Intraoperative Renal Artery Embolization With Concomitant Nephrectomy

R enal cell carcinoma (RCC) represents 3% of adult malignancies, and it affects approximately five to 13 patients per 100,000 individuals in Western countries.1,2 RCC has the propensity to enlarge rapidly and disseminate locally, which frequently results in a highly vascular tumor with local structural invasion. As a result, patients with RCC often present with gross hematuria, flank pain, and palpable abdominal mass.2 Studies have demonstrated that up to 20% of patients with primary RCC have some degree of tumor thrombus extending into the renal pelvis, inferior vena cava, and even the hepatic veins.1,3 Although nephrectomy is the only curative form of therapy, as well as the treatment of choice of primary RCC, surgical treatment can present a daunting challenge due to intraoperative hemorrhage associated with excision of these highly vascularized and locally invasive tumors. In an effort to improve the surgical management of RCC, physicians began to intentionally induce necrosis of the cancerous kidney by transarterial injection of thrombotic agents. Almgard et al first proposed transarterial renal embolization as a means to induce kidney necrosis in 1973.4 Since then, it has become an accepted form of treatment in advanced or unresectable renal cell tumors with persistent bleeding or manifestations of paraneoplastic syndrome. Moreover, it has evolved to become an accepted preoperative adjunct to nephrectomy. Although the predominant benefit of preoperative renal embolization is the reduction of operative blood loss associated with nephrectomy,5 many have noted that it also decreases vena caval tumor size and creates an easier dissection plane as a result of tissue edema.6-9 Transarterial embolization of RCC has also been utilized to palliate patients with nonresectable tumors and severe symptoms such as hemorrhage or flank pain. Transarterial renal embolization of RCC is typically Intraoperative Renal Artery Embolization With Concomitant Nephrectomy