EMBOLIZATION OF Kidney ANGIOMYOLIPOMAS indication and INTEREST

EMBOLIZATION OF KIDNEY ANGIOMYOLIPOMAS

INDICATION AND INTEREST

H. EL MORABIT, N. EL YOUSFI, S. BOUKLATA.Medical emergency imagery

IBN SINA Hospital.

INTERVENTIONAL : INTV1

INTV1

INTRODUCTION

Angiomyolipoma (AML) = benign tumorbleeding risk => into life-threatening patient Support hemorrhagic’s AML = first embolization for hemostasisAML asymptomatic or minimally symptomatic = discussion topic :

• Diameter < 4 cm : surveillance• Diameter > 4 cm : preventive

embolization instead of surgery (increased risk of bleeding).

MATERIALS AND METHODS

03 patients : 01 men et 02 women Mean age = 30 years. Helical CT without and after injection MRI. The materials used for embolization :

– Nonabsorbable particles Embosphère calibrated in two patients

– " metal Spires" in third patient After global and selective arteriography

scanned

RESULTS

efficient Embolization  immediately in the group treated with Embosphère (judged on biological data, hemodynamic and radiological controls on post-embolization).

Recovery in patient treated / spires.

DISCUSSION

The AML  kidney  = tumor made  of varying proportions of :

Adipose tissue, Smooth muscle cells, Abnormal vessels.

Classified as "tumor lesion" from perivascular epithelioid cells (PECOME)

Found in two clinical situations:• 80% sporadic (unilateral female predominance)• 20% congenital (bilateral, affecting both

sexes)

Tumor↑ volume gradually=> risk of hemorrhagic rupture This bleeding risk depends on :• Size,• Multifocality,• Presence of intra

lesional aneurysms and their size

KIDNEY EMBOLIZATION : Purpose   vascular obstruction / of the

catheters or various materials with the respect of parenchyma,

Localized or diffuse, temporary or permanent,

↑ frequency in the treatment of AML for three main reasons:• Benign tumor, • Symptoms often due to hemorrhage• Embolization can preserve the healthy

renal parenchyma

↑ 

Catheters use=> hyperselective embolization interesting the feeder arterial branches of the tumor => ↓ risk of ischemic of the healthy parenchyma

Place of hemostasis embolization +++ in initial management of acute hemorrhagic AML => bleeding stops + not use nephrectomy hemostasis.

Reduction in size after the AML embolization = classic

The success embolization Criteria : ↓the AML size ↓vascular component, on

acquisitions in scaner or MRI after injection of contrast product,

Absence of occurrence of bleeding episode after a prolonged clinical follow-up.

The post-embolic complications: related to the

procedure intervention itself and the catheterization maneuvers,

related to the consequences of ischemia tumor

CONCLUSION

Hemostasis Embolization  =  method to manage the  emergency hemorrhagic AML .

Préventive Embolization alternative to surgery in the treatment of AML > 4 cm, symptomatic or not, or preparation for surgery

Supportcloses coordination between urologists  and radiologists.