D Kunj B Pa el e al. Long- e m ou comes o selec i e a e ial emboliza ion in gian enal angiomyolipoma: a
e ospec i e single-cen e s udy. In . J Med. Pha m. Res., 6 (6): 226‐233, 2025
226
In e na ional Jou nal o Medical
and Pha maceu ical Resea ch
Online ISSN-2958-3683 | P in ISSN-2958-3675
F equency: Bi-Mon hly
A ailable online on: h ps://ijmp .in/
O iginal A icle
Long- e m ou comes o selec i e a e ial emboliza ion in gian enal
angiomyolipoma: a e ospec i e single-cen e s udy
D Kunj B Pa el1, D Ashish Ranjan2, D A pan Yada 3, D Sanchi Rus agi4, D Sanjoy Su eka5, D Uday P a ap Singh6
1‐6 Depa men o U ology and Renal T ansplan a ion, Sanjay Gandhi Pos G adua e Ins i u e o Medical Sciences, Lucknow, U a
P adesh – 226014
A B S T R A C T
Co esponding Au ho :
D Uday P a ap Singh
Depa men o U ology and Renal
T ansplan a ion, Sanjay Gandhi
Pos G adua e Ins i u e o Medical
Sciences, Lucknow, U a P adesh
– 226014.
Recei ed: 17‐09‐2025
Accep ed: 05‐10‐2025
A ailable online: 12‐11‐2025
Objec i es: To e alua e he long- e m ou comes o selec i e ans-a e ial
emboliza ion (TAE) in pa ien s wi h gian (≥10 cm in size) enal angiomyolipomas
(AMLs) a ou e ia y e e al cen e .
Me hods: This e ospec i e, single-cen e s udy included 44 pa ien s who
unde wen selec i e TAE o AMLs o ≥10 cm size be ween July 2018 and June
2024. Collec ed da a included demog aphics, umo cha ac e is ics, clinical
symp oms, ype o in e en ion, umo size be o e and a e emboliza ion, and enal
unc ion. Ou comes assessed we e umo size educ ion, p ese a ion o enal
unc ion, ein e en ion a es du ing ollow-up and complica ions ollowing SAE.
Resul s: The s udy included 46 umo s in 44 pa ien s. Mean pa ien age was 40.4
yea s ( ange:23–60), wi h 86.3% being emales. Mean ollow-up du a ion was 25.2
mon hs ( ange:6–70 mon hs). Ele en pa ien s (25%) we e associa ed wi h TSC, and
all we e o e ed E e olimus pos ope a i ely. The mean umo size dec eased
signi ican ly om 13.2 ± 3.12 cm p e-emboliza ion o 10.3 ± 2.45 cm pos -
emboliza ion (p =0.003). Renal unc ion emained s able du ing ollow-up, wi h no
signi ican changes in se um c ea inine (p = 0.6) and eGFR (p = 0.8). The o e all
success a e was 84.7%, wi h 13.6% expe iencing e in e en ion. Complica ions
included pos -emboliza ion synd ome (43.1%) and alle gic eac ions (6.8%), while
one pa ien equi ed neph ec omy due o a pe ineph ic abscess.
Conclusions: Selec i e TAE is a sa e and e ec i e ea men o gian enal AMLs,
esul ing in signi ican umo size educ ion, symp om elie , and p ese a ion o
enal unc ion. I o e s a minimally in asi e al e na i e o adi ional su gical
app oaches, pa icula ly o pa ien s wi h high su gical isk o hose equi ing
neph on-spa ing p ocedu e.
Copy igh © In e na ional Jou nal o
Medical and Pha maceu ical Resea ch
Keywo ds: Gian Renal Angiomyolipomas (gAMLs), Selec i e ans‐a e ial
angioemboliza ion (TAE), Tube ous scle osis complex (TSC).
INTRODUCTION
Renal angiomyolipoma ( AML) is a benign enal mesenchymal umo o he kidney, mo e commonly obse ed in emales.
The o e all p e alence o AMLs in he gene al popula ion anges om 0.2% o 0.6% [1]. App oxima ely 80% o enal
AMLs a e spo adic, while he emaining 20% a e associa ed wi h ube ous scle osis complex (TSC) o pulmona y
lymphangioleiomyoma osis (LAM), bo h a e a e gene ic condi ions. [2-3] His ologically, angiomyolipomas (AMLs) consis
o a ying amoun s o adipose issue, blood essels, and smoo h muscle cells. [4]
Imaging plays a c ucial ole in he diagnosis and managemen o enal AMLs. These umo s classically diagnosed by he
cha ac e is ic p esence o a on compu ed omog aphy (CT), magne ic esonance imaging (MRI) o ul asonog aphy (US)
o he kidneys. [5]
Angiomyolipomas (AMLs) a e p one o spon aneous up u e due o hei o uous, aneu ysma ic a e ies, which can cause
pain, haema u ia, e ope i oneal haemo hage, o e en dea h. Al hough benign in na u e, AMLs ca y signi ican isks
du ing p egnancy and when lesions a e la ge han 4 cm, wa an ing p ophylac ic ea men o p e en up u e. [6] AMLs
D Kunj B Pa el e al. Long- e m ou comes o selec i e a e ial emboliza ion in gian enal angiomyolipoma: a
e ospec i e single-cen e s udy. In . J Med. Pha m. Res., 6 (6): 226‐233, 2025
227
wi h ube ous scle osis complex (TSC) can be ea ed wi h mammalian a ge o apamycin (mTOR) inhibi o s such as
E e olimus. [7]
T adi ional su gical op ions include open o lapa oscopic umo emo al ia neph on-spa ing su ge y o o al neph ec omy,
wi h he la e ese ed o la ge o complex umo s. Minimal in asi e ea men s include c yo-and adio equency abla ion
o selec i e endo ascula ans-a e ial emboliza ion (TAE). [8] Selec i e TAE is a less in asi e al e na i e o su ge y,
o e ing a ge ed ea men o bleeding essels wi h a low isk o se ious complica ions. This minimally in asi e p ocedu e
has been he p e e ed app oach o enal AMLs o many yea s. [9]
Despi e i s g owing u iliza ion, limi ed da a a e a ailable on he long- e m e icacy and sa e y o TAE, pa icula ly in he
managemen o gian AMLs. [10-11]
This s udy aims o e alua e he long- e m ou comes o selec i e ans-a e ial angioemboliza ion (TAE) in pa ien s wi h
gian (≥10 cm in size) enal angiomyolipomas (AMLs) a ou e ia y e e al cen e.
MATERIALS AND METHODS
S udy Design and pa ien s:
This s udy included all pa ien s who unde wen p ophylac ic o eme gency ea men wi h selec i e TAE o AMLs o ≥
10 cm size a ou ins i u e be ween July 2018 o June 2024. A o al o 52 pa ien s we e ini ially iden i ied, bu 4 we e
excluded due o missing clinical documen s, and 4 we e los o ollow-up, lea ing 44 pa ien s o inal analysis. HIS
(hospi al in o ma ion sys em) eco ds we e used o collec all da a un il June 2024. The adiological and clinical ollow-up
pe iod in his s udy was de ined as he ime in e al om he selec i e a e ial emboliza ion (SAE) p ocedu e un il June
2024. This s udy ecei ed app o al om ins i u e e hical commi ee. (2023-114-Mch-EXP-22)
We collec ed demog aphic da a, including age, gende , ype o AML (spo adic o TSC-associa ed), la e ali y, lesion loca ion
and numbe , and he ype o in e en ion (p ophylac ic o eme gency o acu e bleeding AMLs). Clinical symp oms and
complica ions we e eco ded be o e and a e selec i e a e ial emboliza ion (SAE), along wi h any need o ein e en ion
on ollow up (ei he due o he ecu ence o symp oms o umo size inc ease o mo e han 2 cm on ollow-up imaging).
Labo a o y e alua ions included comple e blood coun , coagula ion p o ile, and se um c ea inine le els be o e SAE and
du ing he ollow-up pe iod.
T iple phase compu ed omog aphy (CT) o magne ic esonance imaging (MRI) we e pe o med o all pa ien s p io o
emboliza ion. Tumo size and ascula i y, bo h be o e and a e emboliza ion, was assessed by an expe ienced adiologis .
The inal umo size a e emboliza ion was de e mined om he mos ecen a ailable imaging (CT/MRI) un il June 2024.
Maximum umo diame e on axial CT/MR scans was used o documen a ion. Tumo measu emen s we e aken a a ious
poin s du ing he ollow-up pe iod.
Selec i e A e ial Emboliza ion:
TAE was pe o med h ough he common emo al a e y unde local anes hesia using modi ied Seldinge ’s echnique. A 5
F diagnos ic ca he e was used o selec i e enal a e iog aphy. Mic oca he e was used o supe -selec i e ca he e iza ion
and emboliza ion o he eeding a e y o a e ies. Pa icula e agen s, such as nonsphe ical poly inyl alcohol (nsPVA) 355–
500μm o 250 μm mic osphe es, we e used o emboliza ion (Fig.1). In selec ed cases, one o mo e mic ocoils we e used
in combina ion wi h pa icles o ea mic oaneu ysms.
Follow-up:
All medical eco ds and ou pa ien cha s we e e iewed. Follow-up da a, including clinical examina ions and labo a o y
es s, we e ob ained om he Hospi al In o ma ion Sys em (HIS). CT o MRI scans we e ypically pe o med 3–6 mon hs
a e SAE and annually he ea e . T ea men ailu e (need o ein e en ion) was de ined as he ecu ence o symp oms
and/o an inc ease in umo size g ea e han 2 cm on ollow-up.
Ou come:
The p ima y ou comes o ou s udy included umo size educ ion, p ese a ion o enal unc ion, and low ein e en ion
a e ollowing SAE o gian AMLs. The seconda y ou come was he limi ed pe iope a i e complica ions.
S a is ical analysis:
Ve sion 25.0 o he IBM SPSS® so wa e package o Windows was used o conduc he analysis. Numbe s (n) and
pe cen ages (%) we e used o cha ac e ize he quali a i e da a, and he Chi-Squa e, Fische Exac , and Mon e Ca lo es s
we e used o analysis. The mean±SD o pa ame ic da a and he median ( ange) [minimum and maximum] o
nonpa ame ic da a we e used o cha ac e ize he quan i a i e da a.
D Kunj B Pa el e al. Long- e m ou comes o selec i e a e ial emboliza ion in gian enal angiomyolipoma: a
e ospec i e single-cen e s udy. In . J Med. Pha m. Res., 6 (6): 226‐233, 2025
228
RESULTS
The p esen s udy included 44 pa ien s wi h 46 AMLs ( wo pa ien s had bila e al umo >10 cm). Pa ien s ages anged om
23-60 yea s wi h mean ± SD o 40.39 ± 11.8 yea s. Majo i y o pa ien s we e emales (86.3%). Pain was he mos common
symp om obse ed, while 32.6% umo s de ec ed inciden ally on imaging. Bila e al umo s we e obse ed in 12 pa ien s
(27.2%), wi h 40.9% o umo s loca ed on he igh side and 31.8% on he le side. 11(25%) pa ien s associa ed wi h TSC
complex and all we e o e ed e e olimus pos ope a i ely. 34 (77.2%) unde wen p ophylac ic SAE, while 22.7%
unde wen as an eme gency in e en ion as shown in Table 1.
Table 1: Demog aphic and Clinical cha ac e is ics o pa ien s
Demog aphic and Clinical cha ac e is ics
No. (%)
No. o pa ien s
44
No. o umou s
46
Age (yea s) (Mean ± SD)
40.39 ± 11.8
Gende
Male
06 (13.6)
Female
38 (86.3)
La e ali y
Righ
18 (40.9)
Le
14 (31.8)
Bila e al
12 (27.2)
Tube ous Scle osis
11 (25.0)
E e olimus ea men
11 (25.0)
Clinical p esen a ion
Pain
18 (39.1)
Re ope i oneal haemo hage
10 (21.7)
Haema u ia
03 (6.5)
Inciden al
15 (32.6)
Indica ion o SAE
P ophylac ic
34 (77.2)
Eme gency
10 (22.7)
Side o Emboliza ion
Righ
24 (54.5)
Le
18 (40.9)
Bila e al
02 (4.5)
Table 2: Ou comes ( umo size, kidney unc ion, success a e and complica ions) a e selec i e a e ial emboliza ion
(SAE) o enal angiomyolipomas ( AMLs)
Va iables
No. (%)
Mean±SD
p- alue
Follow-up, mon hs (Mean ± SD)
25.2 ± 17.1
Size o AMLs, cm (Mean ± SD)
Be o e SAE
13.2 ± 3.12
0.003*
A e SAE
10.3 ± 2.45
Tumo size educ ion, cm (Mean ± SD)
2.9 ± 3.97
Se um c ea inine, mg/dl (Mean ± SD)
Be o e SAE
1.0 ± 0.3
0.6
A e SAE
0.93± 0.5
e-GFR, mL/min/1.73 m2 (Mean ± SD)
Be o e SAE
76.1 ± 26.0
0.8
A e SAE
70.9 ± 22.5
Hospi al s ay (in days) (Mean ± SD)
2.2 ± 1.0
O e all success a e, n (%)
39(84.7)
(a) Re-in e en ion on ollow-up (Inc ease in umo size and/o
ecu ence o symp oms)
06 (13.6)
i. Unde wen epea angioemboliza ion
04(9.09)
ii. Unde wen pa ial neph ec omy
02(4.5)
(b) Pe ineph ic abscess o ma ion and unde wen o al neph ec omy
01 (2.2)
Complica ions (wi hin mon hs) n (%)
25(56.8)
D Kunj B Pa el e al. Long- e m ou comes o selec i e a e ial emboliza ion in gian enal angiomyolipoma: a
e ospec i e single-cen e s udy. In . J Med. Pha m. Res., 6 (6): 226‐233, 2025
229
(a) Mino
i. Pos emboliza ion synd ome (PES)
19 (43.1)
ii. Alle gic eac ion
03 (6.8)
iii. Punc u e si e hema oma
02(4.5)
(b) Majo
Pe ineph ic abscess
01 (2.2)
*p- alue<0.05 is signi ican
Table 2 shows he ou comes ollowing SAE among pa ien s. The pa ien s we e ollowed un il June 2024. The mean ollow-
up was 25.2 mon hs( ange,6-70).
The educ ion in umo size was assessed based on CTs/MRIs ob ained be o e and a e SAE. The mean p eope a i e umo
size was 13.2 ± 3.12 and signi ican ly educed o 10.3± 2.45 du ing he ollow up ime (p-0.003). The change in umo size
du ing he s udy pe iod depic ed in igu e 2. The mean umo size educ ion was 2.9 ± 3.97. (Fig. 1 c,d,e, ).
The mean c ea inine le els be o e and a e SAE we e 1.0 ± 0.3 and 0.93± 0.5 espec i ely, a e a mean ollow up o 25.2
mon hs. The a ia ion was no s a is ically signi ican (p-0.6). (Fig.3). The change in e-GFR be o e and a e SAE no
s a is ically signi ican (p- 0.8). (Fig.4)
bc
e
d
a
P e-emboliza ion angiog am (DSA) o Righ kidney lowe pole AML ( enal a e y and segmen al a e y supplying he umo ), b.
Pos -emboliza ion Angiog am o he same kidney wi h nonsphe ical poly inyl alcohol pa icles (nsPVA) 355 500 m,
0
5
10
15
20
25
1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43 45
SIZE BEFORE SAE SIZE AFTER SAE
D Kunj B Pa el e al. Long- e m ou comes o selec i e a e ial emboliza ion in gian enal angiomyolipoma: a
e ospec i e single-cen e s udy. In . J Med. Pha m. Res., 6 (6): 226‐233, 2025
230
Fig 2: Compa ison o size o umo be o e and a e SAE among pa ien s
Fig 3: Compa ison o S . C ea inine be o e and a e SAE among pa ien s
Fig 4: Compa ison o e-GFR be o e and a e SAE among pa ien s
The o e all success a e was also sa is ac o y which was 84.7%. 6 (13.6%) pa ien s equi ed e-in e en ions on ollow up.
Ou o 6 pa ien s, 4 unde wen success ul epea angioemboliza ion while 2 pa ien equi ed pa ial neph ec omy a e
epea ed ailed angioemboliza ion. One pa ien de eloped a pe ineph ic abscess 3 weeks a e angioemboliza ion, which
was ini ially managed wi h in a enous an ibio ics and pe cu aneous d ainage. La e , she unde wen a o al neph ec omy
due o he kidney's non- unc ioning s a us.
The mean hospi al s ay was 2.2 days. The mos common mino complica ion obse ed was Pos emboliza ion synd ome
(PES) in 19 (43.1%) pa ien s ollowed by alle gic eac ions and punc ion si e hema oma in 3(6.8%) and 2(4.5%) pa ien s
espec i ely. All mino complica ions we e managed conse a i ely wi h NSAIDs, o al an ibio ics, and comp ession
d essings a he punc u e si e.
DISCUSSION
This s udy demons a ed a signi ican educ ion in umo size wi h p ese e enal unc ion and low ecu ence equi ing
su gical ein e en ion ollowing selec i e emboliza ion o gian enal AML. All p ocedu es we e conduc ed unde local
anes hesia, which o e s an ad an age o e su gical op ions ha ypically equi e gene al anes hesia and longe hospi al
s ays.
0
0.2
0.4
0.6
0.8
1
1.2
1.4
1.6
1.8
2
1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43 45
S.CREAT BEFORE SAE S.CREAT AFTER SAE
0
20
40
60
80
100
120
140
160
180
1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43 45
e-GFR BEFORE SAE e-GFR AFTER SAE
D Kunj B Pa el e al. Long- e m ou comes o selec i e a e ial emboliza ion in gian enal angiomyolipoma: a
e ospec i e single-cen e s udy. In . J Med. Pha m. Res., 6 (6): 226‐233, 2025
231
T adi ional su gical op ions include open o lapa oscopic umo emo al ia neph on-spa ing su ge y o o al neph ec omy.
Minimal in asi e ea men s include c yo-and adio equency abla ion o selec i e endo ascula ans-a e ial
emboliza ion (TAE).[3] Selec i e A e ial Emboliza ion (SAE) has eme ged as a new modali y o bo h p e en i e and
eme gency managemen o enal AMLs, o e ing a minimally in asi e app oach ha a ge s small a e ial eede s, a e
he i s s udy by Adle e al[12] Fu he , in 1991, Soulen e al. con i med ha emboliza ion o enal angiomyolipomas is
sa e, well ole a ed, and e ec i e in p e en ing li e- h ea ening hemo hage.[13]. The e is limi ed esea ch di ec ly
compa ing comple e neph ec omy, neph on-spa ing su ge y, and Selec i e A e ial Emboliza ion (SAE) o he ea men
o enal AMLs [14]. Compa ed o pa ial neph ec omy (12%), Selec i e A e ial Emboliza ion (SAE) o enal AMLs
demons a es lowe pos -ope a i e mo bidi y (6.9%), is minimally in asi e, and equi es a sho e hospi aliza ion pe iod
[12, 15]. Addi ionally, SAE o e s apid s abiliza ion in cases o acu e hemo hage, while p ese ing enal unc ion by spa ing
heal hy enal issue, which is especially c ucial o pa ien s wi h ube ous scle osis complex (TSC) and hose wi h bila e al
in ol emen
Li e a u e on Selec i e A e ial Emboliza ion (SAE) o gian enal angiomyolipomas (AMLs) is limi ed. Only a ew
s udies ha e speci ically ocused on his subse o AMLs, o e ing aluable bu limi ed insigh s in o he ou comes and
e icacy o SAE o ea ing gian AMLs.[10-11]
This s udy e alua ed he long- e m ou comes o selec i e a e ial emboliza ion (SAE) in pa ien s wi h gian enal
angiomyolipomas (AMLs) and included a coho o 44 pa ien s wi h 46 AMLs. In compa ison, Abouelkhei e al. [16] and
Nozadze e al. [17] included 33 and 56 pa ien s, espec i ely. Howe e , s udies ocusing exclusi ely on gian AMLs. Bishay
e al. [10] epo ed ou comes in 23 AMLs, while El-Assmy e al. [11] included only 9 AMLs.
The p esen s udy obse ed a p edominan ly emale popula ion (86.3%), consis en wi h he highe p e alence o AMLs
in emales. Simila indings we e epo ed by Abouelkhei e al. [16] and Nozadze e al. [17], whe e emales cons i u ed 72.7%
and 79.6% o hei coho s, espec i ely. The mean age o pa ien s in his s udy was 40.39 ± 11.8 yea s, compa able o he
indings o Abouelkhei e al. [16] whe e he mean age was 38.27 ± 13.9 yea s, and Ba din e al. [18] , which epo ed a mean
age o 52 yea s. These s udies collec i ely indica e ha AMLs mos commonly p esen in middle adul hood. Ou s udy
included 25% o pa ien s had TSC, simila wi h he 36.4%, 40.8%, and 26% epo ed by Abouelkhei e al. [16], Nozadze e
al.[17] and Ba din e al.[18] espec i ely.
P ophylac ic emboliza ion was pe o med in 77.2% o cases while eme gency SAE o acu e bleeding was pe o med in
22.7% o cases. Simila dis ibu ion was ound by Ba din e al.[18] and Nozadze e al.[17], whe e p ophylac ic SAE was done
in 79% and 79.6% o cases, espec i ely. The equen use o p ophylac ic SAE in hese s udies highligh s i s c ucial ole
in p e en ing up u e, especially in la ge enal angiomyolipomas.
The p ima y ou comes o his s udy we e umo size educ ion, p ese a ion o enal unc ion, and low ein e en ion a e.
Tumo size signi ican ly dec eased om a mean o 13.2 ± 3.12 cm p e-SAE o 10.3 ± 2.45 cm pos -SAE (p = 0.003). A
simila end was obse ed in he s udies by P igen e al. [19] and Ba din e al. [18], which epo ed a mean umo size
educ ion o 1.9 ± 1.4 cm and 2.1 ± 2.1 cm, espec i ely, closely ma ching he 2.9 ± 3.97 cm educ ion obse ed in he
p esen s udy.
Renal unc ion was p ese ed in he majo i y o pa ien s, wi h s able se um c ea inine le els obse ed (1.0 ± 0.3 mg/dL
p e-SAE e sus 0.93 ± 0.5 mg/dL pos -SAE, p = 0.6). These esul s a e consis en wi h indings om Hocquele e al. [20],
P igen e al. [19], Nozadze e al. [17], and Ba din e al. [18], who also demons a ed ha selec i e SAE has a minimal long-
e m impac on enal unc ion.
Mino complica ions obse ed in his s udy we e pos -emboliza ion synd ome (PES) (43.1%), alle gic eac ions (6.8%)
and punc u e si e hema oma (4.5%). Simila p e alence o PES was obse ed in o he s udies, such as Ba din e al. [20]and
El-Assmy e al. [11], whe e a es anged om 40% o 50%. Majo complica ions we e a e, wi h only one case o a
pe ineph ic abscess leading o neph ec omy, e lec ing he o e all sa e y o he p ocedu e.
The o e all success a e in his s udy was 84.7% almos simila wi h 91.7 % in Abouelkhei e al. [16],85% in Re- Bishay e
al. [10] in e en ion done in 13.6% o pa ien s, which is sligh ly highe han Hocquele e al. [20] and Abouelkhei e al.[16]
which epo ed 10% and 5.5 % ein e en ion a e on ollow-up. Howe e , epea SAE was e ec i e in mos cases in his
s udy, wi h only wo pa ien s equi ing pa ial neph ec omy.
To da e, only a ew s udies, including hose by Bishay e al. [10]. and El-Assmy e al. [11]., ha e speci ically e alua ed SAE
o gian AMLs. Ou s udy has a la ge coho o 44 pa ien s compa ed o 23 in Bishay e al. [10], and 9 in El-Assmy e al.
[11]. Mo eo e , he success a e in ou s udy was no ably highe a 84.7%, in con as o 62% in Bishay e al. [10] ,(wi h 38%
equi ing epea emboliza ion) and 44% in El-Assmy e al. [11]. These indings highligh he e icacy o SAE as a eliable
ea men op ion o gian enal AMLs, o e ing imp o ed ou comes compa ed o ea lie s udies.
D Kunj B Pa el e al. Long- e m ou comes o selec i e a e ial emboliza ion in gian enal angiomyolipoma: a
e ospec i e single-cen e s udy. In . J Med. Pha m. Res., 6 (6): 226‐233, 2025
232
All 11 pa ien s wi h TSC in his s udy we e p esc ibed e e olimus he apy, bu poo compliance no ed due o side e ec s
such as skin ashes and ulce , se e e s oma i is and nasopha yngi is and gas i is, only a ew pa ien s we e able o con inue
he apy beyond six mon hs. The EXIT-2 ial demons a ed ha E e olimus educed umo olume by mo e han 50% in
42% o pa ien s wi h ube ous scle osis complex (TSC) and enal angiomyolipomas (AMLs) du ing long- e m ollow-up.[7]
Main limi a ions o his s udy a e ha i was a single-cen e s udy wi h e ospec i e design and ela i ely small coho
size. Addi ionally, he popula ion was he e ogeneous, comp ising bo h spo adic and TSC- ela ed cases, as well as pa ien s
wi h di e en indica ions o in e en ion, such as p ophylac ic e sus eme gency ea men . Fu he mo e, he use o
E e olimus in all TSC pa ien s could in oduce bias, as his medica ion may educe umo olume and po en ially in luence
he ou comes.
CONCLUSION
Selec i e TAE is a sa e and e ec i e ea men modali y o gian enal AMLs, o e ing signi ican umo size educ ion,
symp om elie , and enal unc ion p ese a ion wi h minimal complica ions. I ep esen s a aluable al e na i e o su gical
app oaches o la ge AMLs, pa icula ly in high- isk pa ien s o hose seeking neph on-spa ing op ions. Fu u e esea ch
should ocus on op imizing emboliza ion echniques, educing ein e en ion a es, and es ablishing s anda dized ollow-
up p o ocols o u he enhance pa ien ou comes.
Acknowledgmen s
The au ho s g a e ully acknowledge he suppo o he Depa men s o U ology and In e en ion Radiology in he conduc
o his s udy. No inancial g an s we e ecei ed, and he au ho s ha e no indus ial a ilia ions o decla e.
Decla a ion o In es
• Con lic o in e es : The au ho s decla e no con lic o in e es ega ding his s udy.
• Funding: The unding sou ce had no ole in he design, p ac ice o analysis o his s udy.
• App o al o he esea ch p o ocol by an Ins i u ional Re iewe Boa d and he app o al numbe : The s udy
p o ocol was app o ed by he Ins i u ional E hics Commi ee App o al No. (2023-114-Mch-EXP-22).
• In o med Consen : W i en in o med consen was ob ained om all pa icipan s p io o inclusion.
• Regis y and he Regis a ion No. o he s udy/ ial-N/A
• Animal S udies-N/A
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