Angiomyolipoma surgery

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [2] Associate Editor(s)-in-Chief: Faizan Sheraz, M.D. [3]

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.

Transcatheter Arterial Embolization

• Proximal Embolization
  • These are appropriate for the occlusion of a large lumen without distal migration
• Distal Embolization
  • These are appropriate for the occlusion of a large lumen with distal migration
• Palliative Embolization
  • Embolization in patients with end-stage renal disease

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  D

• 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.

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 angiomyolipomas, that have been symptomatic, can be electively resected with a partial nephrectomy.