Embolization of polycystic kidneys as an alternative to nephrectomy before renal transplantation: a pilot study.

In autosomal polycystic kidney disease, nephrectomy is required before transplantation if kidney volume is excessive. We evaluated the effectiveness of transcatheter arterial embolization (TAE) to obtain sufficient volume reduction for graft implantation. From March 2007 to December 2009, 25 patients with kidneys descending below the iliac crest had unilateral renal TAE associated with a postembolization syndrome protocol. Volume reduction was evaluated by CT before, 3, and 6 months after embolization. The strategy was considered a success if the temporary contraindication for renal transplantation could be withdrawn within 6 months after TAE. TAE was well tolerated and the objective was reached in 21 patients. The temporary contraindication for transplantation was withdrawn within 3 months after TAE in 9 patients and within 6 months in 12 additional patients. The mean reduction in volume was 42% at 3 months (p = 0.01) and 54% at 6 months (p = 0.001). One patient required a cyst sclerosis to reach the objective. The absence of sufficient volume reduction was due to an excessive basal renal volume, a missed accessory artery and/or renal artery revascularization. Embolization of enlarged polycystic kidneys appears to be an advantageous alternative to nephrectomy before renal transplantation.

[Role of embolization in renal angiomyolipomas]. / Rôle de l'embolisation dans les angiomyolipomes du rein.

OBJECTIVE: The purpose of this study is to present the role of embolization in the treatment of renal angiomyolipoma (AML) in cases of hemorrhage and to prevent bleeding. METHODS: Over a period of 10 years, 35 AMLs in 34 patients, recruited in two medical centers, were treated with embolization: 16/35 AML were treated urgently to stop bleeding, and 19/35 AML had preventive embolization. Six patients were completely asymptomatic and 13 had a history of previous hematoma or flank pain. Catheterization was highly selective in all cases (coaxial microcatheter in 19 cases), and for embolization we used nonresorbable microparticles, coils, and alcohol. RESULTS: When patients presented with acute bleeding, embolization was efficient in 80% of cases; another embolization was necessary in two cases, and surgery in two others. In six of these cases, surgery was planned and done at a later date. When treatment was preventive, one embolization was necessary in 17 cases, and two embolizations per case were necessary in the other two. Over a period of 18 months of follow-up, we observed a 28% decrease in tumor volume; four patients were treated by surgery at a later date. CONCLUSION: Embolization is the technique of choice to treat a bleeding AML urgently. When preventive treatment is considered, in symptomatic or asymptomatic AML, embolization can be an alternative for surgery, but more data is needed to specify its proper place in the management of these tumors.

[Imaging of the lower limb veins: when and how?]. / Quand et comment réaliser une imagerie des veines des membres?

Evaluation for possible lower limb deep venous thrombosis (DVT) is a very frequently requested examination. In France, imaging diagnosis is essentially based on complete Doppler sonographic evaluation of both lower limbs. In patients with no co-morbid condition, the D-dimer assay is useful to exclude the possibility of DVT. A positive diagnosis of DVT is based on the lack of venous compressibility and abnormal Doppler signal. The diagnostic accuracy relies on adequate knowledge of vascular anatomy and sufficient training, especially at the calf level. For experienced sonographers, the accuracy is similar at the thigh and calf level. In patients with suspected pulmonary embolus, evaluation of the lower extremity veins is mandatory and frequently performed with CT immediately following CT pulmonary angiography. However, this examination has not been validated yet.