Safety and efficacy of transcatheter arterial embolization in renal angiomyolipomas: a systematic review and meta-analysis.

Abstract

Purpose: Transcatheter arterial embolization (TAE) is increasingly utilized in the management of renal angiomyolipomas (AML). However, the growth in its application has not been matched by a proportional increase in the level of evidence validating its safety and efficacy. This meta-analysis aims to evaluate TAE in managing renal AMLs by examining the effects of tumour size reduction and technical success.

Methods: A literature search of several databases was conducted from inception to July 2023. Eligible studies reported adult patients (≥ 18 years old) who underwent TAE for renal AML. The pooled proportions were analyzed using a random-effects model. This review was registered in PROSPERO (CRD42023441331).

Results: A total of 32 studies comprising 1087 patients were included. The average preoperative tumour size across renal AMLs was 8.79 cm (95% CI: 7.64, 9.93; I² = 97%) and the post-operative tumour size was 6.47 cm (95% CI: 5.44, 7.50; I² = 98%). The mean decrease in tumour size was 1.85 cm (95% CI: 1.69, 2.00; I² = 23%), whereas the mean reduction in tumour size percentage was 43.30% (95% CI: 34.30, 52.30; I² = 98%). The technical success rate from 1059 embolizations was 95.70% (95% CI: 0.94, 0.97; I² = 44%), with 65 procedural failures reported.

Conclusion: This meta-analysis provides insights into the efficacy of TAE for renal AMLs, emphasizing notable tumour size reduction and a high technical success rate for selected patients. Despite identified biases, the findings support TAE as a valuable intervention, warranting further research to refine safety profiles and optimize patient outcomes.