TRANSARTERIAL EMBOLIZATION AND ABLATION OF RENAL ARTERIOVENOUS-MALFORMATIONS - EFFICACY AND DAMAGES IN 30 PATIENTS WITH LONG-TERM FOLLOW-UP

Purpose: We evaluate the long-term efficacy and side effects of transa rterial embolization and ablation for renal arteriovenous malformation s. Materials and Methods: A total of 30 patients with cirsoid arteriov enous malformations causing massive hematuria underwent 34 procedures of embolization or ablation. We confirmed the ratios of occluded arter iovenous malformation areas on angiograms and those of infarcted areas on computerized tomography. All patients were followed for 4.1 to 15. 0 years (mean 8.0 +/- 2.8) after the initial procedures. Results: Hema turia ceased in all patients after the initial procedures, including p artial embolization or ablation of the arteriovenous malformations in 8. Massive hematuria recurred in 4 patients, who had undergone absorba ble gelatin sponge (2), embolization, combined alcohol and subselectiv e absorbable gelatin sponge embolization (1) and polyvinyl alcohol par ticles embolization (1). In these 4 cases total ablation of the arteri ovenous malformations with alcohol was successful. In 29 patients, inc luding aforementioned 4, no hematuria recurred after 5 years following total or partial ablation with alcohol. Large nontarget embolization with reflux of subselectively infused absorbable gelatin sponge caused a nonfunctioning kidney in 1 patient, The remaining 33 procedures cau sed 6.3 to 48.0% (mean 15.7 +/- 6.9%) areas of renal infarction, Polyv inyl alcohol embolization caused pulmonary embolism and renin dependen t hypertension. Conclusions: Partial or total transarterial ablation o f arteriovenous malformations with alcohol proved effective for long-t erm cessation of hematuria. However, this procedure as well as transar terial embolization has the potential risk of nontarget infarction.