Angiomyolipoma surgery

Jump to navigation Jump to search

Angiomyolipoma Microchapters

Home

Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Angiomyolipoma from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

Diagnostic Study of Choice

History and Symptoms

Physical Examination

Laboratory Findings

Electrocardiogram

X-ray

CT

MRI

Ultrasound

Other Imaging Findings

Other Diagnostic Studies

Treatment

Medical Therapy

Surgery

Primary Prevention

Secondary Prevention

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Case Studies

Case #1

Angiomyolipoma surgery On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Images

American Roentgen Ray Society Images of Angiomyolipoma surgery

All Images
X-rays
Echo & Ultrasound
CT Images
MRI

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Angiomyolipoma surgery

CDC on Angiomyolipoma surgery

Angiomyolipoma surgery in the news

Blogs on Angiomyolipoma surgery

Directions to Hospitals Treating Angiomyolipoma

Risk calculators and risk factors for Angiomyolipoma surgery

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]

  • 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:

Radiofrequency Ablation or Cryoablation:

References

  1. Lewis JH, Weingold AB (1985). "The use of gastrointestinal drugs during pregnancy and lactation". Am J Gastroenterol. 80 (11): 912–23. PMID 2864852.
  2. 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.
  3. 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.
  4. Image courtesy of Dr. Andrew Lawson. Radiopaedia(original file [1]). Creative Commons BY-SA-NC
  5. 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.
  6. 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.
  7. 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.
  8. 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.
  9. 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.
  10. 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.

Template:WikiDoc Sources