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Case Reports
. 2022 Oct 11:9:955932.
doi: 10.3389/fsurg.2022.955932. eCollection 2022.

Case report: A hybrid technique for a safe nephrectomy in a giant kidney angiomyolipoma

Vincenzo Vento  1 , Andrea Benedetto Galosi  2   3 , Andrea Ranghino  4 , Luca Montecchiani  1 , Luca Felici  1 , Silvia Loggi  5 , Elisabetta Cerutti  5 , Giulio Milanese  2   3 , Carmine Franzese  2   3 , Daniele Castellani  2   3 , Emanuele Gatta  1
Affiliations
Case Reports

Case report: A hybrid technique for a safe nephrectomy in a giant kidney angiomyolipoma

Vincenzo Vento et al. Front Surg. .

Abstract

Background: Giant angiomyolipoma is usually associated with genetic syndromes and complications (spontaneous rupture and bleeding, hematuria, hypertension) and mass-related symptoms (flank and abdominal pain).

Case presentation: We present a case of a 20-year-old woman suffering from tuberous sclerosis who was referred to our hospital with a giant angiomyolipoma causing abdominal pain. A contrast-enhanced computed tomography showed a left angiomyolipoma, measuring 28 cm × 17 cm × 27 cm. After a multidisciplinary team discussion, the patient was submitted for a nephrectomy. Percutaneous temporary occlusion of the main renal artery was achieved through an endovascular balloon catheter. Through the balloon catheter guidewire, 2,500 IU of heparin was infused to reduce the risk of tumor vein thrombosis and venous embolism. This allowed a safe kidney manipulation through a left thoracoabdominal approach. The postoperative course was uneventful. Pathology showed a 40 cm × 30 cm × 9 cm and 10 kg AML. One year after surgery, the patient is on follow-up, and her estimated glomerular filtration is 120.5 ml/min/1.73 m2.

Conclusion: The present case showed that the endovascular control of the main renal artery could be considered a useful approach to safely managing huge renal masses when renal hilar control is expected to be very difficult.

Keywords: angiomyolipoma; endovascular procedures; nephrectomy; rare diseases; tuberous sclerosis.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The handling editor declared a past co-authorship with one of the authors (DC).

Figures

Figure 1
Figure 1
Preoperative contrast-enhanced computed tomography of the abdomen: (A) axial plane (red arrow: right renal angiomyolipoma); and (B) sagittal plane.
Figure 2
Figure 2
(A) Intraoperative left renal artery angiography (red arrow: main renal artery). (B) Endovascular clamping of the left renal artery (endovascular balloon occluding the main renal artery).
Figure 3
Figure 3
(A) Left thoraco-phreno-laparotomy. (B) Surgical specimen.
Figure 4
Figure 4
Postoperative contrast-enhanced computed tomography of the abdomen: (A) axial plane; (B) sagittal plane.
See this image and copyright information in PMC

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