SIR 2024
Embolization
Henderson M. Jones, MD, JD
Fellow
Mayo Clinic Arizona
Financial relationships: Full list of relationships is listed on the CME information page.
Alex Wallace, MD
Interventional Radiologist
Mayo Clinic Hospital Florida
Disclosure information not submitted.
Sadeer Alzubaidi, MD
Interventional Radiologist
Mayo Clinic
Financial relationships: Full list of relationships is listed on the CME information page.
Indravadan J. Patel, MD
Division Chief - Interventional Radiologist
Mayo Clinic Arizona
Financial relationships: Full list of relationships is listed on the CME information page.
Sailendra Naidu, MD
Interventional Radiologist
Mayo Clinic Arizona
Disclosure information not submitted.
Retrospective review from 2005-2023 of renal AMLs treated electively with embolization from a single enterprise. Patient demographics, technical embolization details (including embolic agent used), complications and pre/post cross sectional imaging were reviewed. Pre procedure 3D volume calculations and Hounsfield unit density histograms were performed on each AML, placing them into lipid rich ( >50% lipid) or lipid poor (< 50% lipid) groups. 3D volume calculations were performed of the first cross sectional imaging study following embolization to assess volume change. Fisher’s exact tests, unequal variance t-tests, Spearman’s correlation, and linear regression were used to assess associations.
Results: 45 patients with 50 AMLs (6 male, mean age 53.0) were included. 20 AMLs were lipid poor and had a mean volume decrease of 55.7% (23.8) compared to volume decrease of 36.0% (24.5) in 30 lipid rich AMLs (p=0.007). Fat composition, evaluated as a continuous variable, was moderately correlated with percent volume change (rs=0.45). 23 AMLs were treated with alcohol/ethiodized oil only, 13 with calibrated microspheres only. The remainder had multiple embolics and were excluded from the comparison. The AMLs treated with alcohol/ethiodized oil had a mean volume decrease of 49.8% (24.2) compared to 37.9% (29.7) in the microspheres (p=.231). Subgroup analysis showed in lipid rich AMLs, there was a 47.4% (23.6) reduction with alcohol/ethiodized oil and a 32.1% (29.9) reduction with microspheres (p=.219).
Conclusion: Lipid poor AMLs demonstrate greater volume reduction compared to lipid rich AMLs following embolization. The embolic agent (alcohol/ethiodized oil vs calibrated microspheres) did not demonstrate a statistically significant difference in volume reduction. Further study with a larger sample size may be warranted.