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Ethanol and Polyvinyl Alcohol Mixture for Transcatheter Embolization of Renal Angiomyolipoma

Uri Rimon1,2, Mordechai Duvdevani2,3, Alexander Garniek1,2, Gil Golan1,2, Paul Bensaid1,2, Jacob Ramon2,3 and Benyamina Morag1,2

1 Department of Diagnostic Imaging, Sheba Medical Center, Tel-Hashomer, Israel 52621.
2 Sakler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
3 Department of Urology, Sheba Medical Center, Tel-Hashomer, Israel 52621.


Figure 1
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  		Fig. 1A —35-year-old man with intrarenal bleeding in large angiomyolipoma of left kidney. Early phase anteroposterior digital subtraction angiogram before embolization shows hypervascular angiogenic component (short arrows) with 4-cm aneurysm (star) with single feeder vessels (long arrow).

 

Figure 2
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  		Fig. 1B —35-year-old man with intrarenal bleeding in large angiomyolipoma of left kidney. Late phase of A shows hypervascular angiogenic component (arrows) and 4-cm aneurysm (star). Complete embolization was achieved (not shown).

 

Figure 3
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  		Fig. 1C —35-year-old man with intrarenal bleeding in large angiomyolipoma of left kidney. Angiogram shows selective catheterization of aneurysm feeder. Minicoil embolization was performed (not shown).

 

Figure 4
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  		Fig. 1D —35-year-old man with intrarenal bleeding in large angiomyolipoma of left kidney. Anteroposterior angiogram 18 months after embolization shows new aneurysm (star) and recurrence of hypervascular but smaller angiogenic component (arrows). Second embolization was performed.

 

Figure 5
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  		Fig. 1E —35-year-old man with intrarenal bleeding in large angiomyolipoma of left kidney. Anteroposterior angiogram after third embolization (29 months after first embolization) shows marked reduction in angiogenic component.

 

Figure 6
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  		Fig. 1F —35-year-old man with intrarenal bleeding in large angiomyolipoma of left kidney. Contrast-enhanced axial CT scan shows large (largest diameter, 13 cm) angiomyolipoma (arrows) before embolization.

 

Figure 7
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  		Fig. 1G —35-year-old man with intrarenal bleeding in large angiomyolipoma of left kidney. Unenhanced axial CT scan at same level as F after three embolizations shows reduction in tumor size (arrows) and coil artifacts 41 months after first embolization.

 

Figure 8
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  		Fig. 2A —44-year-old woman with bleeding angiomyolipoma of upper pole of left kidney. Anteroposterior digital subtraction angiogram obtained before embolization shows moderate tumor vascularity (arrows).

 

Figure 9
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  		Fig. 2B —44-year-old woman with bleeding angiomyolipoma of upper pole of left kidney. Follow-up anteroposterior angiogram 16 months after embolization shows obliteration of angiogenic component.

 

Figure 10
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  		Fig. 2C —44-year-old woman with bleeding angiomyolipoma of upper pole of left kidney. Contrast-enhanced axial CT scan in acute bleeding phase shows tumor (arrows) with maximum diameter of 12 cm.

 

Figure 11
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  		Fig. 2D —44-year-old woman with bleeding angiomyolipoma of upper pole of left kidney. Contrast-enhanced axial CT scan 37 months after embolization shows mainly lipomatous well-defined tumor (arrows). Maximum diameter decreased to 6.5 cm.

 

Figure 12
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  		Fig. 3A —24-year-old woman with tuberous sclerosis who had undergone right nephrectomy because of uncontrolled bleeding angiomyolipoma. Preventive embolization of angiomyolipoma in left kidney was performed. Angiogram before embolization.

 

Figure 13
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  		Fig. 3B —24-year-old woman with tuberous sclerosis who had undergone right nephrectomy because of uncontrolled bleeding angiomyolipoma. Preventive embolization of angiomyolipoma in left kidney was performed. Angiogram after embolization.

 

Figure 14
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  		Fig. 3C —24-year-old woman with tuberous sclerosis who had undergone right nephrectomy because of uncontrolled bleeding angiomyolipoma. Preventive embolization of angiomyolipoma in left kidney was performed. Follow-up angiogram 60 months after first embolization shows hypertrophic capsular artery (arrow) supplying angiomyolipoma. Lesion was embolized with ethanol-polyvinyl alcohol mixture and minicoil.

 

Figure 15
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  		Fig. 3D —24-year-old woman with tuberous sclerosis who had undergone right nephrectomy because of uncontrolled bleeding angiomyolipoma. Preventive embolization of angiomyolipoma in left kidney was performed. Angiogram after second embolization.

 

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