الفهرس 
Introduction
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Abstract
Renal artery embolization is an effective minimally invasive alternative to surgery for the management of symptomatic and asymptomatic renal angiomyolipomas (AMLs). The aim of this work is to evaluate the role of trans-catheter selective arterial embolization in the management of renal angiomyolipomas (including control of symptoms and tumour size reduction). This study was carried out at the Interventional Radiology Unit, Radiology Department, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt throughout the period from April, 2021 to June, 2022. Our prospective minimally invasive study included 30 patients with renal AMLs (7 males, 23 females) aged from 23 to 60 years old. They underwent 35 arteriographies for 33 renal AMLs and managed by SAE as an urgent management of symptomatic bleeding renal AMLs of any size, as a prophylaxis of high-risk renal AMLs (>4cm) or as a pre-operative adjunct treatment for surgery to prevent intra-operative blood loss. All patients undergo follow-up by clinical assessment, medical imaging and laboratory investigations. All patients were subjected to the following: A) Full History Taking Included: a) Personal history included; age, sex and special habits as smoking, alcoholism. b) History of the present illness included presenting symptoms with onset, course and duration of these symptoms. c) Past history with special concern on recent medical intervention in which percutaneous instrumentation was used. d) Medical, surgical and family history. B) Clinical Examination Included: a) General examination. b) Local examination. C) Laboratory investigations: • Complete blood count (CBC) and haemoglobin level. • Coagulation profile. • Renal and liver function tests. • Urine analysis (for erythrocyte count in urine). D) Radiological Imaging: Different imaging modalities were used for the diagnosis of AMLs & pre-embolization planning as the following: 1) Abdominal US: Grey scale Ultrasonography followed by color Duplex examination were done for all patients by using Philips (iu_22) machine, to identify the number, location and size of renal AMLs, signs of ruptured AML and vascular lesions as aneurysm. 2) UECT scan: was done for all patients, by using Philips (Brilliance 64 multidetector) machine, to identify the number and location of the tumour, the actual pre-embolization tumour size and the actual size of different haematomas. 3) CECT scan and CTA for renal vessels: Multiphasic CT study was done before 21 arteriographies, by using Philips (Brilliance 64 multidetector) machine. 4) Gadolinium-enhanced MRA: was done before 2 arteriographies, by using Philips (Ingenia 3.0 Tesla) machine. 5) Diagnostic catheter angiography: was done for all patients, by using Toshiba (CAT-805B) machine. The last 3 modalities help to detect renal vascular anatomy, renal vascular variants, renal vascular malformations, the feeding vessels supplying the renal AML and planning for the angiography procedure. E) selective Arterial Embolization: • 30 patients were managed by SAE. They underwent 35 arteriographies for 33 renal AMLs. • Good patient preparation with proper choice of anesthesia. • Toshiba (CAT-805B) machine and Digital subtraction angiography (DSA) techniques were utilized in all cases. • Different embolic materials were used including; microcoils microspheres and absolute alcohol. • All patients undergo follow-up by clinical assessment, medical imaging and laboratory investigations. Our current study revealed: • A high overall success rate (90.9%). • A high technical success rate (88.6%). • A high clinical success rate (86.6% of patients presented with gross haematuria showed stoppage of haematuria within 3 days post-embolization (P= <0.001) and about 96% of bleeding AMLs showed complete disappearance or marked organization of hematomas 3 months post-embolization (P= <0.001). • Low rates of re-embolization (8.6%) and recurrence (6.1%). • Low complication rates; major complications (2.9%) and minor complications (28.6%). • A positive association between TSC-associated renal AMLs and bleeding symptoms (p=0.027). • A positive association between intra-lesional vascular anomalies and bleeding symptoms (p=0.016). • A highly significant tumour size reduction after SAE [Maximum diameter reduction rate of 16.33% and volume reduction rate of 42.66% (p<0.001)]. • No significant changes in serum creatinine levels and haemoglobin before and after SAE on follow-up visits. In conclusion, SAE is an effective and safe procedure in the management of renal AMLs either in emergency or preventively with preservation of renal functions and elimination of the potential risk of nephrectomy. Recommendations: 1. Increase the number of studied groups. 2. Assure that pre-arteriography images of all patients are obtained from same hospital with same equipments. 3. Good patient preparation before embolization. 4. The use of superselective technique in embolization is mandatory to reduce the risk of ischemia induced hypertension and related renal impairment. 5. Increase the duration of follow-up period.