The Role of Partial Nephrectomy without Arterial Embolization in Giant Renal Angiomyolipoma
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Angiomyolipoma is a benign neoplasm composed of varying admixtures of blood vessels, smooth muscle cells, and adipose tissue. Because of an increased risk of spontaneous haemorrhage, surgical approach is needed greater than 4–8 cm size. We here report our partial nephrectomy experience in the 24 cm size giant angiomyolipoma. 26-year-old woman referred to our clinic with a 24 cm size angiomyolipoma in her lower pole of right kidney. The inferior vena cava was deviated to the left by the mass. All the blood tests were normal and we offered her the choices of partial nephrectomy or nephrectomy. Right subcostal approach was used. The patient underwent resection of the mass with a safety region of 1 cm. Frozen section evaluation was consistent with angiomyolipoma and free for surgical margin. Warm ischemia time was 35 min. and intraoperative bleeding volume was 200 cc. Postoperative 2nd day the drain was taken and hospital stay was 4 days. In literature we observed very rare angiomyolipoma cases with such a large dimension treated by partial nephrectomy without arterial embolization. If technically suitable partial nephrectomy is the main chioce in this kind of benign lesions in young patients.Keywords:
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scaramuzzi n., walsh r.m., brennan p. &walsh m. (2001) Clin. Otolaryngol.26, 307–309 Treatment of intractable epistaxis using arterial embolization Arterial embolization has become the procedure of choice for managing intractable epistaxis in certain centres in North America and Europe, with arterial ligation reserved for those patients in which it fails. In Ireland, the role of this relatively new technique is poorly defined. The aim of this retrospective study was to investigate the outcome of all patients who underwent arterial embolization for intractable epistaxis in Dublin since it was introduced in 1998. Embolization resulted in complete and immediate resolution of epistaxis in 10 out of 12 patients (82%). Two patients required carotid ligation because of persistent epistaxis. One other patient had a further minor epistaxis 2 days following embolization, which was treated successfully with cautery. No major complications occurred in any of the patients. This study suggests that arterial embolization is an effective and safe method of managing patients with intractable epistaxis.
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Objective To study the methods for diagnosis and treatment of renal angiomyolipoma with spontaneous rupture.Methods The clinical data of 13 cases with renal angiomyolipoma rupture in our hospital were reviewed.All the patients were examined by ultrasonography.Ten of those were examined by CT scanning and three were examined by MRI.Eight received nephrectomy,five received partial nephrectomy,one of those received partial nephrectomy in other side renal after one side renal had received partial nephrectomy.Results Thirteen patients undergone surgical operation restored to health smoothly,the 5 patients received partial nephrectomy were heathy and had normal renal function.Conclusion Ultrasound is helpful to the diagnosis,CT scanning and MRI is the best diagnostic procedure which may confirm the character of the lesion and the range of bleeding.If the tumour exceeds 4cm,active treatment should be considered.Any operative management should preserve the functional nephrons as much as possible.Partial nephrectomy is a better choise for treatment of renal angiomyolipoma with spontaneous rupture.
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Arterial embolization was performed in ten skeletal metastases occurring in nine patients: eight patients presented with renal cell carcinoma and one with bronchogenic carcinoma. Five metastatic lesions were located in the spine, one in the pelvis, three in the proximal humerus and one in the proximal femur. Selective arterial embolization was performed preoperatively in seven cases and as a palliative treatment in three cases. The embolic material used was polyvinyl alcohol particles, gelatin sponge and coils or a combination of these. Arterial embolization was technically successful in all patients achieving subtotal (> 90%) tumour devascularization in five metastases and a 75% devascularization in the remaining five lesions. In operative patients, median intra-operative volume of blood transfusion was 510 mL. Palliative embolization was followed by major pain relief in two cases and moderate relief in one case lasting from 7 to 26 months. Arterial embolization is an effective and safe adjunctive treatment of hypervascular bone metastases.
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Purpose:To evaluate the efficacy of seletive renal artery embolization in symptomatic renal angiomyolipoma (AML) with chinese medicine bletilla striata as a vascular embolization agent.Methods:5 patients with symptomatic AMLS,1 male,4 female with a mean age of 55,underwent selective renal arterial embolizations.Before embolization the diagnosis were confirmed by US and CT.After embolization, follow up was made in all patients for 2~4 years.Results:The clinical symptoms in all 5 patients disappeared or relieved in different degrees.The shrink of tumor mass reached 52% to 75%, with a mean percentage of 64% at 24~48 months. CT follow up showed liquefactive necrosis in all 5 embolized tumors ,which was distributed as separate smaller areas, but no large cystic lesion found. No severe late complications found. Conclusions:Selective renal artery embolization should be considered as a primary theraputic modality for multiple angiomyolipomas or a very large one in a kidney, which can′t be removed by partial nephrectomy or enucleation. Bletilla Striata,as an embolization agent should be studied furtherly and applied widely.
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Angiomyolipoma is a benign neoplasm composed of varying admixtures of blood vessels, smooth muscle cells, and adipose tissue. Because of an increased risk of spontaneous haemorrhage, surgical approach is needed greater than 4–8 cm size. We here report our partial nephrectomy experience in the 24 cm size giant angiomyolipoma. 26-year-old woman referred to our clinic with a 24 cm size angiomyolipoma in her lower pole of right kidney. The inferior vena cava was deviated to the left by the mass. All the blood tests were normal and we offered her the choices of partial nephrectomy or nephrectomy. Right subcostal approach was used. The patient underwent resection of the mass with a safety region of 1 cm. Frozen section evaluation was consistent with angiomyolipoma and free for surgical margin. Warm ischemia time was 35 min. and intraoperative bleeding volume was 200 cc. Postoperative 2nd day the drain was taken and hospital stay was 4 days. In literature we observed very rare angiomyolipoma cases with such a large dimension treated by partial nephrectomy without arterial embolization. If technically suitable partial nephrectomy is the main chioce in this kind of benign lesions in young patients.
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To determine if elective, angiographically directed embolization of enlarged renal angiomyolipomas can be used to prevent future hemorrhagic episodes in patients with tuberous sclerosis and thus avoid nephrectomy.Records were reviewed for all 5 patients who underwent elective, subtotal embolization of large, symptomatic angiomyolipomas at the authors' institution between 1975 and 1996.All 5 patients had tuberous sclerosis and bilateral renal angiomyolipomas. Initial embolization in these patients was performed in 1975, 1981, 1993 (2 patients) and 1994. In 1 patient only a single embolization session was required. In another, initial embolization on the left side was followed by embolization on the right 13 months later. Two patients underwent 2 sessions, and 1 patient had 4 sessions over a 13-year period. Subtotal embolization with particulate material led to a decrease in size of the most severely affected portion of the kidney. One large angiomyolipoma underwent sterile liquefaction after embolization; percutaneous catheter drainage was required. The embolization allowed subsequent partial nephrectomy in this patient.Embolization is effective for the long-term management of renal angiomyolipomas in patients with tuberous sclerosis; in this way nephrectomy and loss of renal function can usually be avoided.
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No AccessJournal of UrologyAdult Urology1 Sep 2011Selective Arterial Embolization of Angiomyolipomas: A Comparison of Smaller and Larger Embolic Agents Jacqueline D. Villalta, Mathew D. Sorensen, Jeremy C. Durack, Robert K. Kerlan, and Marshall L. Stoller Jacqueline D. VillaltaJacqueline D. Villalta Department of Urology, University of California, San Francisco, San Francisco, California , Mathew D. SorensenMathew D. Sorensen Department of Urology, University of California, San Francisco, San Francisco, California , Jeremy C. DurackJeremy C. Durack Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California , Robert K. KerlanRobert K. Kerlan Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California , and Marshall L. StollerMarshall L. Stoller Department of Urology, University of California, San Francisco, San Francisco, California View All Author Informationhttps://doi.org/10.1016/j.juro.2011.04.082AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: Selective transarterial embolization for renal angiomyolipomas is effective in preventing or limiting hemorrhage and preserving normal parenchyma. Data are insufficient regarding the safety and efficacy of embolic agents. We compared transarterial embolization of angiomyolipomas using embolic agents of different sizes. Materials and Methods: We performed a retrospective review of all transarterial angiomyolipoma embolizations from 1999 to 2010, and evaluated demographics, procedural data, embolization response and outcomes comparing smaller (less than 150 microns) and larger (more than 150 microns) embolic agents. Results: Overall 48 patients underwent 66 embolization procedures for 72 angiomyolipomas. Smaller agents were used more commonly (58%). Age, gender, indications, pre-embolization angiomyolipoma size and prevalence of tuberous sclerosis were similar between the groups. Angiomyolipomas decreased a mean ± SD 25% ± 18% after embolization with no differences between the groups (p = 0.24). There were 10 angiomyolipomas that required 14 repeat embolizations (median 14 months). Repeat embolization of the same mass was almost sixfold more likely in those embolized with smaller agents (OR 5.88, 95% CI 1.64–20.8, p = 0.002). Complications were similar between the groups, although 2 of 3 patients with acute respiratory distress underwent embolization with smaller agents. Patients with tuberous sclerosis had similar angiomyolipoma size, decrease in angiomyolipoma size, followup, complications and need for repeat embolization. Practice patterns changed regarding embolization agent size during the study period. Conclusions: Angioembolization with larger embolic agents is associated with higher long-term efficacy compared to smaller agents. Due to concerns for serious pulmonary complications, we no longer use agents smaller than 150 microns. Prospective studies are necessary to evaluate the optimal embolization technique to achieve durable outcomes without increasing patient morbidity. References 1 : Contemporary diagnosis and management of renal angiomyolipoma. J Urol2002; 168: 1315. Link, Google Scholar 2 : The management of renal angiomyolipoma. J Urol1986; 135: 1121. Link, Google Scholar 3 : Management of renal angiomyolipomas associated with tuberous sclerosis complex. J Urol2004; 171: 102. Link, Google Scholar 4 : Management of hemorrhage secondary to renal angiomyolipoma with selective arterial embolization. J Urol1977; 117: 122. 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Google Scholar 18 : Ethanol and polyvinyl alcohol mixture for transcatheter embolization of renal angiomyolipoma. AJR Am J Roentgenol2006; 187: 762. Google Scholar 19 : Partition of calibrated tris-acryl gelatin microspheres in the arterial vasculature of embolized nasopharyngeal angiofibromas and paragangliomas. J Vasc Interv Radiol2005; 16: 507. Google Scholar 20 : Arterial distribution of calibrated tris-acryl gelatin and polyvinyl alcohol microspheres in a sheep kidney model. Invest Radiol2006; 41: 8. Google Scholar 21 : Transcatheter arterial embolization in patients with kidney diseases: an overview of the technical aspects and clinical indications. Korean J Radiol2010; 11: 257. Google Scholar 22 : Fatal pulmonary embolism after embolization of a hepatocellular carcinoma using microspheres. Radiologia2008; 50: 248. 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Google Scholar © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsCited byFlum A, Hamoui N, Said M, Yang X, Casalino D, McGuire B, Perry K and Nadler R (2015) Update on the Diagnosis and Management of Renal AngiomyolipomaJournal of Urology, VOL. 195, NO. 4 Part 1, (834-846), Online publication date: 1-Apr-2016.Murray T, Doyle F and Lee M (2015) Transarterial Embolization of Angiomyolipoma: A Systematic ReviewJournal of Urology, VOL. 194, NO. 3, (635-639), Online publication date: 1-Sep-2015.Laguna M (2013) Re: Everolimus for Angiomyolipoma Associated with Tuberous Sclerosis Complex or Sporadic Lymphangioleiomyomatosis (EXIST-2): A Multicentre, Randomised, Double-Blind, Placebo-Controlled TrialJournal of Urology, VOL. 191, NO. 3, (626-627), Online publication date: 1-Mar-2014. Volume 186Issue 3September 2011Page: 921-927 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.Keywordspostoperative complicationstherapeuticembolizationtuberous sclerosisangiomyolipomaMetricsAuthor Information Jacqueline D. Villalta Department of Urology, University of California, San Francisco, San Francisco, California Nothing to disclose. More articles by this author Mathew D. Sorensen Department of Urology, University of California, San Francisco, San Francisco, California Nothing to disclose. More articles by this author Jeremy C. Durack Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California Nothing to disclose. More articles by this author Robert K. Kerlan Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California Nothing to disclose. More articles by this author Marshall L. Stoller Department of Urology, University of California, San Francisco, San Francisco, California Financial interest and/or other relationship with EMKinetics, Ravine Group, Pfizer, PercSys and Boston Scientific. More articles by this author Expand All Advertisement PDF downloadLoading ...
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The purpose of this study is to evaluate the efficacy, safety and clinical outcome of lower gastrointestinal bleeding treated by transcatheter arterial embolization. We retrospectively reviewed the patients who underwent transcatheter arterial embolization for lower gastrointestinal bleeding in our hospital from January 2006 to November 2016. We reviewed the characteristics of patients, bleeding location, etiology, details of embolization and clinical outcomes on medical records. Totally, we enrolled 29 patients in this study. These patents had more medical comorbidities and were not suitable for invasive surgical intervention, so they received transcatheter arterial embolization to treat lower gastrointestinal bleeding. There were six patients with early recurrent bleeding and two patient with bowel ischemia after embolization. Two patients with local recurrent bleeding underwent secondary embolization for recurrent bleeding and the bleeding was stopped successfully. The total clinical success rate was 86.2%. Transcatheter arterial embolization was effective and safe to treat lower gastrointestinal bleeding for non-surgical candidate. Embolization should be performed as distally as possible, but superselective embolization of vasa recta still carried risk of post-embolization bowel ischemia. Intensive observation after embolization was necessary to detect post-embolization bowel ischemia and recurrent bleeding.
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Cystic neoplasms of the kidney are quite rare. Because they contain various differential diagnoses and their radiological features are not specific, their diagnosis is very difficult except for histopathological data. Usually, they can be confused radiologically with benign cysts of the kidney or angiomyolipoma. Radical or partial nephrectomy is the most commonly preferred curative treatment method when it shows features like rapidly growing or malignancy. Histopathological examination is required for definitive diagnosis. In this article, we aimed to present a rare case of tubulocystic renal cell carcinoma after partial nephrectomy in our clinic, who was followed up in another center for years with the pre-diagnosis of angiomyolipoma, in the light of the literature.
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To evaluate the efficacy of selective arterial embolization in symptomatic renal angiomyolipoma (AML) and the change in angiomyogenic components during long-term follow-up after embolization.Fourteen adult patients with symptomatic AMLs underwent 16 selective arterial embolizations. The embolic materials used were absolute alcohol with (n = 5) or without (n = 3) iodized oil, Gianturco coils (n = 4), and polyvinyl alcohol foam powder with gelatin sponge (n = 2). Follow-up ultrasonography and computed tomography (CT) were performed in six and 14 patients, respectively. The effectiveness of selective arterial embolization was evaluated on the basis of the area of the angiomyogenic components in the AML on initial and follow-up images and clinical improvement.All patients showed devascularization of the tumor on the postembolization angiograms. In 13 patients, clinical symptoms disappeared. The follow-up period was 7-72 months (mean, 33 months). One patient underwent nephrectomy at 7 months after embolization because of a large cystic lesion found at 1 month. In long-term CT follow-up (> or =12 months) in 12 patients, nearly all angiomyogenic components disappeared, but fatty components partially shrank with liquefactive necrosis in tumors.Selective arterial embolization is an effective and safe treatment of AML. The angiomyomatous components crucial for the prevention of bleeding were very sensitive to the embolization.
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