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. 2011 Dec;28(4):396-406.
doi: 10.1055/s-0031-1296082.

Renal artery embolization

Steven Sauk  1 , Darryl A Zuckerman
Affiliations

Renal artery embolization

Steven Sauk et al. Semin Intervent Radiol. 2011 Dec.

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; hemorrhage; interventional radiology; kidney; renal artery.

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Figures

Figure 1
Figure 1
Classic renal artery anatomy.
Figure 2
Figure 2
(A) Computed tomography in a patient with nonresectable renal cell carcinoma presenting with intractable hematuria. (B) Initial renal arteriogram shows a vascular mass occupying much of the kidney and a focus of what was felt to be either active bleeding or a small intratumoral aneurysm. (C) Postembolization shows successful devascularization of part of the kidney; to reduce the risk of severe postembolization syndrome, it was elected to treat only part of the tumor on the initial presentation.
Figure 3
Figure 3
Angiomyolipoma, with the patient presenting with hematuria. (A) Computed tomography shows an angiomyolipoma (AML) in the upper pole; note the bilateral masses typical of a patient with tuberous sclerosis. The patient has had embolization of other renal tumors in the past. (B) initial diagnostic arteriogram (early phase); (C) initial diagnostic arteriogram (later phase). (D) Postrenal artery embolization arteriogram shows successful devascularization of the AML. The agent used was a mixture of alcohol and Ethiodol.
Figure 4
Figure 4
(A) Renal pseudoaneurysm seen by color Doppler ultrasound following a percutaneous biopsy; the patient presented with left flank pain but no hematuria. (B) A diagnostic left renal arteriogram shows a lobular pseudoaneurysm in the lower pole (C) following embolization; the aneurysm has been excluded from the circulation, leaving most of the remaining parenchyma intact.
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