Renal Artery Embolization Research Articles

Prophylactic renal artery embolization before pregnancy in patients with lymphangioleiomyomatosis and renal angiomyolipoma.

ObjectivePregnant patients with lymphangioleiomyomatosis (LAM) and renal angiomyolipomas (AMLs) require care for both renal AMLs and pulmonary dysfunction because AMLs can grow and rupture during pregnancy, potentially causing hemorrhagic shock and fetal death. This study examined whether prophylactic transcatheter arterial embolization (TAE) could prevent the pregnancy-associated growth and rupture of renal AMLs in patients with LAM.MethodsThis retrospective study included five women with 14 renal AMLs (initial diameter, ≥2 cm) first encountered between September 2010 and August 2015 who subsequently became pregnant. Seven tumors in five patients were embolized, and seven tumors in two patients were not treated. Changes in the volume of each tumor were evaluated.ResultsUntreated tumors were much more likely to grow than embolized tumors both during pregnancy (100% vs. 0%) and at the first follow-up visit after delivery (100% vs. 14%). One untreated hypervascular tumor grew rapidly during pregnancy to 409% of the pretreatment volume. No tumor ruptured.ConclusionsProphylactic pre-pregnancy TAE decreased the growth and bleeding of renal AMLs during pregnancy in patients with LAM. TAE can be recommended for hypervascular tumors before pregnancy regardless of the size of the aneurysm.

Akut Renal Arter Kanamalarında Endovasküler Tedavi: Etkinliği ve Böbrek Fonksiyonlarına Etkisi

Aim: The aim of this study was to investigate the efficacy and complications of endovascular treatment of acute renal artery hemorrhage and the etiology of the condition. Material and Methods: Twenty-two patients who underwent endovascular embolization with renal acute artery hemorrhage between 2016 and 2020 were evaluated retrospectively. Etiologies of the acute renal artery hemorrhage were investigated. Laboratory and clinical follow-up information were analyzed for the efficacy and the complication of the treatment. The serum creatinine levels of the patients before and after the procedure were compared. Results: Selective renal artery embolization procedures were performed in a total of 22 patients. Of the 22 patients, 10 (45.5%) were male and 12 (54.5%) were female. The patients' ages ranged from 5 to 79 years, and the mean age of the patients was 51.5±18.6 years. Clinical success was achieved in 91.7% of embolization procedures. A statistically significant increase was seen in the serum creatinine levels of the patients after the procedure compared to 24 hours before the angiography procedure (median: 0.97 vs. 0.93, p=0.046). No significant change was observed in serum blood urea nitrogen and the estimated glomerular filtration rate levels (p=0.338, and p=0.067, respectively). Acute renal failure and postembolization syndrome were observed in only one patient as complications. The complication rate was found to be 4.5%. Conclusion: Selective embolization of the renal artery has high clinical success in acute renal artery hemorrhages without impairing renal function. The treatment has advantages such as no need for general anesthesia, and low complication rates.

Percutaneous cryoablation combined with prior transcatheter arterial embolization for renal cell carcinomas of 3cm or larger: a prospective study.

We prospectively evaluated the safety and efficacy of percutaneous cryoablation combined with transcatheter renal arterial embolization for the treatment of tumors ≥ 3cm in diameter. We included patients aged ≥ 20years with histologically proven renal cell carcinoma with a tumor diameter ≥ 3cm who were inoperable or refused surgery. Prior to ablation, transcatheter arterial embolization was performed using a mixture of absolute ethanol and iodized oil. All cryoablation procedures were performed percutaneously under computed tomography fluoroscopy guidance. The primary endpoint was safety, which was evaluated for adverse events using CTCAE version 4.0. The secondary endpoint was survival; overall survival, progression-free survival, and cancer-specific survival were calculated. From October 2013 to March 2016, 19 patients (mean age, 75 ± 13years; 5 women, 14 men) were prospectively enrolled. The mean tumor diameter was 3.9 ± 0.7 (range 3.1-5.3) cm. Four grade 3 hematologic adverse events occurred, while no symptomatic grade ≥ 3 events occurred. The median follow-up period was 68 (range 52-84) months. During the follow-up period, two patients developedlocal tumor progression at 3 and 42months after the initial ablative procedure; no patient showed distant metastasis. Two patients died from causes other than RCC. Overall survival, progression-free survival, and cause-specific survival were 100%, 95%, and 100% at 3years, and 95%, 84%, and 100% at 5years, respectively. Percutaneous cryoablation combined with prior TAE for the treatment of tumors ≥ 3cm in diameter was safe and achieved favorable survival.

Efficacy and safety of selective renal arterial embolization in renal angiomyolipoma: a prospective single-center study

BackgroundPreventing acute complication of renal angiomyolipoma (AML), preserving renal parenchyma, and improving long-term renal function are the treatment targets of renal angiomyolipoma. Treatment should be considered for symptomatic lesions or those who are at risk of complications, especially bleeding symptoms, which are linked to tumor size, angiogenic component grade, and presence of tuberous sclerosis complex (TSC). Selective arterial embolization (SAE) has become the new norm for preventive or emergency treatment of renal AMLs with minimally invasive selective targeting of small arterial feeders, we aimed to assess the efficacy and safety of selective renal arterial embolization (SAE) in the management of complicated renal angiomyolipoma and to detect the predictors of prophylactic SAE in cases of non-complicated AML.ResultsBleeding symptoms were significantly more frequent in patients with TSC-associated renal AMLs (C = 0.333 and p = 0.036) and patients with intra-lesional aneurysm > 3 mm (C = 0.387 and p = 0.013). Overall success rate: thirty-three (91.7%) renal AMLs were successfully embolized with no recurrence. While three (8.3%) renal AMLs were not; one (2.8%) renal AML was not embolized due to technical failure and two (5.5%) renal AMLs showed recurrence. Primary (technical) success rate: thirty-three (86.9%) successful embolization, five (13.1%) arteriographies were done with failed embolization. The maximum diameter and volume of the lesions after SAE showed statistically significant reduction (z = 4.25 and p < 0.001).ConclusionsSAE is an effective and safe technique to manage renal AMLs preoperatively or in an emergency. TSC-associated lesions, and intra-lesional aneurysms (aneurysms > 3 mm in diameter) were significantly more associated with bleeding symptoms, considering them significant predictors for prophylactic SAE in non-complicated AML.

Renal arterial embolization: Indications, angiographic findings, and outcomes in a series of 170 patients.

The lack of overall experience and reporting on angiographic findings in previously published studies of renal arterial embolization (RAE) compelled us to report our overall experience on a series of patients. A retrospective study was performed analyzing data of patients enrolled for RAE between 2010 and 2019. History, physical examination, and laboratory data were reviewed for all patients. Abdominal ultrasound was the initial imaging study, and all patients underwent subsequent computed tomography or magnetic resonance imaging. The outcome of RAE was determined based on radiographic and clinical findings. Data from 202 patients were analyzed, with a mean age of 45 ± 15 years, and 71.3% of patients were male. Iatrogenic injury was the most common indication for RAE (54%), followed by renal tumors, trauma, and spontaneous, in 27.7%, 10.4%, and 8.4% of patients, respectively. Renal angiography revealing pseudoaneurysm alone or with other pathology in the lower pole of the kidney was the most common finding (40.6%), whereas no lesions were identified on angiography in 32 patients (15.8%), after which RAE was subsequently aborted. Renal arterial embolization was successful in 158 of 170 patients (92.9%) after 1 or more trials (maximum of 4). Microcoil alone or with other embolic materials was the most commonly used material for embolization (85%). Iatrogenic injury was the most common indication for RAE. Pseudoaneurysm alone or with other lesions was the most common lesion on renal angiography; however, angiography showed a negative result in 16% of patients, even those with symptoms. When lesions are present on angiography, the overall success of repeated trials of RAE reached 92.9%.

Development of an enterocutaneous fistula from an intestinal perforation in a patient with autosomal dominant polycystic kidney disease

We herein report a case of enterocutaneous fistula in a patient with autosomal dominant polycystic kidney disease (ADPKD). A 37-year-old Japanese man was admitted to our hospital. Three months prior to transfer to our hospital, he developed intense flank pain with gross hematuria. His serum creatinine had decreased to 7.8 mg/dL and hemodialysis was started, but gross hematuria persisted and he developed hypotension. Upon admission, plain chest radiography did not reveal any free air, but computed tomography (CT) showed generalized ventral subcutaneous air from the head to the lower extremities and enlarged kidneys. Enterography showed leakage of contrast medium from the descending colon into the subcutaneous area. C-reactive protein was 23.1 mg/dL. A colostomy was placed in the transverse colon proximal to the perforation, and systemic subcutaneous drainage was performed. The fever subsequently resolved, and the C-reactive protein test became negative. Three months later, renal artery embolization was performed, and 12 months thereafter, CT showed a marked decrease in kidney size. We assume that a markedly enlarged kidney leaded to intestinal perforation, which developed into an enterocutaneous fistula. Consequently, intestinal fluid leaked into the subcutaneous cavity of the abdominal wall and spread systemically, resulting in extensive subcutaneous abscesses.

Intrarenal pseudoaneurysm after percutaneous nephrolithotomy: a case report

ABSTRACT Background: Percutaneous nephrolithotomy (PNL) is the gold standard to treat large or complex renal stones. Intrarenal pseudoaneurysm is a rare, yet clinically significant, complication of PNL. Case summary: A 58-year-old man with a 3 cm calculus in the lower calyx of the left kidney was operated on by PNL 3 days before presentation to the emergency department. The patient presented with massive hematuria and dizziness. Upon presentation, the patient appeared uncomfortable and in distress. He was in hemorrhagic shock. The patient was resuscitated with intravenous fluids and blood transfusion. An urgent computed tomography scan showed multiple clots in the left renal pelvis and bladder with a retroperitoneal hematoma. The patient underwent angiography which revealed an inferior pole branch pseudoaneurysm. The pseudoaneurysm was treated by endovascular embolization with N-butyl-2-cyanoacrylate. No postoperative complications were seen. Conclusion: Selective renal artery embolization is an effective treatment for pseudoaneurysm post PNL with excellent outcomes.

Abstract No. 57 Hypertension following renal artery embolization for renal angiomyolipoma: a single-center retrospective review

Renal angiomyolipomas (AML) are benign tumors that can grow to considerable size and cause life-threatening hemorrhage. Selective arterial embolization (SAE) is a minimally invasive treatment to devascularize and shrink AMLs. Post-procedural systemic hypertension has not been previously described as a risk of the procedure. Our providers diagnosed post-procedural hypertension in several patients following SAE and sought to determine the incidence in our patient population.

V01-09 URETEROCALICOSTOMY IN TWO PATIENTS WITH MULTIPLE FAILED PYELOPLASTIES

You have accessJournal of UrologyCME1 May 2022V01-09 URETEROCALICOSTOMY IN TWO PATIENTS WITH MULTIPLE FAILED PYELOPLASTIES Michael Gross, Jason Scovell, and Robert Stein Michael GrossMichael Gross More articles by this author , Jason ScovellJason Scovell More articles by this author , and Robert SteinRobert Stein More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002520.09AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Success rates for primary repair of a ureteropelvic junction obstruction (UPJO) are excellent, however recurrent strictures do occur in a subset of patients. Secondary UPJO presents complex and variable surgical challenges and there is no one-size-fits all solution. Ureterocalicostomy, where a healthy segment of ureter is anastomosed to a lower pole calyx, is a reasonable approach as shown in two recent patients. METHODS: Case one is a 25 year old female with a history of left UPJO who underwent primary laparoscopic pyeloplasly followed by endopyelotomy for recurrent UPJO. She additionally experienced severe gross hematuria necessitating embolization of a lower pole branch renal artery. The resulting area of ischemia and parenchymal thinning presented a particularly favorable location for ureterocalicostomy to circumvent her UPJO. This was also felt to be a more anatomic drainage pattern in an otherwise malrotated kidney. The second case is a 31 year old female with UPJO repaired with open pyeloplasty followed by robotic pyeloplasty 13 years later for secondary UPJO who presented with persistent pain and hydronephrosis. This patient was not initially planned for ureterocalicostomy, however the ureter was severely scarred to the lower pole and the more proximal tissue did not appear dissectible or suitable for a buccal mucosal graft and the decision to proceed with ureterocalicostomy was reached intraoperatively. RESULTS: Both patients recovered without complications and experienced symptomatic resolution. Beyond standard principles for dissecting the ureter in pyeloplasty, there is a role for ultrasound in these cases to identify the optimal location for the calicostomy. A nephropexy can also be utilized to reposition the kidney and decrease tension on the anastomosis. Meticulous suturing technique is necessary to ensure apposition of the mucosa to minimize scarring and failure of the repair. CONCLUSIONS: Ureterocalicostomy is a feasible option in select patients and may be an elegant solution to circumvent dense scar tissue and to take advantage of pathologic anatomy. Source of Funding: No source of funding © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e54 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Michael Gross More articles by this author Jason Scovell More articles by this author Robert Stein More articles by this author Expand All Advertisement PDF DownloadLoading ...

Kidney Transplantation in a Patient With Tuberous Sclerosis Complex: A Case Report

Tuberous sclerosis complex (TSC) is a rare autosomal dominant genetic disease caused by mutations of either of 2 genes, TSC1 and TSC2. Renal manifestations include angiomyolipomas (AMLs), multiple cysts, and renal cell carcinoma. AMLs increase bleeding tendency and the risk of renal insufficiency which end-stage develops in 1% of affected patients. A 38-year-old woman suffering from TSC since early childhood has developed multiple complications associated with this disease. The patient was diagnosed with brain tumor-giant cell astrocytoma-which was removed in 1992. In 2006, right nephrectomy was performed due to the unsuccessful right renal artery embolization after the massive hemorrhage into the AML. Moreover, the right idiopathic pneumothorax occurred twice. Therefore, the video-assisted thoracoscopic surgery and pleurodesis were conducted (2006, 2013). The patient is intellectually disabled and unable to make decisions on her own. Her legal guardians (parents) make all decisions associated with her treatment. Diagnostic and therapeutic procedures demanding cooperation were conducted under anesthesia. Because of end-stage renal failure, the patient required the renal replacement therapy (RRT). Preemptive kidney transplantation (KTx) was the best solution for this patient. Procedures such as hemodialysis and peritoneal dialysis were infeasible to perform due to the intellectual disability that inhibits essential cooperation. During KTx qualification tests, the expanding AML with risk of hemorrhage was noticed. The patient was qualified for simultaneous left nephrectomy and KTx from the living donor (her father). The surgery was performed on the 2nd of June 2020. The patient is looked after by her parents, stays in good general condition. The patient's creatinine level is maintained at 0.6 to 0.8 mg/dL. Patients with significant intellectual disability that prevents maintaining conscious cooperation who require RRT must have individually adjusted therapy. In the case of the presented patient, it was decided to perform the preemptive kidney transplantation from her determined father.

Acute pulmonary embolism and severe post thrombolysis renal bleeding, two deadly complications following mini-percutaneous nephrolithotomy: a rare case report

BackgroundAcute pulmonary embolism and severe renal bleeding are two lethal postoperative complications, but there has been no report that involves both of them after mini-percutaneous nephrolithotomy.Case presentationA 62-year-old woman was admitted to our hospital with extremely severe hydronephrosis and multiple right renal calculi. After thorough examination, she received prone-position mini-percutaneous nephrolithotomy under spinal anaesthesia. Three days postoperatively, the patient complained of chest pain and dyspnea. Computed tomography pulmonary angiogram (CTPA) showed multiple embolisms in the left pulmonary artery and its branches. Symptoms were relieved after anticoagulant and thrombolysis therapy. On the 6th postoperative day, the patient developed shortness of breath, computed tomography angiography (CTA) showed massive hemorrhage in the right kidney, diffused contrast medium in the middle and lower part of the right kidney was seen during digital substraction angiography (DSA). Superselective right renal artery embolization (SRAE) was then applied using coil to occlude the responsible artery. The patient generally recovered under conscientious care and was approved to be discharged 26 days postoperatively.ConclusionsThis is the first case that involved both acute pulmonary embolism and severe post thrombolysis renal bleeding. The importance of D-dimer in the prediction and early detection of pulmonary embolism should be noted. For post thrombolysis renal bleeding, SRAE is considered as a reliable treatment.

Percutaneous transcatheter super-selective renal arterial embolization with N-butyl cyanoacrylate for iatrogenic renal hemorrhage

BackgroundTo evaluate the safety and efficacy of percutaneous transcatheter super-selective renal arterial embolization (SRAE) with N-butyl cyanoacrylate (NBCA) for iatrogenic renal hemorrhage. MethodsBetween January 2014 and December 2019, 45 patients (including 18 patients with coagulopathy), who underwent percutaneous transcatheter SRAE with NBCA for iatrogenic renal hemorrhage at our institution, were retrospectively reviewed. The technical success rate, clinical success rate, and embolization-related complications were analyzed. The values of estimated glomerular filtration rate (eGFR), serum creatinine (sCr), and serum urea (sUr) were analyzed at the time of pre-SRAE, post-SRAE, and last follow-up to evaluate the effects of NBCA-based SRAE on renal function. ResultsDiagnostic renal arteriography revealed contrast extravasation in 18 patients and pseudoaneurysms in 27 patients. NBCA mixed with iodized oil in a 1:2–1:4 ratio was the sole embolic agent. No procedure-related mortality or major complications occurred. The technical and clinical success rates were both 100%. The values of eGFR, sCr and sUr were not found to be significantly different between pre-SRAE, post-SRAE and last follow-up (eGFR: 91.52 ​± ​21.17 vs. 90.98 ​± ​22.11 vs. 92.14 ​± ​23.51 ​mL/min/1.73 ​m2, p ​= ​0.729; sCr: 74.73 ​± ​11.08 vs. 75.27 ​± ​12.43 vs. 73.95 ​± ​10.14 ​μmol/L, p ​= ​0.543; sUr: 5.69 ​± ​0.84 vs. 5.71 ​± ​0.96 vs. 5.70 ​± ​0.79, p ​= ​0.515, respectively). ConclusionsPercutaneous transcatheter SRAE with NBCA is a safe and effective treatment modality for iatrogenic renal hemorrhage with no deterioration of renal function.

Use of Microballoon Catheter in Transarterial Ethanol Embolization of Renal Angiomyolipoma: A Retrospective Comparative Study with Historical Control?

Purpose: To clarify the utility of microballoon catheter in renal arterial ethanol embolization of renal angiomyolipoma (AML). Material and Methods: A total of 20 patients (15 women, 5 men) with median age of 45 years (39-60 years) underwent embolization to treat 22 AMLs. A mixture of ethanol and iodized oil was injected into the feeding arteries of 13 tumors using balloon occlusion (the balloon embolization group) with a microballoon catheter and 9 tumors without using balloon occlusion (the non-balloon embolization group). Changes in the maximum tumor diameter, tumor volume, and adverse events were evaluated. Result: The median baseline maximum tumor diameters and volumes were 6.3 cm and 61.4 cm3 in the balloon embolization group, and 4.6 cm and 40.1 cm3 in the non-balloon embolization group, respectively. Tumor enhancement disappeared on postembolization angiography in all cases. All tumors shrunk after embolization. There were no statistically significant differences in the percent decrease in the maximum tumor diameter and volume at 10-12 month between balloon occlusion group (31.5% and 67.9%) and control group (34.8% and 62.6%). Fever was significantly more frequent when balloon occlusion was used: 38% vs. 0% (p = 0.03). No major complication was observed in either patient group. Conclusions: Balloon occlusion may not affect tumor shrinkage when embolizing AMLs with a mixture of ethanol and lipiodol.

Safety and efficacy of Endovascular Management of high-grade blunt renal injury

ObjectivesTo provide data on the safety and efficacy of renal arterial embolization (RAE) in patients with high-grade blunt renal injury. Materials and methodsFifteen patients with high-grade blunt renal injury (AAST grades IV-V) admitted to our hospital from July 2014 to December 2019 were retrospectively reviewed in this study. Their clinical success rate and complications were investigated accordingly. ResultsFifteen patients with high-grade blunt renal injury, 13 men and 2 women with an average age of 41.6 years, including 11 hemodynamically unstable patients and 4 stable patients, were treated with RAE. Among these patients, 73.3% (11 of 15) had grade IV, and 26.7% (4 of 15) had grade V injuries, while 53.3% (8 of 15) patients had concomitant injuries. One patient received main RAE and 14 patients received selective RAE. The clinical success rate after the first embolization was 93.3% (14 of 15). RAE was repeated and was successfully performed in one patient with sustained hematuria. No significant difference in creatinine levels was found before and after embolization. During the follow-up period of 2–82 months, two patients required tube drainage due to urine leaks, one patient developed renal failure requiring renal replacement therapy, and one patient developed secondary hypertension. ConclusionsRAE can provide a high success rate of hemostasis for both hemodynamically stable and unstable patients with high-grade blunt renal injury, and only minor complications are observed with this procedure.

Rescue acute pain treatment after renal artery embolization using erector spinae plane (ESP) block.

Rescue acute pain treatment after renal artery embolization using erector spinae plane (ESP) block.

Volume preservation of a shattered kidney after blunt trauma by superselective renal artery embolization.

PURPOSE We examined whether superselective embolization of the renal artery could be effectively employed to preserve traumatic kidneys and assessed its clinical outcomes. METHODS Between December 2015 and November 2019, 26 patients who had American Association for the Surgery of Trauma grade V traumatic shattered kidneys were identified. Among them, a retrospective review was conducted of 16 patients who underwent superselective renal artery embolization for shattered kidney. The mean age was 41.2 ± 15.7 years, and the mean follow-up duration was 138.2 ± 140.1 days. Patient data including procedure details and clinical outcomes were reviewed, and the preserved volume of kidney parenchyma was calculated. RESULTS Bleeding control was achieved in 13 (81%) patients and kidney preservation was achieved in 11 (79%). There was no mortality, and the median intensive care unit stay was 1.5 days. The mean volume of remnant kidney was 122.3 ± 66.0 cm3 (70%) on the last follow-up computed tomography. The estimated glomerular filtration rate was not significantly changed after superselective renal artery embolization. CONCLUSION Superselective renal artery embolization using a microcatheter for the shattered kidney effectively controlled hemorrhage in acute stage trauma and enabled kidney preservation.

Safety and Efficacy of Angio-embolization for Complex Renal Cell Carcinoma and Angiomyolipoma: Experience and Results in 20 Patients

<i>Objective:</i> To evaluate the efficacy and safety of renal artery embolization in treatment of complex angiomyolipoma and renal cell carcinoma. <i>Patients and Methods: </i>Twenty patients were included in this study, 11 patients with primary renal cell carcinoma and 9 patients with AML. These patients were examined by US, CT or and MRI before RAE to evaluate size of the tumor, assess extension of renal cell carcinoma, exclude distant metastasis and assess the complications of angiomyolipoma. Renal artery embolization yield, complications and the impact of patient`s management were analyzed. <i>Results</i>: This study included 20 patients (12 males and 8 females). The age range was 17-75 (47.8±15.5) years. The type of renal masses were renal cell carcinoma in 11 patients and angiomyolipoma in 9 patients (5 bilateral and 4 unilateral). According to the modified Clavien system, 4 patients developed Grade I complication (3 patients developed flank pain (15%) treated with oral analgesics and 1 patient (5%) developed self-limiting perinephric hematoma which resolved spontaneously under antibiotic coverage. <i>Conclusion: </i>RAE is a safe, effective and well tolerated treatment of AML either if large sized which is liable to rupture or symptomatic to stop bleeding. Also, it allows preoperative de-vascularization of RCC to facilitate its surgical resection and as palliative treatment if RCC is un-resectable or metastatic.

No effect of desmopressin administration before kidney biopsy on the risk of major post-biopsy bleeding

Background/AimsThe most important complication of kidney biopsy is bleeding, and it is unclear whether desmopressin is effective in preventing it. Thus, the study was conducted to compare post-biopsy bleeding with or without desmopressin prescription prior to percutaneous kidney biopsy. MethodsIn this single-centered, retrospective, and observational study, 3,018 adult patients who underwent kidney biopsy between January 1, 2003 and March 31, 2019 at our institute were recruited. Of these, 776 patients received desmopressin. To compare the differences in major bleeding events between patients administered and not administered with desmopressin, propensity score matching was performed. ResultsBefore propensity score (PS) matching, it was observed that patients in the desmopressin group were significantly older (p<0.001) and had a higher blood pressure (p<0.001), higher serum creatinine (p<0.001), lower hemoglobin levels (p<0.001), and lower platelet counts (p=0.001) than those in the no-desmopressin group. Furthermore, the incidence of renal artery embolization was not significantly different between the two groups (p=0.077); however, blood transfusions occurred significantly more frequently in the desmopressin group (p<0.001). A comparison of the two groups after PS matching did not reveal any differences in the incidence of renal artery embolization (p=0.341), blood transfusion (p=0.579), and total major bleeding events (p=0.442). Furthermore, there was no difference in the incidence of perinephric hematoma on computed tomography or ultrasound (p=0.120). ConclusionsWe do not recommend desmopressin administration before kidney biopsy.

Safety and Effectiveness of Medical Therapy and Surgical Intervention for Renal Angiomyolipoma Associated With Tuberous Sclerosis Complex.

Our study aimed to evaluate the effect of daily oral dose of everolimus in the treatment of patients with tuberous sclerosis complex (TSC) associated with renal angiomyolipoma (RAML), and the feasibility and safety of surgical treatment approach. We retrospectively investigated a total of 13 patients diagnosed of TSC-associated renal angiomyolipoma (TSC-RAML) who were scheduled for everolimus therapy. At 3-9 months after starting everolimus therapy, 4 of the study patients were symptomatic and underwent partial renal resection surgery. Two of these surgeries were performed open nephron sparing surgery (NSS) after TAE (Trans-arterial embolization), while the remaining 2 underwent robot-assisted partial nephrectomy (RAPN). A multi-slice helical CT scan performed among all the patients every 3months, which was used to measure the volume and the density of the lesion. Follow-up CT images revealed a significant reduction (P < .05) in the RAML volume, at a rate ranging from 11.6 to 42.5%, in response to everolimus therapy (10mg/day) in TSC-RAML patients. Further, a significant decrease in the mean tumor density (P < .05), as compared to its baseline value, was also observed. Super-selective renal arterial embolization done prior to NSS was effective in reducing the intraoperative bleeding and stabilizing the patient during the NSS procedure: mean warm ischemia time was 29.5minutes (range 18-40minutes) and mean intraoperative bleeding volume was 275mL (range 200-350mL). Post-surgical (both NSS and RAPN) follow-up showed a favorable perioperative morbidity profile with good renal functional preservation. At the end of 2years, all patients were well, with no signs of progression or recurrence of the condition, and demonstrated normal renal function. The results suggested oral everolimus as an effective non-invasive therapy to treat TSC-RAML patients. Post mTOR inhibitor therapy, NSS and RAPN are preferred mode of surgical intervention in symptomatic patients. TAE prior to NSS is beneficial.

SUPERSELECTIVE EMBOLIZATION OF THE RENAL ARTERIES AS A MONOTHERAPY OF KIDNEY TUMOR IN A PATIENT WITH HIGH ANESTHESIOLOGIC RISK

Introduction: Renal artery embolization is a minimally invasive X-ray endovascular operation that is used in the treatment of various urological diseases. This operation is of increasing interest due to its ability to occlude not only proximal, but also distal renal vessels with a low risk of complications. Recent developments in endovascular technology make embolization one of the effective and safe methods applicable to stop renal bleeding, preoperative preparation for surgical treatment of renal malignant tumors, and first-line treatment for angiomyolipomas. For a certain category of patients, renal artery embolization is practically no alternative method of treatment. This applies to comorbid patients with kidney tumors and aggravated somatic status, in whom the anesthetic risk makes open or laparoscopic surgical treatment impossible, and embolization can reduce symptoms, improve the quality of life of such patients and prolong the patient's life.Clinical case: we demonstrate the experience of X-ray surgical treatment of cT1aN0M0 left kidney cancer in an 80-year-old patient.Conclusion: Embolization of renal arteries in some cases can be an effective and safe alternative treatment for renal cell carcinoma in somatically burdened patients who cannot perform surgical treatment.