Embolização arterial superseletiva para tratamento de angiomiolipoma em paciente com rim único

Abstract

Abstract: The authors report on a case of a young woman who had previously undergone a right nephrectomy due to renal angiomyolipomas, currently presenting voluminous angiomyolipomas of the remaining kidney. The patient’s urologist referred her for endovascular treatment. Superselective arterial embolization of one tumor (located at the inferior renal pole), was conducted successfully. Several attempts at selective catheterization were made to embolize the second angiomyolipoma (located at the superior lobe), without jeopardizing a significant amount of the surrounding renal parenchyma, but this ultimately proved not to be feasible. The procedure and recovery were uneventful. The patient was discharged on the first postoperative day and has been followed for 9 months with no complications. The authors provide a brief review of the indications, technical aspects and complications of endovascular treatment of renal angiomyolipomas and also discuss the advantages of the endovascular approach over surgical resection for this kind of tumor.

Figura 1. Reconstrução da tomografia computadorizada para planejamento do tratamento endovascular. As pontas das setas apontam os dois maiores tumores, localizados nos polos renais superior e inferior; a seta aponta o pedículo arterial associado a vascularização do tumor localizado no polo inferior. Notar a ausência do rim direito pela nefrectomia prévia.

Figura 2. (A) Arteriografia renal seletiva pré-embolização; as setas apontam os tumores-alvo para a embolização. (B) Arteriografia superseletiva do pedículo nutridor do tumor localizado no polo renal inferior. (C) Arteriografia renal seletiva pós-embolização; as pontas das setas apontam a projeção do tumor no polo renal inferior (já embolizado), e as setas apontam o tumor localizado no polo renal superior (não embolizado); observar a preservação do parênquima renal adjacente ao tumor embolizado.

Figure 1. Reconstruction from the computed tomography executed for planning of endovascular treatment. The arrowheads indicate the two larger tumors, located at the upper and lower poles of the kidney; the arrow indicates the arterial pedicle associated with vascularization of the lower pole tumor. Note the absence of the right kidney due to the previous nephrectomy.

Figure 2. (A) Selective arteriography of the kidney prior to embolization; the arrows indicate the target tumors for embolization. (B) Superselective arteriography of the pedicle feeding the tumor at the lower pole of the kidney. (C) Selective renal arteriography after embolization; the arrowheads indicate the projection of the lower pole tumor (already embolized), and the arrows indicate the upper pole tumor (which was not embolized); observe the preserved renal parenchyma adjacent to the embolized tumor.