Review of the article "First experience of superselective embolization of renal arteries supplying the tumor with subsequent laparoscopic kidney resection"

Introduction: Renal artery embolization is a minimally invasive X-ray endovascular operation that is used in the treatment of various urological diseases. This operation is of increasing interest due to its ability to occlude not only proximal, but also distal renal vessels with a low risk of complications. Recent developments in endovascular technology make embolization one of the effective and safe methods applicable to stop renal bleeding, preoperative preparation for surgical treatment of renal malignant tumors, and first-line treatment for angiomyolipomas. For a certain category of patients, renal artery embolization is practically no alternative method of treatment. This applies to comorbid patients with kidney tumors and aggravated somatic status, in whom the anesthetic risk makes open or laparoscopic surgical treatment impossible, and embolization can reduce symptoms, improve the quality of life of such patients and prolong the patient's life.Clinical case: we demonstrate the experience of X-ray surgical treatment of cT1aN0M0 left kidney cancer in an 80-year-old patient.Conclusion: Embolization of renal arteries in some cases can be an effective and safe alternative treatment for renal cell carcinoma in somatically burdened patients who cannot perform surgical treatment.

Download Full-text

Embolisation of the renal arteries in the treatment of nephrogenic arterial hypertension

Vestnik of Russian military medical Academy ◽

10.17816/brmma12357 ◽

2018 ◽

Vol 20 (3) ◽

pp. 203-206

Author(s):

G G Hubulava ◽

K L Kozlov ◽

S S Mihailov ◽

A N Shishkevich ◽

E Yu Bessonov ◽

...

Keyword(s):

Arterial Hypertension ◽

World Literature ◽

Modern Society ◽

Renal Arteries ◽

Superselective Embolization ◽

The World ◽

Renal Artery Embolization ◽

Materials Used ◽

Resistant Arterial Hypertension ◽

Venous Fistula

This review article examines the possibilities of surgical treatment of one of the socially significant diseases of modern society - arterial hypertension. The reasons for the development of parenchymal arterial hypertension have been disassembled. The reasons for the development of renovascular hypertension are discussed. Illuminates the pathogenesis of nephrogenic hypertension, statistical data on its prevalence. The issue of embolization of renal arteries in the treatment of nephrogenic arterial hypertension is considered. The forms of nephrogenic arterial hypertension in which the use of embolization is indicated. The etiology and pathogenesis of arterio-venous fistulas of the kidneys are described. Details of the world literature concerning the treatment of arterio-venous fistula and malformations of the kidneys are considered in detail. A review of literature data on materials used in embolisation of renal arteries in patients with arteriovenous fistula and malformations of the kidney is given. The etiology and pathogenesis of arterio-venous malformations of the kidneys are highlighted. The goal of embolization of the renal arteries in the preparation of patients with terminal renal failure and resistant arterial hypertension to kidney transplantation is described. The issue of preoperative preparation of patients before embolization of the renal arteries, the choice of operative access is considered. Methods of embolization of the renal arteries, possible complications and methods of their prevention are described. The data of the world literature concerning application of selective and superselective embolization of renal arteries in patients with parenchymal arterial hypertension are covered. The issue of potential use of renal artery embolization in other forms of nephrogenic arterial hypertension is also highlighted.

Download Full-text

Kidney resection with preliminary superselective embolization of vessels nourishing the tumour

Urology and andrology ◽

10.20953/2307-6631-2016-1-54-61 ◽

2016 ◽

Vol 4 (1) ◽

pp. 54-61

Author(s):

Yu.G. Alyaev ◽

◽

N.I. Sorokin ◽

S.A. Kondrashin ◽

E.V. Shpot’ ◽

...

Keyword(s):

Superselective Embolization ◽

Kidney Resection

Download Full-text

First experience of superselective embolization of renal arteries supplying the tumor with subsequent laparoscopic kidney resection

Cancer Urology ◽

10.17650/1726-9776-2021-17-3-30-36. ◽

2021 ◽

Vol 17 (3) ◽

pp. 30-36

Author(s):

V. L. Astashov ◽

V. V. Shapovalov ◽

V. V. Balanyuk ◽

A. I. Zagorul’ho ◽

D. V. Kozlov ◽

...

Keyword(s):

Blood Loss ◽

Renal Artery ◽

Kidney Cancer ◽

Renal Tumors ◽

Two Stage ◽

Second Stage ◽

Superselective Embolization ◽

Single Kidney ◽

Functioning Kidney ◽

Kidney Resection

Background. Patients with signs of tumor lesions in a single kidney or in the only one functioning kidney, with bilateral renal tumors are at high risk of functional failure or insufficiency of the kidney after surgery. Joint discussions with specialists in X-ray endovascular surgeries resulted in the development of a treatment algorithm for patients with localized kidney cancer who require organ-sparing surgery without ischemic kidney resection.Objective: to evaluation of the immediate results of two-stage surgical treatment of localized kidney cancer in patients with signs of tumor lesions in a single kidney or in the only one functioning kidney, with bilateral renal tumors, including superselective embolization of the artery supplying the tumor at the first stage, and laparoscopic kidney resection without renal ischemia parenchyma at the second stage.Materials and methods. This study included 5 patients with localized kidney cancer, who underwent two-stage treatment at Moscow Regional Oncology Dispensary between 24.03.2021 and 19.04.2021. The first stage included superselective embolization of the artery supplying the tumor; the second stage implied laparoscopic kidney resection 6-7 days following the first stage.Results. The median age of the patients was 62 years (range: 42-73 years). Four patients (80%) had unilateral kidney lesions, while 1 patient (20 %) had bilateral (synchronous) kidney cancer. The mean RENAL score was 8 (range: 6-10); patients were distributed as follows: score 4-6 in 40 %, score 7-9 in 40 %, and score >10 in 20 % of patients. At the first stage, patients underwent endovascular embolization of the branches of the renal artery. Patients had superselective embolization of either middle (n = 3; 60 %), upper (n = 1; 20 %), or lower (n = 1; 20 %) segmental arteries supplying the tumor. In one of them (20 %), we identified 3 large arterial branches; in another one (20 %), we identified 2 large arterial branches.At the second stage, we performed laparoscopic kidney resection. None of the patients required renal artery clamping, because there was an excellent visualization of the demarcation zone and no significant blood loss. The resection area was sutured in 1 case (20 %). In 2 individuals (40 %), a hemostatic sponge was installed in the removed tumor bed. In the remaining 2 cases (40 %), hemostasis was ensured by coagulation. The median blood loss was 100 mL (range: 50-200 mL). The postoperative period was uneventful in all patients. None of the patients developed symptoms of acute renal failure.Conclusion. Thus, superselective embolization of arteries supplying a kidney tumor has undeniable advantages in organ-sparing surgeries for patients with localized kidney cancer and some additional kidney problems, when organ preservation is crucial for patient's life.

Download Full-text

Laparoscopic removal of a kidney tumor after superselective embolization of the kidney vessels

Andrology and Genital Surgery ◽

10.17650/2070-9781-2020-21-1-65-69 ◽

2020 ◽

Vol 21 (1) ◽

pp. 65-69

Author(s):

V. V. Zemlyansky ◽

O. B. Zhukov ◽

T. A. Kurmanov ◽

Zh. D. Zhumagazin ◽

A. M. Chinaliev

Keyword(s):

Blood Loss ◽

Tumor Resection ◽

Tumor Diameter ◽

Kidney Tumor ◽

Feeding Artery ◽

Loss Of Function ◽

Kidney Tumors ◽

Study Objective ◽

Superselective Embolization ◽

Kidney Resection

The study objective is to evaluate the effectiveness of using superselective embolization of the renal arterial bed prior to organ-preserving laparoscopic kidney tumor resection.Materials and methods. At the Center for Urology, Kidney Transplantation and Nephrology of the National Research Oncology Center (Nur-Sultan, Kazakhstan) between 2015 and 2019 laparoscopic kidney tumor resection was performed in 45 patients; in 9 patients with stage T1 kidney tumors, superselective embolization was also performed. Mean age of the patients was 54 years, mean tumor diameter was 2.8 cm. Localization near the kidney pole and presence of an artery isolatedly supplying the tumor were the main indications for superselective embolization of the feeding artery prior to kidney resection.Results. Mean blood loss was 280 ml. Complications characteristic of post-embolization period (pain, fever, arterial hypertension), as well as loss of function of the organ, were absent 3, 6 and 12 months after the procedure per laboratory and radiological examinations.Conclusion. Superselective embolization of the tumor feeding artery is an effective method allowing to minimize warm ischemia of the renal parenchyma and perform kidney resection with minimal blood loss.The authors declare no conflict of interest.All patients gave written informed consent to participate in the study and to the publication of their data.

Download Full-text