Renal artery embolization

Redd D, Chaouk H, Shengelaia G et al. (2002) Comparative study of PVA particles, Embospheres and Gelspheres in a rabbit renal artery embolization model (abstract). J Vase Interv Radiol 13 S57... 

Fig. 10.6.5. In vivo detectability of 700-900 pm MR marked microspheres after renal artery embolization in the sheep. The left kidney has been emboli-zed with trisacryl-gelatin microspheres containing an MR marker (L), and the right kidney with control trisacryl-gelatin microspheres (R). MRI study of the explanted kidneys was performed 24 h after embolization (3D SPGR Tl, slice thickness). MR marked microspheres are detectable in the cortical area. No control microsphere is detected in the opposite side...

At MDACC, of the 100 patients with RCC treated by renal artery embofization and reported by Wallace et al. (1981), 49 patients with metastases from renal carcinoma were treated by renal artery embolization of the primary neoplasm to debulk the tumor in preparation for systemic treatment with 5FU, mitomycin C, and interferon-a. Embolization proved to be as effective in reducing tumor cell population as nephrectomy. This regimen had a 35% response rate (Sella et al. 1992). 

Of the renal neoplasms in the differential diagnosis of RCC, a benign renal angiomyolipoma (AML) with hemorrhage may have radiologic features similar to those of RCC and can be managed by renal artery embolization (Fig. 9.12). 

The vascular supply to the kidney is considered end-organ, and infarction is common after embolization. Therefore, in patients with renal insufficiency or underlying diseases such as tuberous sclerosis or von Recklinghausen s disease, nephron-sparing procedures are vital. Superselective embolization is advisable in all cases of renal artery embolization unless partial or total nephrectomy is planned. 

Renal artery embolization was popularized by Alm-gard in the early 1970s. Over the next two decades, investigators debated the usefulness of embolotherapy in the management of renal cell carcinoma, but the decreasing number of reports in the literature since then indicates a loss of interest in this technique over time, particularly in the last decade. Most of the published reports are now over 20 years old. Angiography, catheterization, and embolization... 

In 1999, Kalman and Varenhorst [20] published a survey of the pertinent literature which appeared during 1973-1997 on renal artery embolization for management of renal cell carcinoma (Table 16.3). Each one of the selected articles presented a minimum of 20 embolization cases, and each study aimed to investigate the clinical effect of embolization. All reports were scrutinized for study... 

Of the 51 publications, only 7 were prospective studies [8, 32-37]. The remainder were retrospective studies, or the study design was not specified. Most studies were from observation, and only four had historical control groups. As of 2004, no prospective randomized clinical trial of renal artery embolization has been reported. The methodologic... 

Several variables have been considered in measurement of the intended outcome, including intraoperative blood loss. Twelve studies evaluated intraoperative blood loss after renal artery embolization. In three studies, blood loss was based on subjective estimation only [48-50]. One study compared... 

Palliation of symptoms in nonoperable patients was also included in some outcome analyses. The details of symptoms and therapeutic effects of renal artery embolization are generally lacking, but studies generally reported thathematuria, pain, and paraneoplastic symptoms were alleviated. In one study, severe hematuria resolved in 11 of 14 patients, and incomplete embolization of the tumor blood supply from parasitized lumbar arteries resulted in persistent hematuria in 3 of 14 patients [11]. In another study, malignant hypercalcemia resolved after embolization [10]. Kalman and Varenhorst concluded that a small group of patients with specific, tumor-related symptoms may benefit from embolization. However, the palliative effect of embolization cannot be evaluated from the available data, and the effectiveness of the procedure awaits validation. 

Bakal CW, Cynamon J, Lakritz PS, Sprayregen S (1993) Value of preoperative renal artery embolization in reducing blood transfusion requirements during nephrectomy for renal cell carcinoma. J Vase Interv Radiol 4 727-731... 

Nurmi M, Satokari K, Puntala P (1987) Renal artery embolization in the palliative treatment of renal adenocarcinoma. Scand J Urol Nephrol 21 93-96... 

Sanchez FW, Vujic I, Ayres RI, CurryNS, Gobien RP (1985) Hemorrhagic renal angiomyolipoma superselective renal arterial embolization for preservation of renal function. Cardiovasc Jntervent Radiol 8 39-42... 

Truche A, Cartier J, Imbert B, Maurizi J, Zaoui P, Carron P. Renal artery embolization after intravenous mercury injection. Kidney Int 2012 82 939. 

Teigen CL, Mitchell SE, Venbrux AC, Christenson MJ, McLean RH (1992) Segmental renal artery embolization for treatment of pediatric renovascular hypertension. J Vase Interv Radiol 3 111-117... 

Li S, Wang X, Zhang X, Yang R, Zhang H, Zhub L, Houa X. (2002). Studies on alginate-chitosan microcapsules and renal arterial embolization in rabbits./ Control Release, 84,87-98. 

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