Angiomyolipoma surgery: Difference between revisions
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__NOTOC__ | __NOTOC__ | ||
{{Angiomyolipoma}} | {{Angiomyolipoma}} | ||
{{CMG}} {{AE}}{{Faizan}} | {{CMG}} {{AE}}{{Faizan}},{{Rekha}} | ||
==Overview== | ==Overview== | ||
Surgery is not the first-line treatment option for patients with angiomyolipoma. Transcatheter arterial embolization is usually reserved for patients with complicated disease. | [[Surgery]] is not the first-line treatment option for patients with [[angiomyolipoma]]. [[Transcatheter arterial chemoembolization|Transcatheter]] arterial embolization is usually reserved for patients with complicated disease. | ||
==Surgery== | ==Surgery== | ||
Angiomyolipoma do not normally require surgery unless there is life-threatening bleeding. | [[Angiomyolipoma]] do not normally require [[surgery]] unless there is life-threatening bleeding.<ref name="pmid2864852">{{cite journal| author=Lewis JH, Weingold AB| title=The use of gastrointestinal drugs during pregnancy and lactation. | journal=Am J Gastroenterol | year= 1985 | volume= 80 | issue= 11 | pages= 912-23 | pmid=2864852 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2864852 }} </ref> | ||
===Transcatheter Arterial Embolization=== | ===Transcatheter Arterial Embolization=== | ||
*Proximal [[Embolization]] | [[Embolisation]] is considered as a safe and effective method for treating patients with [[Angiomyolipoma]]. Recently, it has been recommended that [[prophylactic]] trans-catheter arterial [[embolization]] can be performed in case of large [[angiomyolipoma]] that is greater than 4 cm in size.<ref name="pmid29804911">{{cite journal| author=Ryan JW, Farrelly C, Geoghegan T| title=What Are the Indications for Prophylactic Embolization of Renal Angiomyolipomas? A Review of the Current Evidence in the Literature. | journal=Can Assoc Radiol J | year= 2018 | volume= 69 | issue= 3 | pages= 236-239 | pmid=29804911 | doi=10.1016/j.carj.2018.01.002 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29804911 }}</ref><ref name="pmid19618235">{{cite journal| author=Leong S, Keeling AN, McGrath FP, Lee MJ| title=Transcatheter embolisation of renal angiomyolipoma. | journal=Ir J Med Sci | year= 2010 | volume= 179 | issue= 2 | pages= 211-6 | pmid=19618235 | doi=10.1007/s11845-009-0390-9 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19618235 }}</ref> | ||
**These are appropriate for the occlusion of a large lumen without distal migration | |||
*Distal Embolization | *[[Proximal]] [[Embolization]] | ||
**These are appropriate for the [[occlusion]] of a large [[lumen]] without distal migration | |||
*[[Distal]] [[Embolization]] | |||
**These are appropriate for the [[occlusion]] of a large lumen with distal migration | **These are appropriate for the [[occlusion]] of a large lumen with distal migration | ||
*Palliative Embolization | *[[Palliative]] [[Embolization]] | ||
**Embolization in patients with end-stage renal disease | **[[Embolization]] in patients with [[end-stage renal disease]] | ||
<gallery | <gallery widths="200" class="center" mode="packed-hover"> | ||
Renal-angiomyolipoma- | File:Renal-angiomyolipoma-8 (1).jpg|A | ||
File:Renal-angiomyolipoma-8 (2).jpg|B | |||
File:Renal-angiomyolipoma-8 (3).jpg|C | |||
File:Renal-angiomyolipoma-8 (4).jpg|D | |||
</gallery> | </gallery> | ||
*'''Figures A-D: '''Angiographic runs showed a significantly ptosed right [[kidney]], with supply to the large upper pole [[angiomyolipoma]] via tortuous artery arising from the superior division of the right [[renal artery]].<ref name="radio">Image courtesy of Dr. Andrew Lawson. [http://www.radiopaedia.org Radiopaedia](original file [http://radiopaedia.org/cases/renal-angiomyolipoma-8]). [http://radiopaedia.org/licence Creative Commons BY-SA-NC]</ref> | |||
'''Embolization Procedure''' | '''Embolization Procedure''' | ||
*Selective [[catheterization]] of the branch supplying the angiomyolipoma is achieved via microcatheter | *Selective [[catheterization]] of the branch supplying the [[angiomyolipoma]] is achieved via microcatheter | ||
*Contrast is infused | *Contrast is infused | ||
*Embolization is usually performed using a 50:50 dilution of absolute alcohol in lipiodol | *[[Embolization]] is usually performed using a 50:50 dilution of absolute [[alcohol]] in lipiodol | ||
*A total of 12 mL is injected under careful angiographic observation to ensure no reflux to vessels supplying [[renal cortex]] | *A total of 12 mL is injected under careful angiographic observation to ensure no reflux to vessels supplying [[renal cortex]] | ||
===Partial Nephrectomy=== | ===Partial Nephrectomy=== | ||
Larger | |||
* Larger, symptomatic and ruptured angiomyolipomas, can be electively resected with a [[partial nephrectomy]], with the advantage of a kidney preservation and the benefits of a minimal [[invasive]] procedure without compromising the safety of the patient<ref name="pmid24106637">{{cite journal| author=Ploumidis A, Katafigiotis I, Thanou M, Bodozoglou N, Athanasiou L, Ploumidis A| title=Spontaneous Retroperitoneal Hemorrhage (Wunderlich Syndrome) due to Large Upper Pole Renal Angiomyolipoma: Does Robotic-Assisted Laparoscopic Partial Nephrectomy Have a Role in Primary Treatment? | journal=Case Rep Urol | year= 2013 | volume= 2013 | issue= | pages= 498694 | pmid=24106637 | doi=10.1155/2013/498694 | pmc=3784227 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24106637 }}</ref> | |||
* It has been shown that the pretreatment with the sirolimus an [[mTOR]] inhibitor facilitates the nephron sparing resection by reducing the tumor volume by 38-95%.<ref name="pmid23054313">{{cite journal| author=Staehler M, Sauter M, Helck A, Linsenmaier U, Weber L, Mayer K et al.| title=Nephron-sparing resection of angiomyolipoma after sirolimus pretreatment in patients with tuberous sclerosis. | journal=Int Urol Nephrol | year= 2012 | volume= 44 | issue= 6 | pages= 1657-61 | pmid=23054313 | doi=10.1007/s11255-012-0292-z | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23054313 }}</ref> | |||
=== Complete Nephrectomy: === | |||
* Complete [[nephrectomy]] is usually considered in cases where risk of development of the urinary fistula and of [[hemorrhage]] is high after partial [[nephrectomy]]. | |||
=== Radiofrequency Ablation or Cryoablation: === | |||
* It is considered to be safe and effective alternative to embloization and [[nephron]] sparing [[surgery]], used in the treatment of renal masses <3 cm or smaller without bleeding [[complications]].<ref name="pmid23345372">{{cite journal| author=Atwell TD, Schmit GD, Boorjian SA, Mandrekar J, Kurup AN, Weisbrod AJ et al.| title=Percutaneous ablation of renal masses measuring 3.0 cm and smaller: comparative local control and complications after radiofrequency ablation and cryoablation. | journal=AJR Am J Roentgenol | year= 2013 | volume= 200 | issue= 2 | pages= 461-6 | pmid=23345372 | doi=10.2214/AJR.12.8618 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23345372 }}</ref><ref name="pmid19493268">{{cite journal| author=Sooriakumaran P, Gibbs P, Coughlin G, Attard V, Elmslie F, Kingswood C et al.| title=Angiomyolipomata: challenges, solutions, and future prospects based on over 100 cases treated. | journal=BJU Int | year= 2010 | volume= 105 | issue= 1 | pages= 101-6 | pmid=19493268 | doi=10.1111/j.1464-410X.2009.08649.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19493268 }}</ref><ref name="pmid20152280">{{cite journal| author=Prevoo W, van den Munckhof MP, Meinhardt W, Horenblas S, van den Bosch MA| title=Radiofrequency ablation of kidney tumours in patients with a solitary kidney. | journal=Clin Radiol | year= 2010 | volume= 65 | issue= 3 | pages= 230-6 | pmid=20152280 | doi=10.1016/j.crad.2009.11.007 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20152280 }}</ref><ref name="pmid22176671">{{cite journal| author=Castle SM, Gorbatiy V, Ekwenna O, Young E, Leveillee RJ| title=Radiofrequency ablation (RFA) therapy for renal angiomyolipoma (AML): an alternative to angio-embolization and nephron-sparing surgery. | journal=BJU Int | year= 2012 | volume= 109 | issue= 3 | pages= 384-7 | pmid=22176671 | doi=10.1111/j.1464-410X.2011.10376.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22176671 }}</ref> | |||
==References== | ==References== | ||
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [2] Associate Editor(s)-in-Chief: Faizan Sheraz, M.D. [3],Rekha, M.D.
Overview
Surgery is not the first-line treatment option for patients with angiomyolipoma. Transcatheter arterial embolization is usually reserved for patients with complicated disease.
Surgery
Angiomyolipoma do not normally require surgery unless there is life-threatening bleeding.[1]
Transcatheter Arterial Embolization
Embolisation is considered as a safe and effective method for treating patients with Angiomyolipoma. Recently, it has been recommended that prophylactic trans-catheter arterial embolization can be performed in case of large angiomyolipoma that is greater than 4 cm in size.[2][3]
- Proximal Embolization
- Distal Embolization
- These are appropriate for the occlusion of a large lumen with distal migration
- Palliative Embolization
- Embolization in patients with end-stage renal disease
-
A
-
B
-
C
-
D
.jpg)
.jpg)
.jpg)
.jpg)
- Figures A-D: Angiographic runs showed a significantly ptosed right kidney, with supply to the large upper pole angiomyolipoma via tortuous artery arising from the superior division of the right renal artery.[4]
Embolization Procedure
- Selective catheterization of the branch supplying the angiomyolipoma is achieved via microcatheter
- Contrast is infused
- Embolization is usually performed using a 50:50 dilution of absolute alcohol in lipiodol
- A total of 12 mL is injected under careful angiographic observation to ensure no reflux to vessels supplying renal cortex
Partial Nephrectomy
- Larger, symptomatic and ruptured angiomyolipomas, can be electively resected with a partial nephrectomy, with the advantage of a kidney preservation and the benefits of a minimal invasive procedure without compromising the safety of the patient[5]
- It has been shown that the pretreatment with the sirolimus an mTOR inhibitor facilitates the nephron sparing resection by reducing the tumor volume by 38-95%.[6]
Complete Nephrectomy:
- Complete nephrectomy is usually considered in cases where risk of development of the urinary fistula and of hemorrhage is high after partial nephrectomy.
Radiofrequency Ablation or Cryoablation:
- It is considered to be safe and effective alternative to embloization and nephron sparing surgery, used in the treatment of renal masses <3 cm or smaller without bleeding complications.[7][8][9][10]
References
- ↑ Lewis JH, Weingold AB (1985). "The use of gastrointestinal drugs during pregnancy and lactation". Am J Gastroenterol. 80 (11): 912–23. PMID 2864852.
- ↑ Ryan JW, Farrelly C, Geoghegan T (2018). "What Are the Indications for Prophylactic Embolization of Renal Angiomyolipomas? A Review of the Current Evidence in the Literature". Can Assoc Radiol J. 69 (3): 236–239. doi:10.1016/j.carj.2018.01.002. PMID 29804911.
- ↑ Leong S, Keeling AN, McGrath FP, Lee MJ (2010). "Transcatheter embolisation of renal angiomyolipoma". Ir J Med Sci. 179 (2): 211–6. doi:10.1007/s11845-009-0390-9. PMID 19618235.
- ↑ Image courtesy of Dr. Andrew Lawson. Radiopaedia(original file [1]). Creative Commons BY-SA-NC
- ↑ Ploumidis A, Katafigiotis I, Thanou M, Bodozoglou N, Athanasiou L, Ploumidis A (2013). "Spontaneous Retroperitoneal Hemorrhage (Wunderlich Syndrome) due to Large Upper Pole Renal Angiomyolipoma: Does Robotic-Assisted Laparoscopic Partial Nephrectomy Have a Role in Primary Treatment?". Case Rep Urol. 2013: 498694. doi:10.1155/2013/498694. PMC 3784227. PMID 24106637.
- ↑ Staehler M, Sauter M, Helck A, Linsenmaier U, Weber L, Mayer K; et al. (2012). "Nephron-sparing resection of angiomyolipoma after sirolimus pretreatment in patients with tuberous sclerosis". Int Urol Nephrol. 44 (6): 1657–61. doi:10.1007/s11255-012-0292-z. PMID 23054313.
- ↑ Atwell TD, Schmit GD, Boorjian SA, Mandrekar J, Kurup AN, Weisbrod AJ; et al. (2013). "Percutaneous ablation of renal masses measuring 3.0 cm and smaller: comparative local control and complications after radiofrequency ablation and cryoablation". AJR Am J Roentgenol. 200 (2): 461–6. doi:10.2214/AJR.12.8618. PMID 23345372.
- ↑ Sooriakumaran P, Gibbs P, Coughlin G, Attard V, Elmslie F, Kingswood C; et al. (2010). "Angiomyolipomata: challenges, solutions, and future prospects based on over 100 cases treated". BJU Int. 105 (1): 101–6. doi:10.1111/j.1464-410X.2009.08649.x. PMID 19493268.
- ↑ Prevoo W, van den Munckhof MP, Meinhardt W, Horenblas S, van den Bosch MA (2010). "Radiofrequency ablation of kidney tumours in patients with a solitary kidney". Clin Radiol. 65 (3): 230–6. doi:10.1016/j.crad.2009.11.007. PMID 20152280.
- ↑ Castle SM, Gorbatiy V, Ekwenna O, Young E, Leveillee RJ (2012). "Radiofrequency ablation (RFA) therapy for renal angiomyolipoma (AML): an alternative to angio-embolization and nephron-sparing surgery". BJU Int. 109 (3): 384–7. doi:10.1111/j.1464-410X.2011.10376.x. PMID 22176671.