Efficacy of iodized oil in emergency ultraselective arterial embolization for fatal massive hemorrhage due to renal angiomyolipoma: a single-center retrospective cohort study.

Abstract

Background: In recent years, the area of minimally invasive, targeted therapy for kidney tumors has seen considerable advancement; however, little progress has been made in the evaluation of renal angiomyolipoma (RAML). We aimed to investigate the efficacy of emergency ultraselective arterial embolization for the treatment of fatal massive bleeding caused by RAML.

Methods: At The First Hospital of Jilin University, a retrospective study was conducted between January 1, 2019 and March 1, 2024. The enrolled patients were those experiencing intense flank pain with a ruptured RAML and hemorrhage as confirmed through computed tomography (CT) and magnetic resonance imaging (MRI) in the emergency department. We performed renal arteriography and vascular ultraselective embolization in patients with ruptured and bleeding RAML. Patient information, including age, sex, tumor size, embolic material, several blood laboratory parameters, and postembolization syndrome (PES) occurrence, was retrospectively analyzed. PES was defined as the occurrence of fever, pain, nausea, or vomiting.

Results: This study ultimately enrolled 27 patients. After emergency embolization, 27 patients had 100% stable red blood cells and hemoglobin, and 7 patients had a single lesion and underwent surgical resection after the bleeding was stabilized. After emergency embolization, 22 patients experienced relief of low back pain as compared to pretreatment conditions, and the rate of lower back pain relief was 81.48%. Significantly higher creatinine and urea nitrogen levels were observed in three patients prior to the operation, and these levels reverted to their original state after renal function protection therapy. Despite varying levels of PES, all of the patients' symptoms returned to their normal levels following symptomatic treatment, with no significant impact on their quality of life or recovery period.

Conclusions: Emergency ultraselective arterial embolization for the treatment of bleeding in fatal RAML is safe, rapid, and effective and has few complications. The use of iodized oil can not only serve an embolic function but also provide a tracer effect in subsequent reexamination.