Several renal artery techniques can be performed, such as partial renal artery embolization, superselective embolization or total embolizazion. Partial renal artery embolization techniques are used when it is desirable to eliminate vascular supply to a portion of the kidney with the goal of minimizing the destruction of functioning kidney. This can be accomplished by selective catheterization selleck kinase inhibitor of segmental/lobar renal artery branches supplying a lesion. Embolization of such arteries may cause segmental infarcts of the kidney. Alternatively, superselective embolization can provide controlled occlusion of specific minuscule renal artery branches that feed a lesion, with minimal compromise of surrounding normal vascularization.
On the other hand, the goal of total embolization is complete obliteration of renal function or elimination of blood supply to tumors that involve a large portion of the renal parenchyma (14). The benefits of renal artery embolization before nephrectomy for renal cell carcinoma include immunologic response and decreased tumor size and vascularity, thereby enabling less extensive surgical resection and intraoperative blood loss. In addition, embolization results in oedema of the kidney and tumor, which facilitates its resection (15). Schwartz et Al suggest that the optimum delay to surgery after RAE is 24�C48 hours to maximize the benefits of tissue oedema, to allow the surgeon to proceed before collateral vessels formed and to minimize the period of post-infarction syndrome (8).
However, May et Al indicate that preoperative renal artery embolization does not improve the survival of patients after surgery in renal cell carcinoma (16). Complications such incomplete embolization, coil migration, and groin hematomas occur in less than 2% of patients after RAE. Inadvertent nontarget embolization can result in spine, lower extremity, and bowel infarction. Similarly, large embolization agent reflux associated with subselective techniques resulting in loss of renal function kidney and PVA embolization causing pulmonary embolism and hypertension are other known adverse outcomes of renal artery embolization. Overall, the incidence of infection related to renal artery embolization is very low (15). Also uncommon after renal artery embolization for tumors is necrosis requiring percutaneous drainage (17).
Post-infarction syndrome is a very common occurrence after renal artery embolization, particularly with complete embolization, for which over 90% of patients are afflicted. The syndrome is generally mild and consists of flank pain, fever, nausea or vomiting, and elevated Batimastat white blood cell count beginning 1�C3 days after renal artery embolization. Treatment is symptomatic and consists of analgesics, antipyretics, and antiemetics as needed, although spontaneous resolution occurs within several days (18).