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Rofo 2004; 176(6): 809-816
DOI: 10.1055/s-2004-812752
Übersicht

© Georg Thieme Verlag KG Stuttgart · New York

Perkutane Totalembolisation der Niere - eine Übersicht

Transarterial Embolization of the Kidney: Review of the LiteratureJ.-M Neuerburg1 , K. Lehrmann1
  • 1Zentrale Abteilung für Diagnostische und Interventionelle Radiologie, Ev. und Johanniter Klinikum Duisburg/Dinslaken/Oberhausen gGmbH, Duisburg
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Publikationsverlauf

Publikationsdatum:
25. März 2004 (online)

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Zusammenfassung

Die perkutane transarterielle Totalembolisation der Niere stellt ein minimalinvasives Therapieverfahren zur radiologischen Nephrektomie dar. In dieser Übersicht werden Indikationen, Technik, Erfolgs- und Komplikationsrate dieses Verfahrens beleuchtet. Mit Ausnahme von in der Regel temporären Beschwerden im Rahmen eines Postembolisationssyndroms, welches mit einer Häufigkeit zwischen 47 % und 100 % angegeben wird, treten Komplikationen relativ selten auf (0 - 20 %) bei einer Mortalitätsrate bis zu 3,3 %. Während die technische Erfolgsrate des Verfahrens unabhängig von der zugrunde liegenden Indikationsstellung hoch ist und in der Regel mit über 90 % angegeben wird, wird die klinische Erfolgsrate maßgeblich von der zu behandelnden Grunderkrankung beeinflusst. Bei inoperablen Tumorleiden kann durch Embolisation eine Verlängerung der Überlebensrate erzielt werden.

Abstract

The percutaneous transarterial total embolization of the kidney is a minimal invasive therapeutic procedure for radiological nephrectomy. The reported indications, technique, results and complications of percutaneous transarterial total renal embolization are reviewed. Aside from transient symptoms as part of the postembolization syndrome with a stated incidence of 47 % to 100 % of embolizations, other complications are relatively rare and occur in the range of 0 % to 20 % with a mortality of up to 3.3 %. Technical success is high and not related to the diagnosis. However, clinical success depends on the underlying disease. Embolization of non-resectable renal tumors may improve the survival rate.

Key words

Arteries - therapeutic embolization - kidney - interventional procedures

Literatur

  • 1 Lalli A F, Peterson N, Bookstein J J. Roentgen-guided infarctions of kidneys and lungs: a potential therapeutic technique.  Radiology. 1969;  93 434-435
    PubMedGoogle Scholar
  • 2 Almgard L E, Fernstorm I, Haverling M. et al . Treatment of renal adenocarcinoma by embolic occlusion of the renal circulation.  Brit J Urol. 1973;  45 474-479
    PubMedGoogle Scholar
  • 3 Drooz A T, Curtis A L, Timothy E A. et al . Quality Improvement guidelines for percutaneous transcatheter embolization.  J Vasc Interv Radiol. 2003;  14 237-242
    PubMedGoogle Scholar
  • 4 Giuliani L, Carmignani G, Belgrano E. et al . Usefulness of preoperative transcatheter embolization in kidney tumors.  Urology. 1981;  17 431-434
    CrossrefPubMedGoogle Scholar
  • 5 Lammer J, Justich E, Schreyer H. et al . Complications of renal tumor embolization.  Cardiovasc Intervent Radiol. 1985;  8 31-35
    CrossrefPubMedGoogle Scholar
  • 6 Onishi T, Oishi Y, Suzuki Y. et al . Prognostic evaluation of transcatheter arterial embolization for unresectable renal cell carcinoma with distant metastasis.  BJU Int. 2001;  87 312-315
    CrossrefPubMedGoogle Scholar
  • 7 Vogel J, Görich J, v A hlen H. et al . Ergebnisse nach Katheterembolisation bei Nierenzellkarzinom.  Akt Radiol. 1995;  5 301-304
    PubMedGoogle Scholar
  • 8 Zielinski H, Szmigielski S, Petrovich Z. Comparison of preoperative embolization followed by radical nephrectomy with radical nephrectomy alone for renal cell carcinoma.  Am J Clin Oncol. 2000;  23 6-12
    CrossrefPubMedGoogle Scholar
  • 9 Zupancic B, Bradic I, Batinica S. et al . Our 10-year experience with embolized Wilms’ tumor.  Eur J Pediatr Surg. 1995;  5 88-91
    PubMedGoogle Scholar
  • 10 Munro N P, Woodhams S, Nawrocki J D. et al . The role of transarterial embolization in the treatment of renal cell carcinoma.  BJU Int. 2003;  92 240-244
    CrossrefPubMedGoogle Scholar
  • 11 Keller F S, Coyle M, Rosch J. et al . Percutaneous renal ablation in patients with end-stage renal disease: alternative to surgical nephrectomy.  Radiology. 1986;  159 447-451
    PubMedGoogle Scholar
  • 12 Iaccarino V, Russo D, Niola R. et al . Total or partial percutaneous renal ablation in the treatment of renovascular hypertension: radiological and clinical aspects.  Br J Radiol. 1989;  62 593-598
    PubMedGoogle Scholar
  • 13 Golwyn D H Jr, Routh W D, Chen M Y. et al . Percutaneous transcatheter renal ablation with absolute ethanol for uncontrolled hypertension or nephrotic syndrome: results in 11 patients with end-stage renal disease.  J Vasc Interv Radiol. 1997;  8 527-533
    PubMedGoogle Scholar
  • 14 Cofan F, Real M I, Vilardell J. et al . Percutaneous renal artery embolisation of non-functioning renal allografts with clinical intolerance.  Transpl Int. 2002;  15 149-155
    CrossrefPubMedGoogle Scholar
  • 15 Delgado P, Diaz F, Gonzalez A. et al . Transvascular ethanol embolization: first option for the management of symptomatic nonfunctioning renal allografts left in situ.  Transplant Proc. 2003;  35 1684-1685
    CrossrefPubMedGoogle Scholar
  • 16 González-Satué C, Riera L, Franco E. et al . Percutaneous embolization of the failed renal allograft in patients with graft intolerance syndrome.  BJU Int. 2000;  86 610-612
    CrossrefPubMedGoogle Scholar
  • 17 Ubara Y, Tagami T, Sawa N. et al . Renal contraction therapy for enlarged polycystic kidneys by transcatheter arterial embolization in hemodialysis patients.  Am J Kidney Dis. 2002;  39 571-579
    PubMedGoogle Scholar
  • 18 Vorwerk D, Günther R W, Kaufmann G. Embolisation der Niere. Günther RW, Thelen M Interventionelle Radiologie Stuttgart; Thieme 1996: 250-257
    Google Scholar
  • 19 Göbel E A, Gött U, Habighorst L V. et al . Anaesthesiologische Gesichtspunkte bei der Katheter-Embolisation zur permanenten Occlusion der Nierenarterie.  Anaesthesist. 1978;  27 131-133
    PubMedGoogle Scholar
  • 20 Kalman D, Varenhorst E. The role of arterial embolization in renal cell carcinoma.  Scand J Urol Nephrol. 1999;  33 162-170
    CrossrefPubMedGoogle Scholar
  • 21 Weckermann D, Schlotmann R, Tietze W. et al . Gas formation after renal artery embolisation: genesis and clinical relevance.  Urol Int. 1992;  49 211-214
    PubMedGoogle Scholar
  • 22 Kadir S, Marshall F F, White R I Jr. et al . Therapeutic embolization of the kidney with detachable silicone balloons.  J Urol. 1983;  129 11-13
    PubMedGoogle Scholar
  • 23 Gianturco C, Anderson J H, Wallace S. Mechanical device for arterial occlusion.  Amer J Roentgenol. 1975;  124 428-435
    PubMedGoogle Scholar
  • 24 Haapanen A A, Dean P B. Renal vein ethanol concentration during ablation of renal cell carcinoma.  Cardiovasc Intervent Radiol. 1986;  9 205-208
    PubMedGoogle Scholar
  • 25 Riedl P, Flamm J. Kontrollangiographische Befunde nach palliativer Nierenarterienokklusion mit der GAW-(Gianturco, Anderson-Wallace-)Spirale.  Fortschr Röntgenstr. 1979;  130 398-403
    PubMedGoogle Scholar
  • 26 Salamat M, Brown P R, Magee C A. et al . Experimental evaluation of a new transcatheter vascular embolization device in the swine model.  J Vasc Intervent Radiol. 2002;  13 301-312
    PubMedGoogle Scholar
  • 27 Tadavarthy M J, Moller J H, Amplatz K. Polyvinyl alcohol (Ivalon) - a new embolic material.  Amer J Roentgenol. 1975;  125 609-616
    PubMedGoogle Scholar
  • 28 Link D P, Strandberg J D, Virmani R. et al . Histopathologic appearance of arterial occlusions with hydrogel and polyvinyl alcohol embolic material in domestic swine.  J Vasc Interv Radiol. 1996;  7 897-905
    PubMedGoogle Scholar
  • 29 Kauffmann G W, Richter G M. Embolisationsmaterialien. Günther RW, Thelen M Interventionelle Radiologie Stuttgart; Thieme 1996: 220-230
    Google Scholar
  • 30 Fisher R G, Ben-Menachem Y, Whigham C. Stab wounds of the renal artery branches: angiographic diagnosis and treatment by embolization.  Amer J Roentgenol. 1989;  152 1231-1235
    PubMedGoogle Scholar
  • 31 Leinonen A. Embolization of renal carcinoma. Comparison between the early results of Gelfoam and absolute ethanol embolization.  Ann Clin Res. 1985;  17 299-305
    PubMedGoogle Scholar
  • 32 Ellman B A, Parkhill B J, Marcus P B. et al . Renal ablation with absolute ethanol. Mechanism of action.  Invest Radiol. 1984;  19 416-423
    CrossrefPubMedGoogle Scholar
  • 33 Cox G G, Lee K R, Price H I. et al . Colonic infarction following ethanol embolization of renal-cell carcinoma.  Radiology. 1982;  145 343-345
    PubMedGoogle Scholar
  • 34 Turner R D, Rand R W, Bentson J R. et al . Ferromagnetic silicone necrosis of hypernephromas by selective vascular occlusion to the tumor: a new technique.  J Urol. 1975;  113 455-459
    PubMedGoogle Scholar
  • 35 Han Y M, Bjarnason H, Gu X. et al . Renal artery embolization with diluted hot contrast medium: an experimental study.  J Vasc Interv Radiol. 2001;  12 862-868
    PubMedGoogle Scholar
  • 36 Park S I, Lee D Y, Won J Y. et al . Renal artery embolization using a new liquid embolic material obtained by partial hydrolysis of polyvinyl acetate (Embol): initial experience in six patients.  Korean J Radiol. 2000;  1 121-126
    PubMedGoogle Scholar
  • 37 Konya A, Wright K C. Capillary embolization using ethiodol-ethanol for complete renal ablation.  Invest Radiol. 2002;  37 512-520
    CrossrefPubMedGoogle Scholar
  • 38 Helpap B, Brühl P, Thelen M. Morphologische Veränderungen nach arterieller Katheterembolisation der Niere.  Fortschr Röntgenstr. 1978;  128 278-282
    PubMedGoogle Scholar
  • 39 Hall W H, McGahan J P, Link D P. et al . Combined embolization and percutaneous radiofrequenzy ablation of a solid renal tumor.  Amer J Roentgenol. 2000;  174 1592-1594
    PubMedGoogle Scholar
  • 40 Tacke J, Mahnken A, Bücker A. et al . Nephron-sparing percutaneous ablation of a 5 cm renal cell carcinoma by superselective embolization and percutaneous RF-ablation.  Fortschr Röntgenstr. 2001;  173 980-983
    PubMedGoogle Scholar
  • 41 Atar E, Belenky A, Neuman-Levin M. et al . Nonfunctioning renal allograft embolization as an alternative to graft nephrectomy: report on seven years’ experience.  Cardiovasc Intervent Radiol. 2003;  26 37-39
    CrossrefPubMedGoogle Scholar
  • 42 Hom D, Eiley D, Lumerman J H. et al . Complete renal embolization as an alternative to nephrectomy.  J Urol. 1999;  161 24-27
    CrossrefPubMedGoogle Scholar
  • 43 Hirao Y, Okajima E, Yoshida K. et al . Renal ablation with absolute ethanol for nonfunctioning hydronephrosis.  Eur Urol. 1993;  24 203-207
    PubMedGoogle Scholar
  • 44 Milewski J B, Malewski A W, Malanowska S. et al . Spinal cord damage as a complication of renal artery embolization in patients with renal carcinoma.  Int Urol Nephrol. 1981;  13 221-229
    PubMedGoogle Scholar
  • 45 Vassiliu P, Sava J, Toutouzas K G. et al . Is contrast as bad as we think? Renal function after angiographic embolization of injured patients.  J Am Coll Surg. 2002;  194 142-146
    PubMedGoogle Scholar
  • 46 Kessel D O, Robertson I, Patel J V. et al . Carbon-dioxide-guided vascular interventions: technique and pitfalls.  Cardiovasc Intervent Radiol. 2002;  25 476-483
    CrossrefPubMedGoogle Scholar
  • 47 Spinosa D J, Matsumoto A H, Angle J F. et al . Renal insufficiency: usefulness of gadodiamide-enhanced renal angiography to supplement CO2-enhanced renal angiography for diagnosis and percutaneous treatment.  Radiology. 1999;  210 663-672
    PubMedGoogle Scholar
  • 48 Spinosa D J, Kaufmann J A, Hartwell G D. Gadolinium chelates in angiography and interventional radiology: a useful alternative to iodinated contrast media for angiography.  Radiology. 2002;  223 319-325
    PubMedGoogle Scholar
  • 49 Dinkel H P, Danuser H, Triller J. Blunt renal trauma: minimally invasive management with microcatheter embolization - experience in nine patients.  Radiology. 2002;  223 723-730
    CrossrefPubMedGoogle Scholar
  • 50 Goffette P P, Laterre P F, Miller D C. et al . Traumatic injuries: imaging and intervention in post-traumatic complications (delayed intervention).  Eur Radiol. 2002;  12 994-1021
    CrossrefPubMedGoogle Scholar

Prof. Dr. med. Jörg-Michael Neuerburg

Zentrale Abteilung für Diagnostische und Interventionelle Radiologie, Ev. und Johanniter Klinikum Duisburg/Dinslaken/Oberhausen gGmbH

Fahrnerstraße 133

47169 Duisburg

eMail: joerg.neuerburg@ejk.de