of management of the patients. Literature was reviewed on embolization of angiomyolipoma of the kidney.

Results: Two patients with angiomyolipoma of the kidney, (the first patient a lady with an enlarging angiomyolipoma of the right kidney and the second patient a lady who had spontaneous haemorrhage into a large angiomyolipoma of her right kidney), underwent selective right renal artery angiography and supers-selective embolization of the feeding vessels of their angiomyolipomas. The first patient was given steroid cover (Hydrocortisone and prednisolone) for two weeks in order to reduce or minimise the development of post-embolization syndrome. The second patient was not given any steroid cover. The first patient was discharged home on the first day after her embolization procedure and she did not develop any complications. The second patient who was not given any steroid cover developed post-embolization syndrome which eventually resolved after about six weeks. Literature review indicates that post-embolization syndrome is common after embolization. There is some evidence in the literature to suggest that the use of a short course of steroids around the time of embolization procedure reduces or prevents the development of post-embolization syndrome.

Conclusions: Selective renal artery angiography can be used to diagnose a non-bleeding-angiomyolipoma, as well as bleeding enlarged angiomyolipoma of kidney. Super-selective renal artery embolization of a large angiomyolipoma of the kidney is a useful alternative to partial nephrectomy or full nephrectomy; it has the advantage of not requiring general anaesthesia and it is associated with less morbidity than nephrectomy or partial nephrectomy. Our limited experience and literature review would suggest that perhaps the use of steroids around the time of embolization may reduce the incidence of post-embolization syndrome.