Complication Rates and Effectiveness of Renal Angiomyolipoma Embolisation: A Systematic Review and Meta-analysis

To assess the rates of success, complications, and re-interventions of selective arterial embolisation of renal angiomyolipomas.

A systematic review and meta-analysis was conducted, including studies reporting outcomes of selective arterial embolisation for renal angiomyolipomas. Pooled estimates were calculated for technical success, radiological success, clinical success, tumour shrinkage, re-embolisation rates, surgical re-intervention, and complication rates. Heterogeneity was assessed using I² statistics. Exploratory regression modelling was performed to assess factors associated with re-intervention.

Thirteen studies comprising 478 patients and 542 AMLs were included. Technical success-successful delivery and occlusion of the embolic agent-was achieved in 86.2% of cases (95% CI 80-89.1%; I² = 36.1%). Radiological success, based on CT-assessed tumour shrinkage, was observed in 94% of cases (95% CI 91.2-97.3%; I² = 15.6%). Subgroup analysis revealed ethanol-alone embolisation achieved the highest shrinkage (95.8%) and the lowest re-intervention rate (3.4%). Pooled re-intervention (re-embolisation or surgery) was required in 19% of cases (95% CI 10-34%; I² = 85.9%). Minor complications occurred in 46% of procedures, predominantly post-embolisation syndrome (PES, 43%; 95% CI 35-53%; I² = 88.8%). Major complications, such as retroperitoneal bleeding, significant haematuria, abscesses, or prolonged hospital admission, were rare (pooled rate: 5.7%; 95% CI 3.9-8.2%), and the pooled rate for surgical re-intervention was 4% (95% CI 2-7%) with low heterogeneity (I² = 9.6%; p = 0.333).

Embolisation is a safe primary treatment option for renal angiomyolipomas with high technical and radiologic success, low major complications, and rates of surgical intervention. Embolic agent choice significantly impacted outcomes in this cohort.