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H. EL MORABIT, N. EL YOUSFI, S. BOUKLATA. Medical emergency imagery IBN SINA Hospital. EMBOLIZATION OF Kidney ANGIOMYOLIPOMAS indication and INTEREST . INTERVENTIONAL : INTV1. INTV1. INTRODUCTION. Angiomyolipoma (AML) = benign tumor - PowerPoint PPT Presentation
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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.