Elective and Emergency Renal Angiomyolipoma Embolization with Ethylene Vinyl Alcohol Copolymer: Feasibility and Initial Experience

Abstract

PurposeTo report preliminary experience with angiomyolipoma (AML) transcatheter arterial embolization using ethylene vinyl alcohol (EVOH) copolymer liquid embolic agent. Materials and MethodsEmbolization was performed in 22 consecutive patients (mean age, 53.5 y; 16 women and 6 men) for symptomatic AMLs or AMLs > 4 cm. Mean AML size before treatment was 7 cm (range, 3.5–13 cm). Superselective embolization of all lesions using microcatheters was performed; EVOH copolymer was the only embolic agent used. Data collected included volume of EVOH copolymer used, AML size before and after treatment, bleeding control, rebleeding, renal function, and complications. ResultsTwenty-seven embolizations were performed for 25 AMLs. In 3 patients, embolization of 2 different AMLs was performed. A mean volume of 2.5 mL (range, 1–8 mL) of 6% EVOH copolymer was administered per lesion. Of embolizations, 17 (63%) were elective, and 10 (37%) were urgent. For urgent cases, primary and secondary bleeding control rates were 80% and 100%, respectively. Two urgent embolizations had early rebleeding from different previously treated vessels and a successful second embolization was performed. Mean follow-up time was 37.7 months (range, 5–124 months). Rate of postembolization syndrome was 18.5%. Mean size reduction of 45.7% ± 21.5 over the maximum length of the AML before treatment was achieved. No AML regrowth occurred during follow-up. Minor and major complication rates were 7.4% and 0%, respectively. No rebleeding and no renal function impairment occurred during follow-up. ConclusionsAML embolization with EVOH copolymer is feasible, safe, and effective. EVOH copolymer could be another embolic option for AML treatment.