Transarterial Embolization of Angiomyolipoma - A Systematic Review.

INTRODUCTION: Transarterial embolization (TAE) is increasingly used in the management of renal angiomyolipoma (AML). The level of evidence establishing the safety and efficacy of TAE has not increased in parallel. MATERIALS AND METHODS: Using the MOOSE criteria, a systematic review of transarterial embolization of angiomyolipoma was performed to establish procedural safety and efficacy. MEDLINE PubMed search revealed 1739 publications, of which 31 studies met eligibility criteria. RESULTS: 524 cases of TAE of AML were included. Self-limiting post-embolization syndrome occurred following 35.9%. Further morbidity occurred in 6.9%. No procedural mortality was reported. At a mean follow-up period of 39 months, mean size reduction was 3.4 cm (-38.3% of AML diameter). Unplanned repeat embolization or surgery was required in 20.9% during this period. The most frequent indications for repeat procedures include angiomyolipoma revascularization (30.0%), unchanged or increasing size (22.6%), refractory or recurring symptoms (16.7%), and representation with acute retroperitoneal hemorrhage (14.3%). A combination of two or more embolic agents was used in 46.8%, ethanol monotherapy in 41.7%, coil monotherapy in 6.2%, and foam or microparticle monotherapy in 5.2%. CONCLUSIONS: Transarterial embolization of angiomyolipoma demonstrates low rates of mortality and serious complications. Retreatment rates and size reduction at a mean follow-up duration of 39 months are presented. Longitudinal data assessing long-term size reduction and retreatment rates are lacking, recommendations guiding the indications for transarterial embolization and clear follow-up require further longitudinal data.