Embolotherapy for Renal Tumors

  • Rahmi Oklu
  • Sanjeeva P. Kalva


Embolotherapy of renal neoplasms is practiced for various hypervascular tumors including angiomyolipoma, renal cell carcinoma, and metastatic renal cancer. First conceived during 1970s, it was primarily advocated for palliative therapy of symptomatic renal cell carcinomas [1]. Currently, the indications for embolotherapy of malignant renal tumors include, in addition to palliation, preoperative treatment of large renal tumors to reduce intraoperative blood loss, and as an adjunct to radiofrequency ablation to reduce perfusion mediated cooling for a more effective ablation [2, 3]. Embolization of large hypervascular tumors prior to nephrectomy has been shown to significantly reduce the volume of blood transfused during surgery compared to those patients with tumors not embolized or incompletely embolized [2, 4]. In addition, preoperative embolization facilitates surgical dissection. Edema induced by embolization creates a definable plane within the renal parenchyma, and this reduces operative time [4, 5]. In patients with renal cell cancer extending to the renal vein, preoperative embolization may reduce the size of the tumor thrombus making it easier to resect [6, 7]. Though it has not been clinically proven, it is believed that embolization may induce sufficient inflammation, which may accentuate immune response to the tumor [8]. As a palliative measure, embolization helps in the management of pain, hematuria, and paraneoplastic syndromes such as hypercalcemia [9]. In patients with angiomyolipoma, embolotherapy is indicated for treatment of acute bleeding [10]. It helps to avoid nephrectomy and preserves renal function [10]. In addition, prophylactic embolization is often advocated in large angiomyolipomas (size >4 cm) to prevent bleeding and renal dysfunction [11].


Renal Cell Carcinoma Renal Tumor Embolic Agent Arteriovenous Shunt Laparoscopic Partial Nephrectomy 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. 1.
    Goldstein HM, Medellin H, Beydoun MT, et al. Transcatheter embolization of renal cell carcinoma. Am J Roentgenol Radium Ther Nucl Med. 1975;123:557–62.PubMedGoogle Scholar
  2. 2.
    Kalman D, Varenhorst E. The role of arterial embolization in renal cell carcinoma. Scand J Urol Nephrol. 1999;33:62–70.Google Scholar
  3. 3.
    Hoffmann RT, Jakobs TF, Kubisch CH, et al. Renal cell carcinoma in patients with a solitary kidney after nephrectomy treated with ­radiofrequency ablation: mid term results. Eur J Radiol. 2010;73(3):652–6.PubMedCrossRefGoogle Scholar
  4. 4.
    Bakal CW, Cynamon J, Lakritz PS, Sprayregen S. Value of preoperative renal artery embolization in reducing blood transfusion requirements during nephrectomy for renal cell carcinoma. J Vasc Interv Radiol. 1993;4:727–31.PubMedCrossRefGoogle Scholar
  5. 5.
    Klimberg I, Hunter P, Hawkins IF, Drylie DM, Wajsman Z. Preoperative angioinfarction of localized renal cell carcinoma using absolute ethanol. J Urol. 1985;133:21–4.PubMedGoogle Scholar
  6. 6.
    Blute ML, Leibovich BC, Lohse CM, Cheville JC, Zincke H. The Mayo Clinic experience with surgical management, complications and outcome for patients with renal cell carcinoma and venous tumour thrombus. BJU Int. 2004;94:33–41.PubMedCrossRefGoogle Scholar
  7. 7.
    Haferkamp A, Bastian PJ, Jakobi H, et al. Renal cell carcinoma with tumor thrombus extension into the vena cava: prospective long-term followup. J Urol. 2007;177:1703–8.PubMedCrossRefGoogle Scholar
  8. 8.
    McDermott DF. Immunotherapy of metastatic renal cell carcinoma. Cancer. 2009;115:2298–305.PubMedCrossRefGoogle Scholar
  9. 9.
    Maxwell NJ, Saleem-Amer N, Rogers E, Kiely D, Sweeney P, Brady AP. Renal artery embolisation in the palliative treatment of renal carcinoma. Br J Radiol. 2007;80:96–102.PubMedCrossRefGoogle Scholar
  10. 10.
    Hamlin JA, Smith DC, Taylor FC, McKinney JM, Ruckle HC, Hadley HR. Renal angiomyolipomas: long-term follow-up of embolization for acute hemorrhage. Can Assoc Radiol J. 1997;48:191–8.PubMedGoogle Scholar
  11. 11.
    Soulen MC, Faykus Jr MH, Shlansky-Goldberg RD, Wein AJ, Cope C. Elective embolization for prevention of hemorrhage from renal angiomyolipomas. J Vasc Interv Radiol. 1994;5:587–91.PubMedCrossRefGoogle Scholar
  12. 12.
    Lammer J, Justich E, Schreyer H, Pettek R. Complications of renal tumor embolization. Cardiovasc Intervent Radiol. 1985;8:31–5.PubMedCrossRefGoogle Scholar
  13. 13.
    Sweeney P, Wood CG, Pisters LL, et al. Surgical management of renal cell carcinoma associated with complex inferior vena caval thrombi. Urol Oncol. 2003;21:327–33.PubMedCrossRefGoogle Scholar
  14. 14.
    Simone G, Papalia R, Guaglianone S, Forestiere E, Gallucci M. Preoperative superselective transarterial embolization in laparoscopic partial nephrectomy: technique, oncologic, and functional outcomes. J Endourol. 2009;23:1473–8.PubMedCrossRefGoogle Scholar
  15. 15.
    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.PubMedCrossRefGoogle Scholar
  16. 16.
    Onishi T, Oishi Y, Suzuki Y, Asano K. Prognostic evaluation of transcatheter arterial embolization for unresectable renal cell carcinoma with distant metastasis. BJU Int. 2001;87:312–5.PubMedCrossRefGoogle Scholar
  17. 17.
    Yamakado K, Nakatsuka A, Kobayashi S, et al. Radiofrequency ablation combined with renal arterial embolization for the treatment of unresectable renal cell carcinoma larger than 3.5 cm: initial experience. Cardiovasc Intervent Radiol. 2006;29:389–94.PubMedCrossRefGoogle Scholar
  18. 18.
    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;105:390–4.PubMedCrossRefGoogle Scholar
  19. 19.
    Sooriakumaran P, Gibbs P, Coughlin G, et al. Angiomyolipomata: challenges, solutions, and future prospects based on over 100 cases treated. BJU Int. 2010;105(1):101–6.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  1. 1.Division of Vascular Imaging and Interventions, Department of ImagingMassachusetts General Hospital, Harvard Medical SchoolBostonUSA

Personalised recommendations