Introduction: To investigate the feasibility and efficiency of super-selective artery embolization (SAE) before laparoscopic partial nephrectomy (LPN) in treating renal angiomyolipoma (RAML). Materials and Methods: A retrospective analysis was conducted on 36 consecutive patients who underwent SAE before LPN (group A, n = 16) or LPN directly (group B, n = 20) from June 2010 to March 2016. Intraoperative blood loss, blood transfusion, operation time, warm ischemia time (WIT), and prognosis were compared between groups. Results: SAE before LPN decreased operating time, intraoperative blood loss and WIT (p < 0.05), and improved postoperative renal function (p < 0.001). Complications in group B included intraoperative blood loss of 4 patients and postoperative hematuria of 2 patients who recovered a few days later. No complications were observed in group A. In the follow-up of 3 months, a patient in group B formatted retroperitoneal hematoma without any symptoms and received expectant treatment. Conclusions: The application of SAE before LPN can decrease the difficulty of the surgery, the complications, and the risk of rebleeding and RAMLs recurrence.

1.
Bhatt JR, Richard PO, Kim NS, et al: Natural history of renal angiomyolipoma (AML): most patients with large AMLs >4cm can be offered active surveillance as an initial management strategy. Eur Urol 2016;70:85-90.
2.
Bissler JJ, Kingswood JC: Renal angiomyolipomata. Kidney Int 2004;66:924-934.
3.
Heidenreich A, Hegele A, Varga Z, et al: Nephron-sparing surgery for renal angiomyolipoma. Eur Urol 2002;41:267-273.
4.
Steiner MS, Goldman SM, Fishman EK, et al: The natural history of renal angiomyolipoma. J Urol 1993;150:1782-1786.
5.
Oesterling JE, Fishman EK, Goldman SM, et al: The management of renal angiomyolipoma. J Urol 1986;135:1121-1124.
6.
Cavicchioli FM, D'Elia C, Cerruto MA, et al: Giant bilateral renal angiomyolipomas: a case report. Urol Int 2014;92:366-368.
7.
Wilson SS, Clark PE, Stein JP: Angiomyolipoma with vena caval extension. Urology 2002;60:695-696.
8.
Que X, Zhu Y, Ye C, et al: Invasive epithelioid angiomyolipoma with tumor thrombus in the inferior vena cava: a case report and literature review. Urol Int 2017;98:120-124.
9.
Moudouni SM, Tligui M, Sibony M, et al: Malignant epithelioid renal angiomyolipoma involving the inferior vena cava in a patient with tuberous sclerosis. Urol Int 2008;80:102-104; discussion 104.
10.
Stein RJ, White WM, Goel RK, et al: Robotic laparoendoscopic single-site surgery using GelPort as the access platform. Eur Urol 2010;57:132-136.
11.
Zhang X, Li HZ, Ma X, et al: Retroperitoneal laparoscopic nephron-sparing surgery for renal tumors: report of 32 cases. Urology 2005;65:1080-1084; discussion 1084-1085.
12.
Boorjian SA, Frank I, Inman B, et al: The role of partial nephrectomy for the management of sporadic renal angiomyolipoma. Urology 2007;70:1064-1068.
13.
Chick CM, Tan BS, Cheng C, et al: Long-term follow-up of the treatment of renal angiomyolipomas after selective arterial embolization with alcohol. BJU Int 2010;105:390-394.
14.
Williams JM, Racadio JM, Johnson ND, et al: Embolization of renal angiomyolipomata in patients with tuberous sclerosis complex. Am J Kidney Dis 2006;47:95-102.
15.
Ewalt DH, Diamond N, Rees C, et al: Long-term outcome of transcatheter embolization of renal angiomyolipomas due to tuberous sclerosis complex. J Urol 2005;174:1764-1766.
16.
Ramon J, Rimon U, Garniek A, et al: Renal angiomyolipoma: long-term results following selective arterial embolization. Eur Urol 2009;55:1155-1161.
17.
Kothary N, Soulen MC, Clark TW, et al: Renal angiomyolipoma: long-term results after arterial embolization. J Vasc Interv Radiol 2005;16:45-50.
18.
Kehagias D, Mourikis D, Kousaris M, et al: Management of renal angiomyolipoma by selective arterial embolization. Urol Int 1998;60:113-117.
19.
Prevoo W, van den Bosch MA, Horenblas S: Radiofrequency ablation for treatment of sporadic angiomyolipoma. Urology 2008;72:188-191.
20.
Byrd GF, Lawatsch EJ, Mesrobian HG, et al: Laparoscopic cryoablation of renal angiomyolipoma. J Urol 2006;176(4 pt 1):1512-1516; discussion 1516.
21.
Eijkemans MJ, van der Wal W, Reijnders LJ, et al: Long-term follow-up assessing renal angiomyolipoma treatment patterns, morbidity, and mortality: an observational study in tuberous sclerosis complex patients in the Netherlands. Am J Kidney Dis 2015;66:638-645.
22.
Chan CK, Yu S, Yip S, et al: The efficacy, safety and durability of selective renal arterial embolization in treating symptomatic and asymptomatic renal angiomyolipoma. Urology 2011;77:642-648.
23.
Dindo D, Demartines N, Clavien PA: Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 2004;240:205-213.
24.
Murray TE, Doyle F, Lee M: Transarterial embolization of angiomyolipoma: a systematic review. J Urol 2015;194:635-639.
25.
Crispen PL, Blute ML: Editorial comment on: renal angiomyolipoma: long-term results following selective arterial embolization. Eur Urol 2009;55:1161-1162.
26.
Fazeli-Matin S, Novick AC: Nephron-sparing surgery for renal angiomyolipoma. Urology 1998;52:577-583.
27.
Simmons MN, Lieser GC, Fergany AF, et al: Association between warm ischemia time and renal parenchymal atrophy after partial nephrectomy. J Urol 2013;189:1638-1642.
28.
Luo Y, Hou G, Lu M, et al: Unclamped nephron-sparing surgery with preoperative selective arterial embolization for the management of bilateral giant renal angiomyolipomas. Clin Genitourin Cancer 2014;12:e111-e114.
29.
Muller A, Rouviere O: Renal artery embolization-indications, technical approaches and outcomes. Nat Rev Nephrol 2015;11:288-301.
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.