Giant renal angiomyolipomas – Can they be managed safely through minimally invasive selective angioembolisation? Case series and literature review

Abstract

Objective: The objective was to determine whether giant renal angiomyolipomas (AMLs) can be managed through selective angioembolisation (SA) and compare outcomes to nephron-sparing surgery (NSS) and nephrectomy. Methods: A retrospective case series was compiled from a prospectively maintained database, commenced in 2011 of renal AMLs that underwent SA. We extracted patient demographics, size of AMLs, intervention and outcomes. A literature review of case reports and case series was performed on the management of giant renal AMLs managed through SA, NSS or nephrectomy. Results: Of 30 AMLs that underwent SA, 6 patients met the inclusion criteria. The mean diameter of AMLs prior to embolisation was 14.3 cm. All embolised AMLs decreased in size post-embolisation by an average of 18% (mean: 39-month follow-up). There were no complications in our cohort’s follow-up period, including no rise in any patients’ creatinine associated with SA. Our literature review of 284 articles found 82 articles pertaining to 102 giant renal AMLs. Our review identified SA, NSS and nephrectomy to all be effective management pathways for giant AMLs with minimal complications. Total nephrectomy did result in five patients requiring dialysis post-procedure. Conclusions: SA is an effective intervention for giant AMLs with comparable outcomes to NSS and nephrectomy and should be considered a suitable management option for giant renal AMLs. Level of evidence: Not applicable