Renal Angiomyolipoma (AML) Embolisation in Cyprus
Renal angiomyolipoma is a benign (non-cancerous) growth of the kidney. They are more common in women and usually do not cause any problems. If they increase in size they can cause pain and heavy bleeding which can be life threatening.
Benefits
AML embolisation is a procedure in which Dr Zertalis can navigate a fine tube (catheter) into the blood vessels supplying the renal AML and inject fluid containing very small spheres (embolic particles) in order to block the small arteries and starve the AML of its blood supply. This makes the AML decrease in size and subsequently prevent/control life threatening haemorrhage.
Risks
Angiomyolipoma (AML) embolisation is a safe, effective and accurate procedure, but as with any medical procedure there are some risks and complications that you may uncommonly experience.
Pain: Some patients experience loin pain after the procedure. This can vary from mild to moderate and can be managed with painkillers (analgesia).
Bleeding: Risk of bleeding that is significant is rare. Uncommonly you may get a small bruise at the needle entry point in the groin.
Infection: This is uncommon complication. You will be given antibiotics before the procedure and you will be monitored during and after the procedure to check for signs of infection.
Non-target embolisation: In some patients, the anatomy of the renal artery may allow flow of embolisation particles to arteries supplying normal renal tissue, the adrenal or bowel and can result in injury to these organs. This important complication is rare.
Post-Embolisation Syndrome: This is a common inflammatory response of the body to the procedure of embolisation and starving a part of the body of its blood supply. It can present as general weakness (fatigue), muscle ache (myalgia), and low-grade fever. This responds well to pain killers such as paracetamol and anti-inflammatories (ibuprofen).
Allergy to contrast (X-ray dye): Most adverse events are mild and can be managed safely in our department. A major life-threatening contrast reaction is rare (< 0.005%).
Kidney Impairment: Impairment of kidney function can occur following the treatment due to the contrast agent or dehydration. You will have a drip placed before the procedure. This is to give you sufficient fluids to minimise the risk of problems with kidney function.
Radiation Risk: Immediate harmful effects such as skin burns, or radiation sickness are rare. The radiation dose you receive during the procedure is monitored to prevent this. On rare occasions the procedure will have to be stopped if the threshold for immediate harmful effects is reached. Increase in lifetime risk of cancer due to radiation per examination is also rare (< 0.001%).
Dr Zertalis will explain the procedure and ask you to sign a consent form. Please feel free to ask any questions that you may have and remember that even at this stage, you can still decide not to go ahead with procedure if you choose to do so.
Before the procedure
The procedure is performed under local anaesthetic and sedation. You will be asked not to eat or drink for 6 hours before the procedure. Where necessary a blood test may be required. A short and thin plastic tube (cannula) will be placed into a vein in your arm.
Please let Dr Zertalis know about any medications you take, any allergies you may have and if you previously have had a reaction to the x-ray dye (contrast).
The procedure
You will be asked to change into a hospital gown and lie on the X-ray table flat on your back. You will have devices attached to your chest, arm and finger to monitor you pulse, blood pressure and oxygen levels. You will be given a sedative to relieve anxiety. This is standard for all minimally invasive interventional radiology procedures performed in Cyprus.
The procedure is performed under sterile conditions and Dr Zertalis will wear sterile gowns and gloves. The skin near the point of insertion at the top of the leg (usually the right groin) will be cleaned with antiseptic and you will be covered with sterile drapes.
Dr Zertalis will use ultrasound to inject local anaesthetic in your groin and place a fine plastic tube (vascular sheath) into the artery (common femoral artery).
Dr Zertalis will use X-ray equipment to navigate and guide another fine plastic tube (catheter) through the sheath into the arteries, which supply the AML in your kidney. X-ray dye (contrast) will be injected through the catheter to define the anatomy of your kidney and of the AML. You may experience a warm feeling in your abdomen – this is normal. The arteries supplying the AML are blocked by injecting small spheres suspended in liquid (particles). At the end of the procedure the catheter and vascular sheath are removed and pressure is applied to the groin for 10-15 minutes to prevent bleeding.
Every patient is different, however, expect to be in the radiology department up to 1 hour.
After the procedure
You will be transferred to your ward where your pulse, blood pressure, oxygen levels and the entry site in the groin will be checked by our team at regular intervals. You should expect to be in bed for 6 hours and to stay in hospital for 24 hours.
You will be advised to rest at home for 48 hours. If you experience pain, weakness and mild fever this can be well controlled with pain killers and anti-inflammatory medication. Please discuss driving, return to work and exercise with Dr Zertalis as this varies between patients.
