Selective Arterial Embolization for Large or Symptomatic Renal Angiomyolipoma: 10 Years of Follow-Up

Abstract Objective To assess long-term outcome after selective arterial embolization (SAE) as first-line treatment for large or symptomatic AML. Design, setting and participants Data from a prospectively maintained database on 71 patients who underwent SAE for large or symptomatic AML were reviewed. Patients with sporadic and tuberous-sclerosis-complex (TSC) were included. Outcome measurements The main endpoints were re-embolization rates, occurrence of clinical events related to AML, size of AML, and renal function. Results Thirteen (19.1%) patients reported at least one major clinical event. Major complications affected two patients (2.9%), both ending in complete loss of renal unit function. Four renal-units (5.9%) were eventually treated surgically. The re-embolization rate was 41.1%, with an average time from the initial to a repeat SAE of 2.18 years (range 0.31-10.65 years). The size of the tumor prior to SAE and after 5 and 10 years of follow-up were 8.9cm (7-12), 6.5cm (4-7.5), 7cm (4-7.8) respectively [median (IQR)]. These results are translated to a size reduction of 27% in 10 years follow-up. Patients with TSC had larger tumors on long-term follow-up (77.8 vs. 41.3mm, p = 0.045). The long-term follow-up estimated average glomerular filtration rate was 81.97 (range 26-196). No patient needed renal replacement therapy, and disease-specific survival was 100%. Conclusions SAE is a safe treatment option for patients with symptomatic or large AML. It represents a minimally invasive intervention with good long-term outcome. SAE may be offered as first-line treatment in most cases, though, it is associated with high re-treatment rates.