Simon McQueen1*, Alexander Coombes2, David Benz1
Background: Renal Angiomyolipoma (AML) are vascular tumors that while histologically benign, carry a risk of potentially life threatening haemorrhage. Selective Arterial Embolization (SAE) has been demonstrated as effective treatment, however given most tumours are asymptomatic the challenge facing clinicians is in selection of which AML should undergo treatment. Historically size criteria have been used, but other factors such as tumour vascularity may help guide treatment choices.
Methods: Retrospective cohort analysis of all SAE treated AML at our quaternary level institution in the last ten years, evaluating tumour size, presence of intratumoral aneurysm and aneurysm size as a predictor of spontaneous haemorrhage.
Results: Twenty-seven renal AML underwent SAE. Five tumours had presented with spontaneous haemorrhage. Mean tumour size was 75.4 mm; there was no statistically significant size difference between ruptured and unruptured AML in our study population. 80% of ruptured AML contained at least one intratumoral aneurysm, 27% of unruptured contained an aneurysm (p-value <0.05). Mean aneurysm size in ruptured AMLs was 5.4 mm, unruptured 4.6 mm (p-value>0.05).
Conclusion: The presence of intratumoral aneurysm is a useful predictor for AML that are at risk of spontaneous haemorrhage, and should therefore be considered when selecting patients to undergo SAE.
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