H. EL MORABIT, N. EL YOUSFI, S. BOUKLATA. Medical emergency imagery IBN SINA Hospital. INTERVENTIONAL : INTV1 INTV1

INTRODUCTION  Angiomyolipoma (AML) = benign tumor  bleeding risk => into life-threatening patient  Support hemorrhagic’s AML = first embolization for hemostasis  AML asymptomatic or minimally symptomatic = discussion topic : Diameter < 4 cm : surveillance Diameter > 4 cm : preventive embolization instead of surgery (increased risk of bleeding).

MATERIALS AND METHODS  03 patients : 01 men et 02 women  Mean age = 30 years.  Helical CT without and after injection  MRI.  The materials used for embolization : – Nonabsorbable particles Embosphère calibrated in two patients – " metal Spires" in third patient  After global and selective arteriography scanned

RESULTS  efficient Embolization immediately in the group treated with Embosphère (judged on biological data, hemodynamic and radiological controls on post-embolization).  Recovery in patient treated / spires.

DISCUSSION

 The AML kidney = tumor made ​​ of varying proportions of :  Adipose tissue,  Smooth muscle cells,  Abnormal vessels.  Classified as "tumor lesion" from perivascular epithelioid cells (PECOME)  Found in two clinical situations: 80% sporadic (unilateral female predominance) 20% congenital (bilateral, affecting both sexes)

 Tumor↑ volume gradually=> risk of hemorrhagic rupture  This bleeding risk depends on : Size, Multifocality, Presence of intra lesional aneurysms and their size

KIDNEY EMBOLIZATION :  Purpose  vascular obstruction / of the catheters or various materials with the respect of parenchyma,  Localized or diffuse, temporary or permanent,  ↑ frequency in the treatment of AML for three main reasons: Benign tumor, Symptoms often due to hemorrhage Embolization can preserve the healthy renal parenchyma ↑

 Catheters use=> hyperselective embolization interesting the feeder arterial branches of the tumor => ↓ risk of ischemic of the healthy parenchyma  Place of hemostasis embolization +++ in initial management of acute hemorrhagic AML => bleeding stops + not use nephrectomy hemostasis.  Reduction in size after the AML embolization = classic

 The success embolization Criteria :  ↓the AML size  ↓vascular component, on acquisitions in scaner or MRI after injection of contrast product,  Absence of occurrence of bleeding episode after a prolonged clinical follow-up.

 The post-embolic complications:  related to the procedure intervention itself and the catheterization maneuvers,  related to the consequences of ischemia tumor

CONCLUSION  Hemostasis Embolization = method to manage the emergency hemorrhagic AML.  Préventive Embolization  alternative to surgery in the treatment of AML > 4 cm, symptomatic or not, or preparation for surgery  Support  closes coordination between urologists and radiologists.