Transarterial embolization and ablation of renal arteriovenous malformations: efficacy and damages in 30 patients with long-term followup

J Urol. 1998 Mar;159(3):696-701. doi: 10.1016/s0022-5347(01)63703-0.

Abstract

Purpose: We evaluate the long-term efficacy and side effects of transarterial embolization and ablation for renal arteriovenous malformations.

Materials and methods: A total of 30 patients with cirsoid arteriovenous malformations causing massive hematuria underwent 34 procedures of embolization or ablation. We confirmed the ratios of occluded arteriovenous malformation areas on angiograms and those of infarcted areas on computerized tomography. All patients were followed for 4.1 to 15.0 years (mean 8.0 +/- 2.8) after the initial procedures.

Results: Hematuria ceased in all patients after the initial procedures, including partial embolization or ablation of the arteriovenous malformations in 8. Massive hematuria recurred in 4 patients, who had undergone absorbable gelatin sponge (2), embolization, combined alcohol and subselective absorbable gelatin sponge embolization (1) and polyvinyl alcohol particles embolization (1). In these 4 cases total ablation of the arteriovenous malformations with alcohol was successful. In 29 patients, including aforementioned 4, no hematuria recurred after 5 years following total or partial ablation with alcohol. Large nontarget embolization with reflux of subselectively infused absorbable gelatin sponge caused a nonfunctioning kidney in 1 patient. The remaining 33 procedures caused 6.3 to 48.0% (mean 15.7 +/- 6.9%) areas of renal infarction. Polyvinyl alcohol embolization caused pulmonary embolism and renin dependent hypertension.

Conclusions: Partial or total transarterial ablation of arteriovenous malformations with alcohol proved effective for long-term cessation of hematuria. However, this procedure as well as transarterial embolization has the potential risk of nontarget infarction.

Publication types

  • Comment

MeSH terms

  • Adult
  • Aged
  • Arteriovenous Malformations / complications
  • Arteriovenous Malformations / diagnostic imaging
  • Arteriovenous Malformations / surgery
  • Arteriovenous Malformations / therapy*
  • Catheter Ablation*
  • Embolization, Therapeutic* / adverse effects
  • Ethanol / therapeutic use
  • Female
  • Follow-Up Studies
  • Hematuria / etiology
  • Humans
  • Infarction / etiology
  • Kidney / blood supply
  • Male
  • Middle Aged
  • Radiography
  • Recurrence
  • Renal Artery / abnormalities*
  • Renal Artery / surgery
  • Renal Veins / abnormalities*
  • Renal Veins / surgery
  • Treatment Outcome

Substances

  • Ethanol