Transcatheter renal artery embolization: clinical applications and techniques

Abstract

Renal artery embolization is a minimally invasive procedure that is increasingly being used for treatment of a wide range of conditions. The main indications for renal artery embolization include (1) prenephrectomy and preradiofrequency ablation infarction of renal tumors, (2) management of renal angiomyolipomas, (3) palliations of unresectable renal malignancy, (4) renal hemorrhage (life-threatening or chronic debilitating hematuria), (5) arteriovenous fistulas, (6) vascular malformations, (7) renal artery aneurysms and pseudoaneurysms, and other less common indications, such as severe hydronephrosis and hypertension. A variety of embolic materials are available, such as metal coils, sclerosants (glue, Onyx, absolute ethanol, lipiodol), and particulate embolic agents (polyvinyl alcohol particles and embospheres). Selection of the appropriate agent depends on the clinical application, technical and clinical endpoints, as well as the pathology lesion(s) targeted. Renal artery embolization can be performed alone or in combination with remodeling techniques, stent-grafting, and balloon- or stent-assisted coiling in more complicated cases. The procedure is generally regarded as safe and effective for diverse applications and is considered as an evolving area in the field of endoluminal therapy.