PALLIATIVE SELECTIVE EMBOLIZATION OF THE RENAL ARTERIES IN MALIGNANT
UNRESECTABLE RENAL TUMORS
Kondrashin S.A.1, Koblikov V.V.1, Sorokin N.I.2
1 – Sechenov University. Moscow, Russia.
2 – Faculty of Fundamental Medicine, Lomonosov Moscow State University. Moscow, Russia.
Purpose. To evaluate the effectiveness of transarterial selective embolization of the renal artery in patients with recurrent macrohematuria in inoperable kidney tumors.
Materials and methods. In 2003-2022, in the radiological diagnostic department of Sechenov University, selective embolization for an inoperable kidney tumor was performed in 18 patients (14 men and 4 women) aged from 54 to 95 years (M=71.2±7.2 years). All tumors were isolated, their size was 8.9±1.7 cm. According to the TNM 2017 classification, stage III was in 12 cases (66.7%), stage IV in 6 patients (33.3%). In 8 cases, there was an anatomically single kidney. In all cases, embolization was performed for hematuria of varying severity. After the intervention, the patients received targeted therapy.
The primary diagnosis of a malignant kidney tumor was performed by ultrasound, and then MSCT of the kidneys was used to determine the process expansion (presence of metastases). After selective embolization of the renal arteries, patients were observed by oncologists, the condition of the operated organs was assessed using ultrasound and 4-phase CT of the kidneys.
Results. During primary embolization, renal bleeding was stopped in all cases. Repeat embolization was performed in 12 patients (66.7%) due to recurrent bleeding, and in 6 patients (33.3%), it was performed three times due to bleeding progression according to control radiographic examination or macrohematuria recurrence. A total of 42 endovascular procedures were performed. Hemoglobin levels before embolization ranged from 82 to 114 g/L (Msg = 94.7 ± 8.4 g/L), and blood transfusions were administered to stabilize the patient's condition in 5 cases (27.8%). The duration of repeat interventions ranged from 2 to 63 months. Post-embolization syndrome was observed in 2 patients after total renal artery embolization. Hematuria was present in all patients, and pain was observed in 4 cases (22.2%). After selective embolization, more than 30% of unaffected renal parenchyma was preserved in 16 patients (88.9%). The somatic condition of patients with stage III-IV malignant tumors did not allow radical nephrectomy to be performed in all patients. The 1-year survival rate after selective embolization of kidney tumors was 88.9%, 3-year – 55.6%, 5-year – 16.7%.
Discussion. In inoperable renal tumors with life-threatening hematuria, according to our data, selective renal artery occlusion allowed us to stop bleeding in 100% of cases. It is indicated in cases of large-volume renal cell carcinoma invading the veins and inoperable tumors with massive hematuria and severe local pain due to the tumor. Our results in a small cohort of similar patients confirm the perspectives of such interventions: 1-year kidney survival was 88.9%, 3-year – 55.6%, 5-year – 16.7%. In 90.5% of cases, during selective embolization, the use of emboli with a diameter of 500-700 μm and 0.035" coils, emboli with a diameter of 300-500 μm and 0.018" microcoils allows us to reliably block the blood supply to the tumor and preserve the maximum amount of functioning parenchyma.
Conclusion. If it is impossible to perform organ-preserving surgery in patients with an inoperable kidney tumor accompanied by pronounced clinical symptoms (pain, total macrohematuria), according to vital indications, it is advisable to perform selective embolization of the branches of the renal artery feeding the tumor with maximum preservation of the unaffected renal parenchyma.
Keywords: unresectable stage III-IV kidney cancer, palliative embolization, selective embolization, survival rate.
Corresponding author: Kondrashin S.A. e-mail: Этот e-mail адрес защищен от спам-ботов, для его просмотра у Вас должен быть включен Javascript
For citation: Kondrashin S.A., Koblikov V.V., Sorokin N.I. Palliative selective embolization of the renal arteries in malignant unresectable renal tumors. REJR 2026; 16(1):150-157. DOI: 10.21569/2222-7415-2026-16-1-150-157.
Received: 09.09.25 Accepted: 12.10.25