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Pre-operative renal artery embolization and suprarenal IVC filter placement for prevention of fat embolization in renal angiomyolipoma with venous extension

      Highlights

      • Risk of pulmonary fat embolism in cases of IVC-invasive AML requires mechanical protection.
      • Concurrent preoperative RAE and IVC filter placement is feasible at minimal added risk.
      • Optimal timing is 24–48 h before surgery to balance revascularization and tumor shrinkage.
      • Retrievable IVC filters provide continued protection in the postoperative period.

      Abstract

      Though generally considered benign, angiomyolipomas can invade through the renal vein into the inferior vena cava, putting patients at risk of catastrophic pulmonary fat embolization. Venous invasion is thus an indication for surgical resection but is thought to increase the risk of adverse operative outcomes including intraoperative hemorrhage and embolization of fat and/or tumor thrombus. We report a novel approach to mitigating these complications illustrated in the case of a 43-year-old woman with IVC-invasive renal AML who underwent successful radical nephrectomy after concurrent pre-operative renal artery embolization and placement of a retrievable suprarenal IVC filter.

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      References

        • Fujii Y.
        • Ajima J.
        • Oka K.
        • Tosaka A.
        • Takehara Y.
        Benign renal tumors detected among healthy adults by abdominal ultrasonography.
        Eur Urol. 1995; 27: 124-127
        • Rule A.D.
        • Sasiwimonphan K.
        • Lieske J.C.
        • Keddis M.T.
        • Torres V.E.
        • Vrtiska T.J.
        Characteristics of renal cystic and solid lesions based on contrast-enhanced computed tomography of potential kidney donors.
        Am J Kidney Dis. 2012; 59: 611-618
        • Tan Y.S.
        • Yip K.H.
        • Tan P.H.
        • Cheng W.S.
        A right renal angiomyolipoma with IVC thrombus and pulmonary embolism.
        Int Urol Nephrol. 2010; 42: 305-308
        • Harris K.
        • Hatem E.
        • Maroun R.
        • Seminara D.
        • Maniatis T.
        A renal angiomyolipoma with extension to the renal vein and asymptomatic fat pulmonary embolus.
        Ther Adv Respir Dis. 2014; 8: 133-135
        • Celik S.U.
        • Kocaay A.F.
        • Sevim Y.
        • Cetinkaya O.A.
        • Atman E.D.
        • Alacayir I.
        Renal angiomyolipoma with caval extension and pulmonary fat embolism: a case report.
        Medicine (Baltimore). 2015; 94e1078
        • Schwartz M.J.
        • Smith E.B.
        • Trost D.W.
        • Vaughan Jr., E.D.
        Renal artery embolization: clinical indications and experience from over 100 cases.
        BJU Int. 2007; 99: 881-886
        • Hirota S.
        • Matsumoto S.
        • Ichikawa S.
        • Tomita M.
        • Koshino T.
        • Sako M.
        • et al.
        Suprarenal inferior vena cava filter placement prior to transcatheter arterial embolization (TAE) of a renal cell carcinoma with large renal vein tumor thrombus: prevention of pulmonary tumor emboli after TAE.
        Cardiovasc Intervent Radiol. 1997; 20: 139-141
        • Yamakado K.
        • Tanaka N.
        • Nakagawa T.
        • Kobayashi S.
        • Yanagawa M.
        • Takeda K.
        Renal angiomyolipoma: relationships between tumor size, aneurysm formation, and rupture.
        Radiology. 2002; 225: 78-82
        • Halpenny D.
        • Snow A.
        • McNeill G.
        • Torreggiani W.C.
        The radiological diagnosis and treatment of renal angiomyolipoma-current status.
        Clin Radiol. 2010; 65: 99-108
        • Kuusk T.
        • Biancari F.
        • Lane B.
        • Tobert C.
        • Campbell S.
        • Rimon U.
        • et al.
        Treatment of renal angiomyolipoma: pooled analysis of individual patient data.
        BMC Urol. 2015; 15: 123
        • Li D.
        • Pua B.B.
        • Madoff D.C.
        Role of embolization in the treatment of renal masses.
        Semin Interv Radiol. 2014; 31: 70-81
        • Kothary N.
        • Soulen M.C.
        • Clark T.W.
        • Wein A.J.
        • Shlansky-Goldberg R.D.
        • Crino P.B.
        • et al.
        Renal angiomyolipoma: long-term results after arterial embolization.
        J Vasc Interv Radiol. 2005; 16: 45-50
        • Islam A.H.
        • Ehara T.
        • Kato H.
        • Hayama M.
        • Kashiwabara T.
        • Nishizawa O.
        Angiomyolipoma of kidney involving the inferior vena cava.
        Int J Urol. 2004; 11: 897-902
        • Pouliot F.
        • Shuch B.
        • Larochelle J.C.
        • Pantuck A.
        • Belldegrun A.S.
        Contemporary management of renal tumors with venous tumor thrombus.
        J Urol. 2010; 184 ([quiz 1235]): 833-841
        • Karnes R.J.
        • Blute M.L.
        Surgery insight: management of renal cell carcinoma with associated inferior vena cava thrombus.
        Nat Clin Pract Urol. 2008; 5: 329-339
        • Shuch B.
        • Larochelle J.C.
        • Onyia T.
        • Vallera C.
        • Margulis D.
        • Pantuck A.J.
        • et al.
        Intraoperative thrombus embolization during nephrectomy and tumor thrombectomy: critical analysis of the University of California-Los Angeles experience.
        J Urol. 2009; 181 ([discussion 8–9]): 492-498
        • Bakal C.W.
        • Cynamon J.
        • Lakritz P.S.
        • Sprayregen S.
        Value of preoperative renal artery embolization in reducing blood transfusion requirements during nephrectomy for renal cell carcinoma.
        J Vasc Interv Radiol. 1993; 4: 727-731
        • Zielinski H.
        • Szmigielski S.
        • Petrovich Z.
        Comparison of preoperative embolization followed by radical nephrectomy with radical nephrectomy alone for renal cell carcinoma.
        Am J Clin Oncol. 2000; 23: 6-12
        • Sauk S.
        • Zuckerman D.A.
        Renal artery embolization.
        Semin Interv Radiol. 2011; 28: 396-406
        • Shinohara N.
        • Kotegawa M.
        • Kiyohara Y.
        • Kato I.
        • Iwamoto H.
        • Jinnouchi J.
        • et al.
        An autopsy case of pulmonary embolism due to renal angiomyolipoma in an elderly woman.
        Nihon Ronen Igakkai Zasshi. 1999; 36: 420-424
        • Li X.
        • Liu R.
        • He D.
        Malignant epithelioid angiomyolipoma invading the inferior vena cava: using a temporary vena cava filter to prevent tumour emboli during nephrectomy.
        Can Urol Assoc J. 2014; 8: E564-E566
        • Yang Y.
        • Sun S.
        • Xiao X.
        • Song Y.
        • Cai W.
        • Wang M.
        • et al.
        Temporary balloon occlusion of inferior vena cava in resection of renal tumor with vena cava thrombus extension.
        Urology. 2009; 73: 645-648
        • Ramon J.
        • Rimon U.
        • Garniek A.
        • Golan G.
        • Bensaid P.
        • Kitrey N.D.
        • et al.
        Renal angiomyolipoma: long-term results following selective arterial embolization.
        Eur Urol. 2009; 55: 1155-1161
        • Van Ha T.G.
        Complications of inferior vena caval filters.
        Semin Interv Radiol. 2006; 23: 150-155