Angiomyolipoma surgery

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [2] Associate Editor(s)-in-Chief: Faizan Sheraz, M.D. [3],Rekha, M.D.

Overview

Surgery is not the first-line treatment option for patients with angiomyolipoma. Transcatheter arterial embolization is usually reserved for patients with complicated disease.

Surgery

Angiomyolipoma do not normally require surgery unless there is life-threatening bleeding.^[1]

Transcatheter Arterial Embolization

Embolisation is considered as a safe and effective method for treating patients with Angiomyolipoma. Recently, it has been recommended that prophylactic trans-catheter arterial embolization can be performed in case of large angiomyolipoma that is greater than 4 cm in size.^[2]^[3]

Proximal Embolization
- These are appropriate for the occlusion of a large lumen without distal migration
Distal Embolization
- These are appropriate for the occlusion of a large lumen with distal migration
Palliative Embolization
- Embolization in patients with end-stage renal disease

A
B
C
D

Figures A-D: Angiographic runs showed a significantly ptosed right kidney, with supply to the large upper pole angiomyolipoma via tortuous artery arising from the superior division of the right renal artery.^[4]

Embolization Procedure

Selective catheterization of the branch supplying the angiomyolipoma is achieved via microcatheter
Contrast is infused
Embolization is usually performed using a 50:50 dilution of absolute alcohol in lipiodol
A total of 12 mL is injected under careful angiographic observation to ensure no reflux to vessels supplying renal cortex

Partial Nephrectomy

Larger, symptomatic and ruptured angiomyolipomas, can be electively resected with a partial nephrectomy, with the advantage of a kidney preservation and the benefits of a minimal invasive procedure without compromising the safety of the patient^[5]
It has been shown that the pretreatment with the sirolimus an mTOR inhibitor facilitates the nephron sparing resection by reducing the tumor volume by 38-95%.^[6]

Complete Nephrectomy:

Complete nephrectomy is usually considered in cases where risk of development of the urinary fistula and of hemorrhage is high after partial nephrectomy.

Radiofrequency Ablation or Cryoablation:

It is considered to be safe and effective alternative to embloization and nephron sparing surgery, used in the treatment of renal masses <3 cm or smaller without bleeding complications.^[7]^[8]^[9]^[10]

References

↑ Lewis JH, Weingold AB (1985). “The use of gastrointestinal drugs during pregnancy and lactation”. Am J Gastroenterol. 80 (11): 912–23. PMID 2864852.
↑ Ryan JW, Farrelly C, Geoghegan T (2018). “What Are the Indications for Prophylactic Embolization of Renal Angiomyolipomas? A Review of the Current Evidence in the Literature”. Can Assoc Radiol J. 69 (3): 236–239. doi:10.1016/j.carj.2018.01.002. PMID 29804911.
↑ Leong S, Keeling AN, McGrath FP, Lee MJ (2010). “Transcatheter embolisation of renal angiomyolipoma”. Ir J Med Sci. 179 (2): 211–6. doi:10.1007/s11845-009-0390-9. PMID 19618235.
↑ Image courtesy of Dr. Andrew Lawson. Radiopaedia(original file [1]). Creative Commons BY-SA-NC
↑ Ploumidis A, Katafigiotis I, Thanou M, Bodozoglou N, Athanasiou L, Ploumidis A (2013). “Spontaneous Retroperitoneal Hemorrhage (Wunderlich Syndrome) due to Large Upper Pole Renal Angiomyolipoma: Does Robotic-Assisted Laparoscopic Partial Nephrectomy Have a Role in Primary Treatment?”. Case Rep Urol. 2013: 498694. doi:10.1155/2013/498694. PMC 3784227. PMID 24106637.
↑ Staehler M, Sauter M, Helck A, Linsenmaier U, Weber L, Mayer K; et al. (2012). “Nephron-sparing resection of angiomyolipoma after sirolimus pretreatment in patients with tuberous sclerosis”. Int Urol Nephrol. 44 (6): 1657–61. doi:10.1007/s11255-012-0292-z. PMID 23054313.
↑ Atwell TD, Schmit GD, Boorjian SA, Mandrekar J, Kurup AN, Weisbrod AJ; et al. (2013). “Percutaneous ablation of renal masses measuring 3.0 cm and smaller: comparative local control and complications after radiofrequency ablation and cryoablation”. AJR Am J Roentgenol. 200 (2): 461–6. doi:10.2214/AJR.12.8618. PMID 23345372.
↑ Sooriakumaran P, Gibbs P, Coughlin G, Attard V, Elmslie F, Kingswood C; et al. (2010). “Angiomyolipomata: challenges, solutions, and future prospects based on over 100 cases treated”. BJU Int. 105 (1): 101–6. doi:10.1111/j.1464-410X.2009.08649.x. PMID 19493268.
↑ Prevoo W, van den Munckhof MP, Meinhardt W, Horenblas S, van den Bosch MA (2010). “Radiofrequency ablation of kidney tumours in patients with a solitary kidney”. Clin Radiol. 65 (3): 230–6. doi:10.1016/j.crad.2009.11.007. PMID 20152280.
↑ Castle SM, Gorbatiy V, Ekwenna O, Young E, Leveillee RJ (2012). “Radiofrequency ablation (RFA) therapy for renal angiomyolipoma (AML): an alternative to angio-embolization and nephron-sparing surgery”. BJU Int. 109 (3): 384–7. doi:10.1111/j.1464-410X.2011.10376.x. PMID 22176671.

Template:WikiDoc Sources

[pmid2864852-1] Lewis JH, Weingold AB (1985). “The use of gastrointestinal drugs during pregnancy and lactation”. Am J Gastroenterol. 80 (11): 912–23. PMID 2864852.

[pmid29804911-2] Ryan JW, Farrelly C, Geoghegan T (2018). “What Are the Indications for Prophylactic Embolization of Renal Angiomyolipomas? A Review of the Current Evidence in the Literature”. Can Assoc Radiol J. 69 (3): 236–239. doi:10.1016/j.carj.2018.01.002. PMID 29804911.

[pmid19618235-3] Leong S, Keeling AN, McGrath FP, Lee MJ (2010). “Transcatheter embolisation of renal angiomyolipoma”. Ir J Med Sci. 179 (2): 211–6. doi:10.1007/s11845-009-0390-9. PMID 19618235.

[radio-4] Image courtesy of Dr. Andrew Lawson. Radiopaedia(original file [1]). Creative Commons BY-SA-NC

[pmid24106637-5] Ploumidis A, Katafigiotis I, Thanou M, Bodozoglou N, Athanasiou L, Ploumidis A (2013). “Spontaneous Retroperitoneal Hemorrhage (Wunderlich Syndrome) due to Large Upper Pole Renal Angiomyolipoma: Does Robotic-Assisted Laparoscopic Partial Nephrectomy Have a Role in Primary Treatment?”. Case Rep Urol. 2013: 498694. doi:10.1155/2013/498694. PMC 3784227. PMID 24106637.

[pmid23054313-6] Staehler M, Sauter M, Helck A, Linsenmaier U, Weber L, Mayer K; et al. (2012). “Nephron-sparing resection of angiomyolipoma after sirolimus pretreatment in patients with tuberous sclerosis”. Int Urol Nephrol. 44 (6): 1657–61. doi:10.1007/s11255-012-0292-z. PMID 23054313.

[pmid23345372-7] Atwell TD, Schmit GD, Boorjian SA, Mandrekar J, Kurup AN, Weisbrod AJ; et al. (2013). “Percutaneous ablation of renal masses measuring 3.0 cm and smaller: comparative local control and complications after radiofrequency ablation and cryoablation”. AJR Am J Roentgenol. 200 (2): 461–6. doi:10.2214/AJR.12.8618. PMID 23345372.

[pmid19493268-8] Sooriakumaran P, Gibbs P, Coughlin G, Attard V, Elmslie F, Kingswood C; et al. (2010). “Angiomyolipomata: challenges, solutions, and future prospects based on over 100 cases treated”. BJU Int. 105 (1): 101–6. doi:10.1111/j.1464-410X.2009.08649.x. PMID 19493268.

[pmid20152280-9] Prevoo W, van den Munckhof MP, Meinhardt W, Horenblas S, van den Bosch MA (2010). “Radiofrequency ablation of kidney tumours in patients with a solitary kidney”. Clin Radiol. 65 (3): 230–6. doi:10.1016/j.crad.2009.11.007. PMID 20152280.

[pmid22176671-10] Castle SM, Gorbatiy V, Ekwenna O, Young E, Leveillee RJ (2012). “Radiofrequency ablation (RFA) therapy for renal angiomyolipoma (AML): an alternative to angio-embolization and nephron-sparing surgery”. BJU Int. 109 (3): 384–7. doi:10.1111/j.1464-410X.2011.10376.x. PMID 22176671.

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