1735Vol. 11    |    No. 03    |     May - June 2014    |U R O LO G Y   J O U R N A L

PICTORIAL

Renal Angiomyolipoma Embolization with Flexible Microcatheter
Konstantinos Stamatiou,1 Hippocrates Moschouris,1 Katerina Malagari2

Corresponding Author:

Stamatiou Konstantinos, MD
2 Salepoula Street, 18536 Piraeus, 
Greece.

Tel: +30 210 452 6651
Fax: +30 210 429 6987
E-mail: stamatiouk@gmail.com

Received December 2012
Accepted December 2013

1 General Hospital “Tzanio”, 

Piraeus, Greece.
2 2nd Department of Radiology, 

University of Athens, Athens, 

Greece. 

A 35-year-old woman with a history of multiple angiomyolipomas (AMLs) of the right kidney presented with severe right flank pain and hypotension after a fall. The patient’s hematocrit on admission was 26%. Emergency contrast-enhanced computed tomography (CT) scan showed a perirenal hematoma and findings indicative of rupture of at least one of the 
AMLs (Figure 1, arrow). The patient was referred to the interventional radiology services for emergency angiography. After selec-
tive catheterization of a lower polar artery of the right kidney using a 5 French (F) Cobra-1 catheter, a thin branch was considered 
as a potential feeder of the AML on the basis of its location and course (Figure 2, arrows). However, no tumor vasculature could be 
detected on angiography through the Cobra-1 catheter. Super selective catheterization of this thin branch was achieved using a 2.7 F 
Fathom microcatheter (early phase, Figure 3, arrow). Angiography through this microcatheter revealed several branches which were 
considered as tumor-feeding (late phase, Figure 4, arrows). To facilitate catheterization of the origin of the lower polar artery branch, 
the guidewire of the microcatheter was shaped in the form of a shepherd’s hook, according to a previously described technique.(1) 
Embolization of AML feeders was performed through the Fathom microcatheter using Embozene microspheres (Embozene; Celo-
Nova BioSciences, Peachtree City, Georgia, USA) with a diameter of 250 and 400 μm. A post-embolization angiogram confirmed 
occlusion of the tumor feeders (Figure 5). The patient’s recovery was uneventful and no recurrence of the hemorrhage occurred.

Figure 1. Emergency contrast-
enhanced computed tomog-
raphy scan shows a perirenal 
hematoma (arrow). 

Figure 2. Selective catheteriza-
tion of a lower polar artery of 
the right kidney demonstrates a 
thin branch (arrows). 

Figure  4. Angiography through 
microcatheter revealed several 
branches which were consid-
ered as tumor-feeding (late 
phase, arrows). 

Figure 5. Post-embolization 
angiogram shows occlusion of 
the tumor feeders.

Figure 3. Super selective cath-
eterization of thin branch using 
a 2.7 F Fathom microcatheter 
(early phase, arrow). 

REFERENCE

1. Jee Hyun Baek, Jin Wook Chung, Hwan Jun Jae, Whal Lee, Jae Hyung Park. A New Technique for Superselec-
tive Catheterization of Arteries: Preshaping of a Micro-Guide Wire into a Shepherd's Hook Form. Korean J 
Radiol. 2007;8:225-30.