embolization of kidney angiomyolipomas indication and interest
DESCRIPTION
H. EL MORABIT, N. EL YOUSFI, S. BOUKLATA. Medical emergency imagery IBN SINA Hospital. EMBOLIZATION OF Kidney ANGIOMYOLIPOMAS indication and INTEREST . INTERVENTIONAL : INTV1. INTV1. INTRODUCTION. Angiomyolipoma (AML) = benign tumor - PowerPoint PPT PresentationTRANSCRIPT
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EMBOLIZATION OF KIDNEY ANGIOMYOLIPOMAS
INDICATION AND INTEREST
H. EL MORABIT, N. EL YOUSFI, S. BOUKLATA.Medical emergency imagery
IBN SINA Hospital.
INTERVENTIONAL : INTV1
INTV1
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INTRODUCTION
Angiomyolipoma (AML) = benign tumorbleeding risk => into life-threatening patient Support hemorrhagic’s AML = first embolization for hemostasisAML asymptomatic or minimally symptomatic = discussion topic :
• Diameter < 4 cm : surveillance• Diameter > 4 cm : preventive
embolization instead of surgery (increased risk of bleeding).
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MATERIALS AND METHODS
03 patients : 01 men et 02 women Mean age = 30 years. Helical CT without and after injection MRI. The materials used for embolization :
– Nonabsorbable particles Embosphère calibrated in two patients
– " metal Spires" in third patient After global and selective arteriography
scanned
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RESULTS
efficient Embolization immediately in the group treated with Embosphère (judged on biological data, hemodynamic and radiological controls on post-embolization).
Recovery in patient treated / spires.
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DISCUSSION
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The AML kidney = tumor made of varying proportions of :
Adipose tissue, Smooth muscle cells, Abnormal vessels.
Classified as "tumor lesion" from perivascular epithelioid cells (PECOME)
Found in two clinical situations:• 80% sporadic (unilateral female predominance)• 20% congenital (bilateral, affecting both
sexes)
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Tumor↑ volume gradually=> risk of hemorrhagic rupture This bleeding risk depends on :• Size,• Multifocality,• Presence of intra
lesional aneurysms and their size
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KIDNEY EMBOLIZATION : Purpose vascular obstruction / of the
catheters or various materials with the respect of parenchyma,
Localized or diffuse, temporary or permanent,
↑ frequency in the treatment of AML for three main reasons:• Benign tumor, • Symptoms often due to hemorrhage• Embolization can preserve the healthy
renal parenchyma
↑
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Catheters use=> hyperselective embolization interesting the feeder arterial branches of the tumor => ↓ risk of ischemic of the healthy parenchyma
Place of hemostasis embolization +++ in initial management of acute hemorrhagic AML => bleeding stops + not use nephrectomy hemostasis.
Reduction in size after the AML embolization = classic
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The success embolization Criteria : ↓the AML size ↓vascular component, on
acquisitions in scaner or MRI after injection of contrast product,
Absence of occurrence of bleeding episode after a prolonged clinical follow-up.
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The post-embolic complications: related to the
procedure intervention itself and the catheterization maneuvers,
related to the consequences of ischemia tumor
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CONCLUSION
Hemostasis Embolization = method to manage the emergency hemorrhagic AML .
Préventive Embolization alternative to surgery in the treatment of AML > 4 cm, symptomatic or not, or preparation for surgery
Supportcloses coordination between urologists and radiologists.