Transcatheter Arterial Embolization in Patients with Kidney Diseases: an Overview of the Technical Aspects and Clinical Indications

Romaric Loffroy, MD Pramod Rao, MD Therapeutic embolization is defined as the voluntary occlusion of one or sever- al vessels, and this is achieved by inserting material into the lumen to obtain tran- Byung-Kook Kwak, MD sient or permanent thrombosis in the downstream vascular bed. There are a Shinichi Ota, MD number of indications for this approach in urological practice, in particular for the Ming De Lin, PhD patients with parenchymatous or vascular kidney disease. In this review, we pre- Eleni Liapi, MD sent the different embolization techniques and the principally employed occluding Jean-François Geschwind, MD agents, and then we present the principal clinical indications and we discuss other that may benefit from this non-invasive . The complica- tions, side effects and main precautions associated with this approach are also described.

Index terms: Kidney Arterial embolization oluntary embolization of the renal parenchyma has been used to treat Surgery kidney since the 1970s. Many other applications for very different clinical situations have been developed during this period. We review DOI:10.3348/kjr.2010.11.3.257 V here the various embolization techniques before presenting the indications for such treatments and the obtained results.

Korean J Radiol 2010;11:257-268 Received November 9, 2009; accepted Techniques after revision January 18, 2010.

All authors: Russell H. Morgan Preprocedural Imaging Department of Radiology and Performing pre-procedural imaging for the embolotherapy candidates is very Radiological Sciences, Division of Cardiovascular and Interventional important, and especially for assessing the tumoral or aneurysmal lesions. The Radiology, Johns Hopkins University suggested modalities for detecting kidney diseases include Doppler ultrasonography, School of Medicine, Johns Hopkins Hospital, Baltimore, Maryland 21287, magnetic resonance angiography and most importantly, computed tomographic (CT) USA angiography, which is gaining prominence for assessing patients with good renal

Address reprint requests to: function. Indeed, the three-dimensional imaging capability of modern day CT scanners Romaric Loffroy, MD, Russell H. Morgan has made CT scanners a potent tool for renal imaging. However, Doppler ultrasonog- Department of Radiology and Radiological Sciences, Division of raphy is the simplest investigation and it can provide both structural and functional Cardiovascular and Interventional information. It is highly useful in emergency situations. Arteriography is used less Radiology, Johns Hopkins University often than it was in the past, but it remains the first step of every endovascular School of Medicine, Johns Hopkins Hospital, 600 North Wolfe Street, Blalock procedure and for the cases of combined with hemodynamic instability. 544, Baltimore, Maryland 21287, USA. Tel. (1410) 955-6081 Fax. (1410) 955-0233 Catheter Embolization e-mail: [email protected] Precise mapping of the vascular bed, including the aorta and its branches, and a selective study of the involved kidney must be performed to plan the therapeutic strategy. A catheter sheath introducer is used systematically. In patients with atheroma or tortuous arteries, using a long sheath (35 to 45 cm) with the tip positioned just downstream from the ostium of the renal arteries facilitates iterative catheterization.

Korean J Radiol 11(3), May/Jun 2010 257 Loffroy et al.

The use of 4 Fr or 5 Fr conventional catheters and embolization is more durable than that with using hydrophilic guidewires facilitates superselective catheteri- resorbable materials. This type of material is ideal to zation and t