Renal angiomyolipoma: embolotherapy with a mixture of alcohol and iodized oil

Abstract

Purpose: To evaluate the efficacy of superselective embolotherapy of renal angiomyolipomas with a 1:3 mixture of iodized oil and absolute ethanol as embolic material.

Materials and methods: Fifteen patients with 21 symptomatic renal angiomyolipomas were treated with embolization. The sizes of tumors ranged from 6 cm to 15 cm (mean, 8.6 cm). Six of 15 patients were diagnosed with tuberous sclerosis. The diagnoses of renal angiomyolipoma were made from characteristic computed tomographic findings. All angiomyolipomas were successfully embolized with a 1:3 mixture of iodized oil and absolute ethanol (2-20 mL; mean, 8.5 mL). Patients were followed up from 5 months to 8 years (mean, 35.6 months). The efficacy of embolotherapy was evaluated by symptom-free period, immediate and late complications, and follow-up imaging findings, including changes in tumor size.

Results: Thirteen patients showed no symptom recurrence during follow-up periods from 3 months to 8 years. Two patients with incomplete embolization required repeated embolization because of the recurrence of perinephric hematoma or other symptoms. Twelve patients experienced mild postembolization syndrome, which subsided with conservative management. A moderate amount of pleural effusion developed in one patient and was managed with percutaneous drainage. No patients developed any severe late complications, hypertension, or renal failure. During the follow-up period, 12 tumors decreased in size, whereas there was no change in eight tumors, and in one tumor imaging follow-up was not available.

Conclusion: Embolization with a 1:3 mixture of iodized oil and absolute ethanol is an effective method of treatment in renal angiomyolipoma with favorable results. But incomplete embolization of angiomyolipoma results in a high incidence of recurrent symptoms due to bleeding.