• Angiomyolipoma
• Haemorrhage
• Kidney
• Radiology (Interventional)
• Tomography (Spiral computed)

• Continuous grants The Research and Development Centre at NU Hospital Group
• VGFOUREG-981789 Health and Medical Care Committee of the Regional Executive Board, Region Västra Götaland

• radiomics
• radiomics-clinical nomogram
• renal angiomyolipoma (RAML)
• response
• superselective arterial embolization (SAE)
• tumor volume reduction

• Nephron-sparing surgery
• Off-clamp
• Renal angiomyolipomas

• Humans
• Kidney Neoplasms/surgery
• Kidney Neoplasms/pathology
• Angiomyolipoma/surgery
• Angiomyolipoma/pathology
• Kidney/pathology
• Nephrectomy/methods
• Laparoscopy/methods
• Hamartoma/pathology
• Retrospective Studies
• Nephrons/surgery
• Nephrons/pathology
• Treatment Outcome
• Carcinoma, Renal Cell/surgery

• angiography
• angiomyolipomas
• kidney neoplasms
• radiology
• therapeutic

• Male
• Humans
• Female
• Adult
• Ethiodized Oil/therapeutic use
• Bleomycin
• Prospective Studies
• Polyvinyl Alcohol/therapeutic use
• Angiomyolipoma/diagnostic imaging
• Angiomyolipoma/therapy
• Emulsions
• Enbucrilate/therapeutic use
• Flank Pain
• Hematuria
• Kidney Neoplasms/therapy
• Kidney Neoplasms/drug therapy
• Embolization, Therapeutic/methods
• Treatment Outcome
• Leukemia, Myeloid, Acute/drug therapy

• Case report
• Laparoscopic aspiration
• Renal angiomyolipoma
• Retroperitoneal approach
• Robotic laparoscopic surgery

To clarify the utility of microballoon catheter in renal arterial ethanol embolization of renal angiomyolipoma (AML).

A total of 20 patients (15 women, 5 men) with median age of 45 years (39-60 years) underwent embolization to treat 22 AMLs. A mixture of ethanol and iodized oil was injected into the feeding arteries of 13 tumors using balloon occlusion (the balloon embolization group) with a microballoon catheter and 9 tumors without using balloon occlusion (the non-balloon embolization group). Changes in the maximum tumor diameter, tumor volume, and adverse events were evaluated.

The median baseline maximum tumor diameters and volumes were 6.3 cm and 61.4 cm³ in the balloon embolization group, and 4.6 cm and 40.1 cm³ in the non-balloon embolization group, respectively. Tumor enhancement disappeared on postembolization angiography in all cases. All tumors shrunk after embolization. There were no statistically significant differences in the percent decrease in the maximum tumor diameter and volume at 10-12 month between balloon occlusion group (31.5% and 67.9%) and control group (34.8% and 62.6%). Fever was significantly more frequent when balloon occlusion was used: 38% vs. 0% (p = 0.03). No major complication was observed in either patient group.

Balloon occlusion may not affect tumor shrinkage when embolizing AMLs with a mixture of ethanol and lipiodol.

Although renal angiomyolipoma (AML) is a benign tumor, treatment may be necessary occasionally because it can cause potentially life-threatening retroperitoneal hemorrhage. Transarterial embolization (TAE) is a safe and effective treatment option to prevent the hemorrhagic rupture of AMLs and relieve the symptoms caused by enlarged lesions or active bleeding. However, there is no clear consensus regarding the indications for prophylactic TAE in patients with sporadic renal AMLs. In urgent TAE for bleeding AMLs, there is a likelihood of incomplete embolization when the focus is on stabilizing the clinical symptoms. This pictorial essay discusses the patient selection and technical considerations to achieve optimal therapeutic effects as well as the follow-up findings after TAE.

To study safety and efficacy of selective endovascular trans‐arterial embolization (TAE) of renal angiomyolipoma (AML) in a 10‐year period at a regional tertiary referral center in Denmark.

All 56 patients who underwent TAE of renal AML at Departments of Urology and Radiology, Copenhagen University Hospital – Rigshospitalet, Denmark, from 2009 to 2020 were included. Seven without preoperative and postoperative imaging were excluded, leaving 49 patients for analysis. From national electronic medical records, we retrieved patient characteristics, surgical data, and follow‐up data. Tumor size at the time of embolization and during follow‐up was compared using Student's paired t test. Estimated glomerular filtration rate (eGFR) pre‐ and post‐embolization were compared using Wilcoxon rank sum test.

We included 49 patients of whom 4 had two tumors treated in the same TAE procedure. Median age was 50 years (interquartile range [IQR]: [29–67 years]), and the median follow‐up time was 4.6 years [IQR: 3.0–6.7 years]. Post‐embolization syndrome (PES) was experienced in 27 patients, and non‐PES in 5 patients. Median length of hospital stay was 0 days [IQR, 0–1]. Postoperative Everolimus immunosuppressive treatment was offered to seven patients. Median tumor size was 6.0 cm [IQR: 4.6–7.9 cm] and was significantly reduced to 3.7 cm [IQR: 2.5–5.2 cm] after treatment (p < 0.001). Kidney function was not affected by TAE. Three deaths, not related to AML, were noted during follow‐up.

Embolization of AML was in this cohort effective to significantly reduce tumor size without serious adverse events and loss of renal function. TAE is a safe and efficacious treatment and the preferred minimally invasive treatment option of AML.

• Laparoscopy
• Off-clamp
• Sporadic renal angiomyolipoma
• Surgical technique
• Tumour evacuation

• Angiomyolipoma
• Embolization
• Natural history
• Surveillance

• clinical feature
• renal angiomyolipoma
• rupture
• scoring system
• sporadic

• Adult
• Angiomyolipoma/complications
• China/epidemiology
• Clinical Decision Rules
• Female
• Hamartoma/complications
• Hemorrhage/diagnosis
• Hemorrhage/etiology
• Humans
• Kidney Neoplasms/blood supply
• Kidney Neoplasms/pathology
• Male
• Middle Aged
• Research Design/statistics & numerical data
• Retrospective Studies
• Risk Assessment/methods
• Risk Factors
• Rupture/diagnosis
• Rupture/etiology
• Tumor Burden/physiology

To assess the safety, tumor control and renal function preservation of the emergency retroperitoneal laparoscopic partial nephrectomy (LPN) for ruptured renal angiomyolipoma (AML) and summarize our single-center initial experience.

We performed a retrospective analysis of 15 patients pathologically confirmed renal AML treated with emergency retroperitoneal LPN between January 2016 and May 2019. The patient demographics, operation time, blood loss, transfusion requirements, complications and other surgical parameters were analyzed. Follow-up was performed by serum creatinine and imaging modalities.

Fifteen patients were performed with emergency LPN with the median age 41.6 years. The mean size of the renal AMLs was 7.8 cm. The mean size of the retroperitoneal hematomas was 8.5 cm. All the emergency surgeries were performed successfully without any conversion to nephrectomy or open surgery. The mean operative time was 101 min. The mean warm ischemia time was 28 min. The mean estimated blood loss was 311 ml. Five patients required intraoperative blood transfusion (33.3%, 5/15). The mean transfused RBC was 4 U (range 2-6 U), and the mean transfused plasma was 200 ml (range 200-400 ml). The mean drainage duration was 3 days (range 2–5 days). The mean postoperative hospitalization was 4.7 days. No patients experienced intraoperative complications. The mean serum creatine was slightly higher after surgery (53.1 vs. 55.9 μmol/L). One patient had postoperative perirenal fluid collection. No patients needed dialysis. No recurrence was observed in the patients at the median follow-up of 24.1 months.

Our initial experience shows that the emergency retroperitoneal LPN is a safe, minimally invasive procedure for emergency patients with ruptured renal AMLs. It could be considered as an effective alternative to renal artery embolization in selected emergency patients.

To evaluate the efficacy and safety of transcatheter arterial embolization for renal angiomyolipoma using a 1.8-French tip microballoon catheter and a mixture of ethanol and Lipiodol.

Seven consecutive patients with total of eight angiomyolipomas underwent this procedure between June 2014 and June 2017. A 1.8-French tip microballoon catheter was advanced to the feeding artery of the angiomyolipoma, and transcatheter arterial embolization was performed with a mixture of ethanol and Lipiodol under microballoon inflation. We retrospectively evaluated the characteristics of angiomyolipomas, technical success rate, clinical success rate, renal function, and adverse events. Technical success and clinical success were defined as complete embolization of all feeding arteries and reduction of tumor size, respectively.

The median size of the angiomyolipomas was 46 mm (range, 40–64 mm). Transcatheter arterial embolization was successful in all eight angiomyolipomas. The median volume of the mixture of ethanol and Lipiodol was 6.0 ml (range, 2.0–14 ml). The median ratio of ethanol to Lipiodol was 71% (range, 71–75%). All eight angiomyolipomas shrank with a median shrinkage rate of 34% in diameter (range, 9–63%) and 77% in volume (range, 48–94%). The median follow-up period was 13 months (range, 9–54 months). Clinical success was achieved in all cases. Serum creatinine concentrations and the pre- and post-procedural estimated glomerular filtration rates did not change notably, and there were no major complications.

Transcatheter arterial embolization for renal angiomyolipoma using a 1.8-French tip microballoon catheter with a mixture of ethanol and Lipiodol is effective and safe.

• Embolization
• Interventional radiology
• Microballoon catheter
• Renal angiomyolipoma

We evaluated the efficacy of everolimus in 3 patients who had huge renal angiomyolipomas associated with tuberous sclerosis complex. Two patients with large lipid-rich angiomyolipomas had a history of renal transarterial embolization for renal bleeding, but the effect had only been temporary and the embolized kidneys had continued to enlarge. In case 1, case 2, and case 3, total renal volume was respectively 3,891, 4,035, and 1,179 cm³ before administration of everolimus, decreasing to 3,016 (77%), 3,043 (75%), and 1,051 (89%) cm³ after 1 year of everolimus therapy and to 2,832 (73%), 3,209 (80%), and 1,102 (93%) cm³ after 3 years. New renal bleeding did not occur, but elevation of serum creatinine and urinary protein were noted in 2 patients. While previous reports have largely assessed the effect of everolimus for angiomyolipomas of < 10 cm in the longest diameter, our findings suggest that this drug might also be effective for huge lesions of > 20 cm in diameter. However, total renal volume still exceeds 2,000 cm³ in 2 of our patients, suggesting limited size reduction of lipid-rich angiomyolipomas. In addition, occurrence of everolimus-related nephropathy needs to be monitored carefully.

• Angiomyolipoma
• Everolimus
• Tuberous sclerosis complex