Embolisation of benign and malignant renal tumours

Embolisation, the closing-off of vessels supplying benign and malignant tumours of the kidney, is generally an important part of a more complex treatment concept.

During embolisation, the vessels supplying the tumour are blocked off and the flow of blood is stopped. This also means – in the case of a single round of treatment – that the tumour cells’ supply of nutrients is also cut off, meaning they starve to death.

The treatment of renal tumours – be they benign or malignant – can lead to serious complications from bleeding. The general aim of embolisation is to prevent or to stop this bleeding. This is necessary in various therapeutic situations, e.g. to prepare for radio-frequency ablation, for the surgical, kidney-sparing removal of the tumour or even after surgery.

If the tumour is no longer operable, embolisation can also be used as a sole treatment.

We especially recommend embolisation when:

  • bleeding is a potential risk during surgery (or has developed after surgery)
  • radio-frequency ablation is planned, but due to the patient’s already diminished renal function, the retention of as much healthy renal tissue as possible is vital
  • in individual cases surgical treatment of renal cell carcinoma or radio-frequency ablation are not possible for technical or clinical reasons
  • benign tumours are characterised by bleeding complications and must be treated.

Beforehand

A precise determination of the indication and careful preparation are needed for embolisation of the renal arteries.

To prepare for the procedure, we evaluate the history of the condition and any diagnostic results already available, such as CT images or MRI scans. To this end, we request that a detailed medical history is provided, with a list of the treatments already applied, an indication of the progression of the disease, and the most up-to-date diagnostic images available.

Based on the documents supplied, we can check whether the most important requirements for embolisation are fulfilled. Together with your doctors, we will then schedule the ideal time for your treatment.

During

Through a small access port in the vascular system, usually in the right groin, a narrow catheter is guided under X-ray surveillance into the vessel supplying the affected kidney. By administering small amounts of contrast medium, the branches supplying the tumour can be identified in the branches of the renal vessels and then probed with an even finer catheter (approx. 1 mm diameter).

At this point, either tiny plastic particles or vessel-sealing substances are floated into the tumour until it is ultimately completely cut off from the blood supply.

The narrow catheter is then removed.

To effectively suppress any pain that may occur as the tumour is dying off, all patients are given adequate pain relief during and after the treatment.

After

Embolisation is generally carried out in preparation for surgery or radio-frequency ablation. Accordingly, this principal treatment usually follows it to remove the tumour. If embolisation is the only treatment being given, the tumour’s behaviour is checked afterwards with diagnostic imaging.

Complications following embolisation are rare. Notable ones are typical complications following angiography such as bleeding at the puncture site or other injuries in the area such as tears in the vessel wall (dissections). Temporary feelings of pressure and nausea can also occur, which are part of the so-called post-embolisation syndrome.

Allergic reactions to the contrast medium or one of the substances used are also conceivable, as are local infections / inflammations with abscess formation in the region of the embolisation.

Case 1

Figure 1 shows the case of a 49-year-old patient with recurrent bleeding from one kidney into the urinary organs (ureter, bladder). The bleeding was noticed through a red discolouration of the urine and blockage of the urinary diversion pathways. An MRI scan was first carried out of the kidneys to determine the cause of the bleeding.

Case 2

Figure 2 shows the case of a 65-year-old patient, also with recurrent evidence of blood in her urine. The CT scan of the kidneys shows a hyper-vascularised space occupying lesion (star) in the upper part of the right kidney, suspected to represent a malignant renal cell carcinoma.

Contact


Minimally Invasive Tumour Therapy (MITT)
Charité Campus Virchow-Klinikum (CVK)
Department of Radiology
Augustenburger Platz 1
13353 Berlin

Mahnken A, Tacke J. Renal tumors. Recent Results Cancer Res. 2006; 167: 123–133

Gebauer B, Werk M, Lopez-Hänninen E, et al. Radiofrequency ablation in combination with embolization in metachronous recurrent renal cancer in solitary kidney after contralateral tumor nephrectomy. Cardiovasc. Intervent. Radiol. 2007; 30: 644–649

Li D, Pua BB, Madoff DC. Role of embolization in the treatment of renal masses. Semin. Interv. Radiol. 2014; 31: 70–81