Top

Current Urology Reports

Published in:

01-03-2018 | Kidney Diseases (G Ciancio, Section Editor)

Renal Embolization: Current Recommendations and Rationale for Clinical Practice

Authors: Raja S. Ramaswamy, Olaguoke Akinwande, Tatulya Tiwari

Published in: Current Urology Reports | Issue 3/2018

Abstract

Purpose of Review

Renal embolization (RE) is a minimally invasive endovascular procedure performed primarily by interventional radiology that can be used to treat a variety of urologic conditions including malignant renal tumors, angiomyolipomas, renal trauma, and complications following biopsy. The following review examines renal embolization indications, technique, and potential complications.

Recent Findings

Renal embolization is a versatile therapeutic and adjunctive tool for many acute and chronic urologic conditions. RE has become a first-line therapy for renal trauma in lower grade injuries and increasing in prevalence for higher grade injuries. Additionally, the safety and efficacy of chemoembolization for primary treatment of renal cell carcinoma is under evaluation.

Summary

A multidisciplinary approach between urology and interventional radiology should be pursued for all patients undergoing renal embolization regardless of indication. Preprocedural planning and careful monitoring of complications should be performed to optimize clinical outcomes.

Almgard LE, Fernstrom I, Haverling M, Ljungqvist A. Treatment of renal adenocarcinoma by embolic occlusion of the renal circulation. Br J Urol. 1973;45(5):474–9. https://doi.org/10.1111/j.1464-410X.1973.tb06806.x.CrossRefPubMed

Sauk S, Zuckerman DA. Renal artery embolization. Semin Interv Radiol. 2011;28(4):396–406. https://doi.org/10.1055/s-0031-1296082.CrossRef

Turini D, Nicita G, Fiorelli C, Selli C, Villari N. Selective transcatheter arterial embolization of renal carcinoma: an original technique. J Urol. 1976;116(4):419–21. https://doi.org/10.1016/S0022-5347(17)58840-0.CrossRefPubMed

Kadir S, Marshall FF, White RI Jr, Kaufman SL, Barth KH. Therapeutic embolization of the kidney with detachable silicone balloons. J Urol. 1983;129(1):11–3. https://doi.org/10.1016/S0022-5347(17)51894-7.CrossRefPubMed

Ginat DT, Saad WE, Turba UC. Transcatheter renal artery embolization: clinical applications and techniques. Tech Vasc Interv Radiol. 2009;12(4):224–39. https://doi.org/10.1053/j.tvir.2009.09.007.CrossRefPubMed

Klatte T, Ficarra V, Gratzke C, Kaouk J, Kutikov A, Macchi V, et al. A literature review of renal surgical anatomy and surgical strategies for partial nephrectomy. Eur Urol. 2015;68(6):980–92. https://doi.org/10.1016/j.eururo.2015.04.010.CrossRefPubMedCentralPubMed

•• Ramaswamy RS, Darcy MD. Arterial embolization for the treatment of renal masses and traumatic renal injuries. Techniques in vascular and interventional radiology. 2016;19(3):203–10. A comprehensive review on technique and choice of embolic materials for renal artery embolization.

Patel IJ, Davidson JC, Nikolic B, Salazar GM, Schwartzberg MS, Walker TG, et al. Consensus guidelines for periprocedural management of coagulation status and hemostasis risk in percutaneous image-guided interventions. J Vasc Interv Radiol. 2012;23(6):727–36. https://doi.org/10.1016/j.jvir.2012.02.012.CrossRefPubMed

Venkatesan AM, Kundu S, Sacks D, Wallace MJ, Wojak JC, Rose SC, et al. Practice guidelines for adult antibiotic prophylaxis during vascular and interventional radiology procedures. Written by the Standards of Practice Committee for the Society of Interventional Radiology and Endorsed by the Cardiovascular Interventional Radiological Society of Europe and Canadian Interventional Radiology Association [corrected]. J Vasc Interv Radiol. 2010;21(11):1611–30. quiz 31CrossRefPubMed

10.

Motzer RJ, Agarwal N, Beard C, Bhayani S, Bolger GB, Carducci MA, et al. Kidney cancer. J Natl Compr Cancer Netw. 2011;9(9):960–77. https://doi.org/10.6004/jnccn.2011.0082.CrossRef

11.

Schwartz MJ, Smith EB, Trost DW, Vaughan ED Jr. Renal artery embolization: clinical indications and experience from over 100 cases. BJU Int. 2007;99(4):881–6. https://doi.org/10.1111/j.1464-410X.2006.06653.x.CrossRefPubMed

12.

May M, Brookman-Amissah S, Pflanz S, Roigas J, Hoschke B, Kendel F. Pre-operative renal arterial embolisation does not provide survival benefit in patients with radical nephrectomy for renal cell carcinoma. Br J Radiol. 2009;82(981):724–31. https://doi.org/10.1259/bjr/17514226.CrossRefPubMed

13.

Zielinski H, Szmigielski S, Petrovich Z. Comparison of preoperative embolization followed by radical nephrectomy with radical nephrectomy alone for renal cell carcinoma. Am J Clin Oncol. 2000;23(1):6–12. https://doi.org/10.1097/00000421-200002000-00002.CrossRefPubMed

14.

Kalman D, Varenhorst E. The role of arterial embolization in renal cell carcinoma. Scand J Urol Nephrol. 1999;33(3):162–70. https://doi.org/10.1080/003655999750015934.CrossRefPubMed

15.

Bakal CW, Cynamon J, Lakritz PS, Sprayregen S. Value of preoperative renal artery embolization in reducing blood transfusion requirements during nephrectomy for renal cell carcinoma. J Vasc Interv Radiol. 1993;4(6):727–31. https://doi.org/10.1016/S1051-0443(93)71958-2.CrossRefPubMed

16.

Klimberg I, Hunter P, Hawkins IF, Drylie DM, Wajsman Z. Preoperative angioinfarction of localized renal cell carcinoma using absolute ethanol. J Urol. 1985;133(1):21–4. https://doi.org/10.1016/S0022-5347(17)48768-4.CrossRefPubMed

17.

Onishi T, Oishi Y, Suzuki Y, Asano K. Prognostic evaluation of transcatheter arterial embolization for unresectable renal cell carcinoma with distant metastasis. BJU Int. 2001;87(4):312–5.CrossRefPubMed

18.

Maxwell NJ, Saleem Amer N, Rogers E, Kiely D, Sweeney P, Brady AP. Renal artery embolisation in the palliative treatment of renal carcinoma. Br J Radiol. 2007;80(950):96–102. https://doi.org/10.1259/bjr/31311739.CrossRefPubMed

19.

Mukund A, Gamanagatti S. Ethanol ablation of renal cell carcinoma for palliation of symptoms in advanced disease. J Palliat Med. 2010;13(2):117–20. https://doi.org/10.1089/jpm.2009.0243.CrossRefPubMed

20.

•• Karalli A, Ghaffarpour R, Axelsson R, Lundell L, Bozoki B, Brismar T, et al. Transarterial chemoembolization of renal cell carcinoma: a prospective controlled trial. J Vasc Interv Radiol. 2017;28(12):1664–72. A prospective randomized control study comparing chemoembolization with particulate embolization for the primary treatment of renal cell carcinoma.

21.

• Winokur RS, Pua BB, Madoff DC. Role of combined embolization and ablation in management of renal masses. Semin Interv Radiol. 2014;31(1):82–5. Important article describes the role of combined embolization and ablation in the treatment of AML. CrossRef

22.

Arima K, Yamakado K, Kinbara H, Nakatsuka A, Takeda K, Sugimura Y. Percutaneous radiofrequency ablation with transarterial embolization is useful for treatment of stage 1 renal cell carcinoma with surgical risk: results at 2-year mean follow up. Int J Urol. 2007;14(7):585–90; discussion 90. https://doi.org/10.1111/j.1442-2042.2007.01740.x.CrossRefPubMed

23.

Yamakado K, Nakatsuka A, Kobayashi S, Akeboshi M, Takaki H, Kariya Z, et al. Radiofrequency ablation combined with renal arterial embolization for the treatment of unresectable renal cell carcinoma larger than 3.5 cm: initial experience. Cardiovasc Intervent Radiol. 2006;29(3):389–94. https://doi.org/10.1007/s00270-004-0090-9.CrossRefPubMed

24.

Nakasone Y, Kawanaka K, Ikeda O, Tamura Y, Yamashita Y. Sequential combination treatment (arterial embolization and percutaneous radiofrequency ablation) of inoperable renal cell carcinoma: single-center pilot study. Acta Radiol. 2012;53(4):410–4. https://doi.org/10.1258/ar.2012.110413.CrossRefPubMed

25.

Alasker A, Williams SK, Ghavamian R. Small renal mass: to treat or not to treat. Curr Urol Rep. 2013;14(1):13–8. https://doi.org/10.1007/s11934-012-0296-3.CrossRefPubMed

26.

Bissler JJ, Kingswood JC. Renal angiomyolipomata. Kidney Int. 2004;66(3):924–34. https://doi.org/10.1111/j.1523-1755.2004.00838.x.CrossRefPubMed

27.

• Li D, Pua BB, Madoff DC. Role of embolization in the treatment of renal masses. Semin Interv Radiol. 2014;31(1):70–81. Review article detailing the role of endovascular therapy for the treatment of renal masses. CrossRef

28.

Ewalt DH, Diamond N, Rees C, Sparagana SP, Delgado M, Batchelor L, et al. Long-term outcome of transcatheter embolization of renal angiomyolipomas due to tuberous sclerosis complex. J Urol. 2005;174(5):1764–6. https://doi.org/10.1097/01.ju.0000177497.31986.64.CrossRefPubMed

29.

Halpenny D, Snow A, McNeill G, Torreggiani WC. The radiological diagnosis and treatment of renal angiomyolipoma-current status. Clin Radiol. 2010;65(2):99–108. https://doi.org/10.1016/j.crad.2009.09.014.CrossRefPubMed

30.

Takebayashi S, Horikawa A, Arai M, Iso S, Noguchi K. Transarterial ethanol ablation for sporadic and non-hemorrhaging angiomyolipoma in the kidney. Eur J Radiol. 2009;72(1):139–45. https://doi.org/10.1016/j.ejrad.2008.06.017.CrossRefPubMed

31.

Dabbeche C, Chaker M, Chemali R, Perot V, El Hajj L, Ferriere JM, et al. Role of embolization in renal angiomyolipomas. J Radiol. 2006;87(12 Pt 1):1859–67. Role de l’embolisation dans les angiomyolipomes du rein.CrossRefPubMed

32.

Ramon J, Rimon U, Garniek A, Golan G, Bensaid P, Kitrey ND, et al. Renal angiomyolipoma: long-term results following selective arterial embolization. Eur Urol. 2009;55(5):1155–61. https://doi.org/10.1016/j.eururo.2008.04.025.CrossRefPubMed

33.

Rimon U, Duvdevani M, Garniek A, Golan G, Bensaid P, Ramon J, et al. Ethanol and polyvinyl alcohol mixture for transcatheter embolization of renal angiomyolipoma. AJR Am J Roentgenol. 2006;187(3):762–8. https://doi.org/10.2214/AJR.05.0629.CrossRefPubMed

34.

Kothary N, Soulen MC, Clark TW, Wein AJ, Shlansky-Goldberg RD, Crino PB, et al. Renal angiomyolipoma: long-term results after arterial embolization. J Vasc Interv Radiol. 2005;16(1):45–50. https://doi.org/10.1097/01.RVI.0000143769.79774.70.CrossRefPubMed

35.

Lee YJ, Oh SN, Rha SE, Byun JY. Renal trauma. Radiol Clin N Am. 2007;45(3):581–92, ix. https://doi.org/10.1016/j.rcl.2007.04.004.CrossRefPubMed

36.

Santucci RA, McAninch JW, Safir M, Mario LA, Service S, Segal MR. Validation of the American Association for the Surgery of Trauma organ injury severity scale for the kidney. J Trauma. 2001;50(2):195–200. https://doi.org/10.1097/00005373-200102000-00002.CrossRefPubMed

37.

•• Kautza B, Zuckerbraun B, Peitzman AB. Management of blunt renal injury: what is new? Eur J Trauma Emerg Surg. 2015;41(3):251–8. Review article focusing on the contemporary workup and management of blunt renal trauma. CrossRefPubMed

38.

Santucci RA, Wessells H, Bartsch G, Descotes J, Heyns CF, McAninch JW, et al. Evaluation and management of renal injuries: consensus statement of the renal trauma subcommittee. BJU Int. 2004;93(7):937–54. https://doi.org/10.1111/j.1464-4096.2004.04820.x.CrossRefPubMed

39.

Hotaling JM, Sorensen MD, Smith TG 3rd, Rivara FP, Wessells H, Voelzke BB. Analysis of diagnostic angiography and angioembolization in the acute management of renal trauma using a national data set. J Urol. 2011;185(4):1316–20. https://doi.org/10.1016/j.juro.2010.12.003.CrossRefPubMedCentralPubMed

40.

Sofocleous CT, Hinrichs C, Hubbi B, Brountzos E, Kaul S, Kannarkat G, et al. Angiographic findings and embolotherapy in renal arterial trauma. Cardiovasc Intervent Radiol. 2005;28(1):39–47. https://doi.org/10.1007/s00270-004-0042-4.CrossRefPubMed

41.

Bach AM, Merton DA, Burke JF Jr, Halpern EJ. Sonographic diagnosis of arteriovenous fistula and pseudoaneurysm after biopsy of a transplanted kidney. J Ultrasound Med. 1993;12(9):545–7. https://doi.org/10.7863/jum.1993.12.9.545.CrossRefPubMed

42.

Zhang LJ, Yang GF, Qi J, Shen W. Renal artery aneurysm: diagnosis and surveillance with multidetector-row computed tomography. Acta Radiol. 2007;48(3):274–9. https://doi.org/10.1080/02841850601161521.CrossRefPubMed

43.

Gonzalez J, Esteban M, Andres G, Linares E, Martinez-Salamanca JI. Renal artery aneurysms. Curr Urol Rep. 2014;15(1):376. https://doi.org/10.1007/s11934-013-0376-z.CrossRefPubMed

44.

Garg N, Pipinos II, Longo GM, Thorell WE, Lynch TG, Johanning JM. Detachable coils for repair of extraparenchymal renal artery aneurysms: an alternative to surgical therapy. Ann Vasc Surg. 2007;21(1):97–110. https://doi.org/10.1016/j.avsg.2006.10.007.CrossRefPubMed

45.

Hom D, Eiley D, Lumerman JH, Siegel DN, Goldfischer ER, Smith AD. Complete renal embolization as an alternative to nephrectomy. J Urol. 1999;161(1):24–7. https://doi.org/10.1016/S0022-5347(01)62049-4.CrossRefPubMed

46.

Millard FC, Hemingway AP, Cumberland DC, Brown CB. Renal embolization for ablation of function in renal failure and hypertension. Postgrad Med J. 1989;65(768):729–34. https://doi.org/10.1136/pgmj.65.768.729.CrossRefPubMedCentralPubMed

47.

Hahn ST, Park SH, Lee JM, Kim CY, Chang YS. Renal artery embolization controls intractable pain in a patient with polycystic kidney disease. Cardiovasc Intervent Radiol. 1999;22(5):422–4. https://doi.org/10.1007/s002709900419.CrossRefPubMed

48.

Soulen MC, Faykus MH Jr, Shlansky-Goldberg RD, Wein AJ, Cope C. Elective embolization for prevention of hemorrhage from renal angiomyolipomas. J Vasc Interv Radiol. 1994;5(4):587–91. https://doi.org/10.1016/S1051-0443(94)71558-X.CrossRefPubMed

Title: Renal Embolization: Current Recommendations and Rationale for Clinical Practice
Authors: Raja S. Ramaswamy
Olaguoke Akinwande
Tatulya Tiwari
Publication date: 01-03-2018
Publisher: Springer US
Published in: Current Urology Reports / Issue 3/2018
Print ISSN: 1527-2737
Electronic ISSN: 1534-6285
DOI: https://doi.org/10.1007/s11934-018-0756-5

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Renal Embolization: Current Recommendations and Rationale for Clinical Practice

Abstract

Purpose of Review

Recent Findings

Summary

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Purpose of Review

Recent Findings

Summary

Please log in to get access to this content

Other articles of this Issue 3/2018

Kidney Autotransplantation: Between the Past and the Future

Surgical Management of Adult Acquired Buried Penis

Evolution of the Application of Techniques Derived from Abdominal Transplant Surgery in Urologic Oncology

Endoscopic Management of Urethral Stricture: Review and Practice Algorithm for Management of Male Urethral Stricture Disease

Refractory Urethral Stricture Management: Indications for Alternative Grafts and Flaps

Pelvic Organ Prolapse and Pregnancy in the Female Bladder Exstrophy Patient