TY - JOUR
T1 - Selective Arterial Embolization for Large or Symptomatic Renal Angiomyolipoma
T2 - 10 Years of Follow-up
AU - Anis, Omer
AU - Rimon, Uri
AU - Ramon, Jacob
AU - Khaitovich, Boris
AU - Zilberman, Dorit E.
AU - Portnoy, Orith
AU - Dotan, Zohar A.
N1 - Publisher Copyright:
© 2019 Elsevier Inc.
PY - 2020/1
Y1 - 2020/1
N2 - Objective: To assess long-term outcome after selective arterial embolization (SAE) as first-line treatment for large or symptomatic AML. Design, Setting, and Participants: Data from a prospectively maintained database on 71 patients who underwent SAE for large or symptomatic AML were reviewed. Patients with sporadic and tuberous-sclerosis-complex (TSC) were included. Outcome Measurements: The main endpoints were re-embolization rates, occurrence of clinical events related to AML, size of AML, and renal function. Results: Thirteen (19.1%) patients reported at least 1 major clinical event. Major complications affected 2 patients (2.9%), both ending in complete loss of renal unit function. Four renal units (5.9%) were eventually treated surgically. The re-embolization rate was 41.1%, with an average time from the initial to a repeat SAE of 2.18 years (range 0.31-10.65 years). The size of the tumor prior to SAE and after 5 and 10 years of follow-up were 8.9 cm (7-12), 6.5 cm (4-7.5), 7 cm (4-7.8), respectively [median (IQR)]. These results are translated to a size reduction of 27% in 10 years follow-up. Patients with TSC had larger tumors on long-term follow-up (77.8 vs 41.3 mm, P =. 045). The long-term follow-up estimated average glomerular filtration rate was 81.97 (range 26-196). No patient needed renal replacement therapy, and disease-specific survival was 100%. Conclusions: SAE is a safe treatment option for patients with symptomatic or large AML. It represents a minimally invasive intervention with good long-term outcome. SAE may be offered as first-line treatment in most cases, though, it is associated with high retreatment rates.
AB - Objective: To assess long-term outcome after selective arterial embolization (SAE) as first-line treatment for large or symptomatic AML. Design, Setting, and Participants: Data from a prospectively maintained database on 71 patients who underwent SAE for large or symptomatic AML were reviewed. Patients with sporadic and tuberous-sclerosis-complex (TSC) were included. Outcome Measurements: The main endpoints were re-embolization rates, occurrence of clinical events related to AML, size of AML, and renal function. Results: Thirteen (19.1%) patients reported at least 1 major clinical event. Major complications affected 2 patients (2.9%), both ending in complete loss of renal unit function. Four renal units (5.9%) were eventually treated surgically. The re-embolization rate was 41.1%, with an average time from the initial to a repeat SAE of 2.18 years (range 0.31-10.65 years). The size of the tumor prior to SAE and after 5 and 10 years of follow-up were 8.9 cm (7-12), 6.5 cm (4-7.5), 7 cm (4-7.8), respectively [median (IQR)]. These results are translated to a size reduction of 27% in 10 years follow-up. Patients with TSC had larger tumors on long-term follow-up (77.8 vs 41.3 mm, P =. 045). The long-term follow-up estimated average glomerular filtration rate was 81.97 (range 26-196). No patient needed renal replacement therapy, and disease-specific survival was 100%. Conclusions: SAE is a safe treatment option for patients with symptomatic or large AML. It represents a minimally invasive intervention with good long-term outcome. SAE may be offered as first-line treatment in most cases, though, it is associated with high retreatment rates.
UR - http://www.scopus.com/inward/record.url?scp=85075478948&partnerID=8YFLogxK
U2 - 10.1016/j.urology.2019.09.035
DO - 10.1016/j.urology.2019.09.035
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C2 - 31618658
AN - SCOPUS:85075478948
SN - 0090-4295
VL - 135
SP - 82
EP - 87
JO - Urology
JF - Urology
ER -