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Semin intervent Radiol 2011; 28(4): 396-406
DOI: 10.1055/s-0031-1296082
© Thieme Medical Publishers

Renal Artery Embolization

Steven Sauk1 , Darryl A. Zuckerman1
  • 1Mallinckrodt Institute of Radiology, Section of Vascular and Interventional Radiology, St. Louis, Missouri
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Publication History

Publication Date:
03 January 2012 (online)

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ABSTRACT

Renal artery embolization (RAE) is an effective minimally invasive alternative procedure for the treatment of a variety of conditions. Since the 1970s when RAE was first developed, technical advances and growing experience have expanded the indications to not only include treatment of conditions such as symptomatic hematuria and palliation for metastatic renal cancer, but also preoperative infarction of renal tumors, treatment of angiomyolipomas, vascular malformations, medical renal disease, and complications following renal transplantation. With the drastically improved morbidity associated with this technique in part due to the introduction of more precise embolic agents and smaller delivery catheters, RAE continues to gain popularity for various urologic conditions. The indications and techniques for renal artery embolization are reviewed in the following sections.

KEYWORDS

Embolization - renal artery - kidney - hemorrhage - interventional radiology

REFERENCES

  • 1 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) 419-421
    Google Scholar
  • 2 Kadir S, Marshall F F, White Jr R I, Kaufman S L, Barth K H. Therapeutic embolization of the kidney with detachable silicone balloons.  J Urol. 1983;  129 (1) 11-13
    Google Scholar
  • 3 Hom D, Eiley D, Lumerman J H, Siegel D N, Goldfischer E R, Smith A D. Complete renal embolization as an alternative to nephrectomy.  J Urol. 1999;  161 (1) 24-27
    Google Scholar
  • 4 Ginat D T, Saad W E, Turba U C. Transcatheter renal artery embolization: clinical applications and techniques.  Tech Vasc Interv Radiol. 2009;  12 (4) 224-239
    Google Scholar
  • 5 Takebayashi S, Hosaka M, Kubota Y, Ishizuka E, Iwasaki A, Matsubara S. Transarterial embolization and ablation of renal arteriovenous malformations: efficacy and damages in 30 patients with long-term followup.  J Urol. 1998;  159 (3) 696-701
    Google Scholar
  • 6 Cox G G, Lee K R, Price H I, Gunter K, Noble M J, Mebust W K. Colonic infarction following ethanol embolization of renal-cell carcinoma.  Radiology. 1982;  145 (2) 343-345
    Google Scholar
  • 7 Gang D L, Dole K B, Adelman L S. Spinal cord infarction following therapeutic renal artery embolization.  JAMA. 1977;  237 (26) 2841-2842
    Google Scholar
  • 8 Woodside J, Schwarz H, Bergreen P. Peripheral embolization complicating bilateral renal infarction with gelfoam.  AJR Am J Roentgenol. 1976;  126 (5) 1033-1034
    Google Scholar
  • 9 Diaz-Buxo J A, Kopen D F, Donadio Jr J V. Renal allograft arteriovenous fistula following percutaneous biopsy.  J Urol. 1974;  112 (5) 577-580
    Google Scholar
  • 10 Merkus J W, Zeebregts C J, Hoitsma A J et al.. High incidence of arteriovenous fistula after biopsy of kidney allografts.  Br J Surg. 1993;  80 (3) 310-312
    Google Scholar
  • 11 Loffroy R, Guiu B, Lambert A et al.. Management of post-biopsy renal allograft arteriovenous fistulas with selective arterial embolization: immediate and long-term outcomes.  Clin Radiol. 2008;  63 (6) 657-665
    Google Scholar
  • 12 Hedegard W, Saad W E, Davies M G. Management of vascular and nonvascular complications after renal transplantation.  Tech Vasc Interv Radiol. 2009;  12 (4) 240-262
    Google Scholar
  • 13 Maleux G, Messiaen T, Stockx L, Vanrenterghem Y, Wilms G. Transcatheter embolization of biopsy-related vascular injuries in renal allografts. Long-term technical, clinical and biochemical results.  Acta Radiol. 2003;  44 (1) 13-17
    Google Scholar
  • 14 Dorffner R, Thurnher S, Prokesch R et al.. Embolization of iatrogenic vascular injuries of renal transplants: immediate and follow-up results.  Cardiovasc Intervent Radiol. 1998;  21 (2) 129-134
    Google Scholar
  • 15 Sennett C A, Messersmith R N, Yousefzadeh D K, Thistlethwaite Jr J R. Percapsular and percutaneous embolization of renal transplant pseudoaneurysm and AV fistula: case report.  Cardiovasc Intervent Radiol. 1989;  12 (5) 270-273
    Google Scholar
  • 16 Schwartz M J, Smith E B, Trost D W, Vaughan Jr E D. Renal artery embolization: clinical indications and experience from over 100 cases.  BJU Int. 2007;  99 (4) 881-886
    Google Scholar
  • 17 Kalman D, Varenhorst E. The role of arterial embolization in renal cell carcinoma.  Scand J Urol Nephrol. 1999;  33 (3) 162-170
    Google Scholar
  • 18 Bakal C W, Cynamon J, Lakritz P S, 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) 727-731
    Google Scholar
  • 19 Klimberg I, Hunter P, Hawkins I F, Drylie D M, Wajsman Z. Preoperative angioinfarction of localized renal cell carcinoma using absolute ethanol.  J Urol. 1985;  133 (1) 21-24
    Google Scholar
  • 20 Woodrum D A, Atwell T D, Farrell M A, Andrews J C, Charboneau J W, Callstrom M R. Role of intraarterial embolization before cryoablation of large renal tumors: a pilot study.  J Vasc Interv Radiol. 2010;  21 (6) 930-936
    Google Scholar
  • 21 Ginat D T, Saad W E, Turba U C. Transcatheter renal artery embolization for management of renal and adrenal tumors.  Tech Vasc Interv Radiol. 2010;  13 (2) 75-88
    Google Scholar
  • 22 Yamakado K, Nakatsuka A, Kobayashi S 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) 389-394
    Google Scholar
  • 23 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) 585-590 discussion 590
    Google Scholar
  • 24 Mondshine R T, Owens S, Mondschein J I, Cizman B, Stavropoulos S W, Clark T W. Combination embolization and radiofrequency ablation therapy for renal cell carcinoma in the setting of coexisting arterial disease.  J Vasc Interv Radiol. 2008;  19 (4) 616-620
    Google Scholar
  • 25 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
    Google Scholar
  • 26 Swanson D A, Johnson D E, von Eschenbach A C, Chuang V P, Wallace S. Angioinfarction plus nephrectomy for metastatic renal cell carcinoma—an update.  J Urol. 1983;  130 (3) 449-452
    Google Scholar
  • 27 Rimon U, Duvdevani M, Garniek A et al.. Large renal angiomyolipomas: digital subtraction angiographic grading and presentation with bleeding.  Clin Radiol. 2006;  61 (6) 520-526
    Google Scholar
  • 28 Hamlin J A, Smith D C, Taylor F C et al.. Renal angiomyolipomas: long-term follow-up of embolization for acute hemorrhage.  Can Assoc Radiol J. 1997;  48 (3) 191-198
    Google Scholar
  • 29 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) 139-145
    Google Scholar
  • 30 Dabbeche C, Chaker M, Chemali R et al.. [Role of embolization in renal angiomyolipomas].  J Radiol. 2006;  87 (12 Pt 1) 1859-1867
    Google Scholar
  • 31 Ramon J, Rimon U, Garniek A et al.. Renal angiomyolipoma: long-term results following selective arterial embolization.  Eur Urol. 2009;  55 (5) 1155-1161
    Google Scholar
  • 32 Kothary N, Soulen M C, Clark T W et al.. Renal angiomyolipoma: long-term results after arterial embolization.  J Vasc Interv Radiol. 2005;  16 (1) 45-50
    Google Scholar
  • 33 Soulen M C, Faykus Jr M H, Shlansky-Goldberg R D, Wein A J, Cope C. Elective embolization for prevention of hemorrhage from renal angiomyolipomas.  J Vasc Interv Radiol. 1994;  5 (4) 587-591
    Google Scholar
  • 34 Fisher R G, Ben-menachem Y. Angiography and embolization in renal trauma. In: Baum S, ed. Abram's Angiography: Vascular and Interventional Radiology. 4th ed. Boston: Little, Brown and Company; 1997: 1230-1243
    Google Scholar
  • 35 Teigen C L, Venbrux A C, Quinlan D M, Jeffs R D. Late massive hematuria as a complication of conservative management of blunt renal trauma in children.  J Urol. 1992;  147 (5) 1333-1336
    Google Scholar
  • 36 Fisher R G, Ben-Menachem Y, Whigham C. Stab wounds of the renal artery branches: angiographic diagnosis and treatment by embolization.  AJR Am J Roentgenol. 1989;  152 (6) 1231-1235
    Google Scholar
  • 37 Cope C, Zeit R M. Pseudoaneurysms after nephrostomy.  AJR Am J Roentgenol. 1982;  139 (2) 255-261
    Google Scholar
  • 38 Low R N, Jeffrey Jr R B. Intraperitoneal hemorrhage after renal biopsy: a grave prognostic sign.  AJR Am J Roentgenol. 1988;  151 (1) 113-114
    Google Scholar
  • 39 Ashenburg R J, Blair R J, Rivera F J, Weigele J B. Renal arterial rupture complicating transluminal angioplasty: successful conservative management.  Radiology. 1990;  174 (3 Pt 2) 983-985
    Google Scholar
  • 40 Somani B K, Nabi G, Thorpe P, McClinton S. Endovascular control of haemorrhagic urological emergencies: an observational study.  BMC Urol. 2006;  6 27
    Google Scholar
  • 41 Sofocleous C T, Hinrichs C, Hubbi B et al.. Angiographic findings and embolotherapy in renal arterial trauma.  Cardiovasc Intervent Radiol. 2005;  28 (1) 39-47
    Google Scholar
  • 42 Nakatani T, Uchida J, Han Y S et al.. Renal allograft arteriovenous fistula and large pseudoaneurysm.  Clin Transplant. 2003;  17 (1) 9-12
    Google Scholar
  • 43 Bach A M, Merton D A, Burke Jr J F, Halpern E J. Sonographic diagnosis of arteriovenous fistula and pseudoaneurysm after biopsy of a transplanted kidney.  J Ultrasound Med. 1993;  12 (9) 545-547
    Google Scholar
  • 44 Horwitz M D, Hanbury D C, King C M. Renal artery pseudoaneurysm following partial nephrectomy treated with stent-graft.  Br J Radiol. 2005;  78 (926) 161-163
    Google Scholar
  • 45 Zhang L J, Yang G F, Qi J, Shen W. Renal artery aneurysm: diagnosis and surveillance with multidetector-row computed tomography.  Acta Radiol. 2007;  48 (3) 274-279
    Google Scholar
  • 46 Garg N, Pipinos I I, Longo G M, Thorell W E, Lynch T G, Johanning J M. Detachable coils for repair of extraparenchymal renal artery aneurysms: an alternative to surgical therapy.  Ann Vasc Surg. 2007;  21 (1) 97-110
    Google Scholar
  • 47 Abath C, Andrade G, Cavalcanti D, Brito N, Marques R. Complex renal artery aneurysms: liquids or coils?.  Tech Vasc Interv Radiol. 2007;  10 (4) 299-307
    Google Scholar
  • 48 Millard F C, Hemingway A P, Cumberland D C, Brown C B. Renal embolization for ablation of function in renal failure and hypertension.  Postgrad Med J. 1989;  65 (768) 729-734
    Google Scholar
  • 49 Keller F S, Coyle M, Rosch J, Dotter C T. Percutaneous renal ablation in patients with end-stage renal disease: alternative to surgical nephrectomy.  Radiology. 1986;  159 (2) 447-451
    Google Scholar
  • 50 Hahn S T, Park S H, Lee J M, Kim C Y, Chang Y S. Renal artery embolization controls intractable pain in a patient with polycystic kidney disease.  Cardiovasc Intervent Radiol. 1999;  22 (5) 422-424
    Google Scholar
  • 51 Harley J D, Shen F H, Carter S J. Transcatheter infarction of a polycystic kidney for control of recurrent hemorrhage.  AJR Am J Roentgenol. 1980;  134 (4) 818-820
    Google Scholar

Darryl A. ZuckermanM.D. 

Mallinckrodt Institute of Radiology, Section of Vascular and Interventional Radiology

510 S. Kingshighway Blvd., Campus box 8131, St. Louis, MO 63110

Email: zuckermand@mir.wustl.edu

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