Safety and Efficacy of CT-Guided Percutaneous Cryoablation of Large Angiomyolipomas: Case Series and Review of Literature

Abstract

To evaluate the safety and clinical outcomes of percutaneous cryoablation of large renal angiomyolipomas (AMLs), three patients with large predominantly fat-containing AMLs measuring over 4 cm were treated with cryoablation. Two patients underwent cryoablation alone and one patient underwent selective arterial embolization followed by cryoablation. All patients were followed up with cross-sectional imaging. All procedures were performed safely and successfully. The first two patients had no side effects or complications. The third patient developed tachycardia following the procedure that required additional cardiac monitoring and resolved without difficulty. The follow-up imaging demonstrated reduction in size of the AMLs in all three patients. CT-guided percutaneous cryoablation is a minimally invasive, viable, and safe treatment option for large AMLs without a significant vascular component while improving the patient's clinical outcomes.

Keywords

angiomyolipoma - AML - percutaneous cryoablation

Publikationsverlauf

Artikel online veröffentlicht:
13. Januar 2025

• References

• 1 Pacella G, Faiella E, Altomare C. et al. Different treatments of symptomatic angiomyolipomas of the kidney: two case reports. J Kidney Cancer VHL 2021; 8 (04) 32-37
• 2 Andersen PE, Thorlund MG, Wennevik GE, Pedersen RL, Lund L. Interventional treatment of renal angiomyolipoma: immediate results and clinical and radiological follow-up of 4.5 years. Acta Radiol Open 2015; 4 (07) 2058460115592442
• 3 Nelson CP, Sanda MG. Contemporary diagnosis and management of renal angiomyolipoma. J Urol 2002; 168 (4, Pt 1): 1315-1325
• 4 Bissler JJ, Kingswood JC. Renal angiomyolipomata. Kidney Int 2004; 66 (03) 924-934
• 5 Lemaitre L, Claudon M, Dubrulle F, Mazeman E. Imaging of angiomyolipomas. Semin Ultrasound CT MR 1997; 18 (02) 100-114
• 6 Restrepo JCA, Millan DAC, Sabogal CAR, Bernal AFP, Donoso WD. New trends and evidence for the management of renal angiomyolipoma: a comprehensive narrative review of the literature. J Kidney Cancer VHL 2022; 9 (01) 33-41
• 7 Fernández-Pello S, Hora M, Kuusk T. et al. Management of sporadic renal angiomyolipomas: a systematic review of available evidence to guide recommendations from the European Association of Urology renal cell carcinoma guidelines panel. Eur Urol Oncol 2020; 3 (01) 57-72
• 8 Erinjeri JP, Clark TW. Cryoablation: mechanism of action and devices. J Vasc Interv Radiol 2010; 21 (8, Suppl): S187-S191
• 9 Tatli S, Acar M, Tuncali K, Morrison PR, Silverman S. Percutaneous cryoablation techniques and clinical applications. Diagn Interv Radiol 2010; 16 (01) 90-95
• 10 Papalexis N, Savarese LG, Peta G. et al. The new ice age of musculoskeletal intervention: role of percutaneous cryoablation in bone and soft tissue tumors. Curr Oncol 2023; 30 (07) 6744-6770
• 11 Makki A, Graumann O, Høyer S. et al. Cryoablation of renal angiomyolipoma: an evaluation of safety and efficacy. J Endourol 2017; 31 (11) 1117-1122
• 12 Seyam RM, Alkhudair WK, Kattan SA, Alotaibi MF, Alzahrani HM, Altaweel WM. The risks of renal angiomyolipoma: reviewing the evidence. J Kidney Cancer VHL 2017; 4 (04) 13-25
• 13 Montag S, Rais-Bahrami S, Seideman CA. et al. Delayed haemorrhage after laparoscopic partial nephrectomy: frequency and angiographic findings. BJU Int 2011; 107 (09) 1460-1466
• 14 Ghoneim TP, Thornton RH, Solomon SB, Adamy A, Favaretto RL, Russo P. Selective arterial embolization for pseudoaneurysms and arteriovenous fistula of renal artery branches following partial nephrectomy. J Urol 2011; 185 (06) 2061-2065
• 15 Boorjian SA, Frank I, Inman B. et al. The role of partial nephrectomy for the management of sporadic renal angiomyolipoma. Urology 2007; 70 (06) 1064-1068
• 16 Kiefer RM, Stavropoulos SW. The role of interventional radiology techniques in the management of renal angiomyolipomas. Curr Urol Rep 2017; 18 (05) 36
• 17 Ouzaid I, Autorino R, Fatica R. et al. Active surveillance for renal angiomyolipoma: outcomes and factors predictive of delayed intervention. BJU Int 2014; 114 (03) 412-417
• 18 Kuusk T, Biancari F, Lane B. et al. Treatment of renal angiomyolipoma: pooled analysis of individual patient data. BMC Urol 2015; 15: 123
• 19 Kingswood JC, Bissler JJ, Budde K. et al. Review of the tuberous sclerosis renal guidelines from the 2012 consensus conference: current data and future study. Nephron 2016; 134 (02) 51-58
• 20 Bardin F, Chevallier O, Bertaut A. et al. Selective arterial embolization of symptomatic and asymptomatic renal angiomyolipomas: a retrospective study of safety, outcomes and tumor size reduction. Quant Imaging Med Surg 2017; 7 (01) 8-23
• 21 Wang C, Yang M, Tong X. et al. Transarterial embolization for renal angiomyolipomas: a single centre experience in 79 patients. J Int Med Res 2017; 45 (02) 706-713
• 22 Lin L, Wang C, Pei R. et al. Prophylactic selective arterial embolization for renal angiomyolipomas: efficacy and evaluation of predictive factors of significant shrinkage. Int Urol Nephrol 2018; 50 (10) 1765-1770
• 23 Kothary N, Soulen MC, Clark TW. et al. Renal angiomyolipoma: long-term results after arterial embolization. J Vasc Interv Radiol 2005; 16 (01) 45-50
• 24 Rosenov A, Schindewolf M, Baumgartner I, Saely C. Selective arterial embolizations of renal angiomyolipomas using 96% ethanol: a case series of 5 patients. Clin Med Insights Case Rep 2020; 13: 1179547620906863
• 25 Combes A, McQueen S, Palma CA. et al. Is size all that matters? New predictors of complications and bleeding in renal angiomyolipoma. Res Rep Urol 2023; 15: 113-121
• 26 Vos N, Oyen R. Renal angiomyolipoma: the good, the bad, and the ugly. J Belg Soc Radiol 2018; 102 (01) 41
• 27 Castle SM, Gorbatiy V, Ekwenna O, Young E, Leveillee RJ. Radiofrequency ablation (RFA) therapy for renal angiomyolipoma (AML): an alternative to angio-embolization and nephron-sparing surgery. BJU Int 2012; 109 (03) 384-387
• 28 Lucas SM, Stern JM, Adibi M, Zeltser IS, Cadeddu JA, Raj GV. Renal function outcomes in patients treated for renal masses smaller than 4 cm by ablative and extirpative techniques. J Urol 2008; 179 (01) 75-79 , discussion 79–80
• 29 Raman JD, Raj GV, Lucas SM. et al. Renal functional outcomes for tumours in a solitary kidney managed by ablative or extirpative techniques. BJU Int 2010; 105 (04) 496-500
• 30 Prevoo W, van den Bosch MA, Horenblas S. Radiofrequency ablation for treatment of sporadic angiomyolipoma. Urology 2008; 72 (01) 188-191
• 31 Cristescu M, Abel EJ, Wells S. et al. Percutaneous microwave ablation of renal angiomyolipomas. Cardiovasc Intervent Radiol 2016; 39 (03) 433-440