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  • Review Article
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Renal artery embolization—indications, technical approaches and outcomes

Nature Reviews Nephrology volume 11, pages 288–301 (2015)Cite this article

Subjects

Key Points

  • Renal artery embolization (RAE) is a useful adjunct to medical resuscitation in severe penetrating, iatrogenic or blunt renal traumatisms with active bleeding, and may avoid the need for surgery

  • Patients with renal bleeding and critical haemodynamic instability, despite active resuscitation, should be admitted to surgery and not treated with RAE

  • RAE is recommended for angiomyolipomas that are bleeding; the risk factors that should trigger preventive RAE of asymptomatic angiomyolipomas remain controversial

  • The impact of RAE on renal function is minimal when selective embolization is performed

  • RAE can be used as an alternative to nephrectomy in severe uncontrolled hypertension among patients with end-stage renal disease, renal graft intolerance syndrome or autosomal dominant polycystic kidney disease

  • When RAE is used as an alternative to nephrectomy, the interventional radiologist must ensure that the embolized area is completely destroyed to avoid partial reperfusion and onset of renovascular hypertension

Abstract

Owing to improvements in catheters and embolic agents, renal artery embolization (RAE) is increasingly used to treat nephrological and urological disease. RAE has become a useful adjunct to medical resuscitation in severe penetrating, iatrogenic or blunt renal traumatisms with active bleeding, and might avoid surgical intervention, particularly among patients that are haemodynamically stable. The role of RAE in pre-operative or palliative management of advanced malignant renal tumours remains debated; however, RAE is recommended as a first-line therapy for bleeding angiomyolipomas and can be used as a preventative treatment for angiomyolipomas at risk of bleeding. RAE represents an alternative to nephrectomy in various medical conditions, including severe uncontrolled hypertension among patients with end-stage renal disease, renal graft intolerance syndrome or autosomal dominant polycystic kidney disease. RAE is increasingly used to treat renal artery aneurysms or symptomatic renal arteriovenous malformations, with a low complication rate as compared with surgical alternatives. This Review highlights the potential use of RAE as an adjunct in the management of renal disease. We first compare and contrast the technical approaches of RAE associated with the various available embolization agents and then discuss the complications associated with RAE and alternative procedures.

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Figure 1: Iliac angiogram showing direct bleeding.
Figure 2: Renal CT scan and angiography of a pseudoaneurysm in an 82-year-old patient with history of aortic dissection and laparoscopic partial nephrectomy for a tumour of the left kidney.
Figure 3: Renal MRI and angiography of a 65-year-old patient with history of renal transplantation and chronic post-biopsy arteriovenous fistula (AVF) of the lower pole of the renal transplant.
Figure 4: Images obtained in a 24-year-old patient with history of abdominal blunt trauma.
Figure 5: Embolization of a renal cancer using both micro-particles and coils before radical nephrectromy.
Figure 6: Images obtained from a 57-year-old patient with a 60 mm angiomyolipoma (AML) of the left kidney.
Figure 7: Images obtained from a 60-year-old patient with polycystic kidney disease, a | before, and b | 5 months and c | 6 years following embolization of the left kidney.

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Authors and Affiliations

  1. Department of Imaging, Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, Pierre Bénite, F-69495, France

    Arnaud Muller

  2. Department of Urinary and Vascular Radiology, Hospices Civils de Lyon, Hôpital Edouard Herriot, 5 place d'Arsonval, Lyon Cedex 03, 69437, France

    Olivier Rouvière

  3. Université de Lyon, Université Lyon 1, Faculté de Médcine Lyon Est, Lyon, 69003, France

    Olivier Rouvière

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  1. Arnaud Muller
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A.M. and O.R. contributed equally to writing the article and to review and/or editing of the manuscript before submission.

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Correspondence to Olivier Rouvière.

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Supplementary Figure 1

Images obtained from a 48-year-old patient with history of pulmonary lymphangioleiomyomatosis. (PDF 1102 kb)

Supplementary Figure 2

Images obtained from a 59-year-old patient referred for embolization of a 15 mm right renal artery aneurysm that had shown continuous progression at CT follow-up. (PDF 730 kb)

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Muller, A., Rouvière, O. Renal artery embolization—indications, technical approaches and outcomes. Nat Rev Nephrol 11, 288–301 (2015). https://doi.org/10.1038/nrneph.2014.231

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