Is there still a place for angiography in the management of renal mass lesions?

In recent years, the development of noninvasive imaging modalities for expl oration of the kidney has markedly reduced the use of angiography in the ev aluation of renal masses. Presently, it is not required in routine practice to evaluate renal masses. Ultrasound is the most efficient procedure in de tecting renal tumor. It is acknowledged that arteriography has a limited di agnostic and staging value compared with CT and MRI for the assessment of r enal cell carcinomas (RCC). Most urologists recommend partial nephrectomy o r tumor enucleation in an effort to preserve as much as possible functionin g renal tissue. In such cases a preoperative map of the renal vasculature i s not needed. Information on the main renal artery(ies) and segmental renal arteries can be provided with spiral CT or dynamic MR angiography. Arterio graphy remains useful in exceptional situations. Interventional arteriograp hy is becoming an important part. It is indicated by means of selective emb olization for the treatment of potentially bleeding tumor (i.e. angiomyolip oma) or in emergency in cases of acute hemorrhage. Less frequently, it may be proposed as a palliative procedure for inoperable patients with huge ren al tumor. Two other indications of interventional arteriography are acknowl edged. Some urologists request preoperative embolization of the tumor-harbo ring kidney to decrease/avoid extensive blood loss during surgery and/or to facilitate surgery with huge renal tumors when the renal vessels are diffi cult to reach. The complications of nephron-sparing surgery (partial nephre ctomy or tumor enucleation) related to bleeding or arteriovenous fistulas m ay be cured by arterial embolization.