The use of bilateral total transarterial kidney embolization for the combined treatment of patients with symptomatic autosodominant polycystic kidney disease and end-stage renal disease

Background. Bilateral transarterial renal artery embolization (TAE) is an effective and minimally invasive technical procedure that can be used in the combined treatment of patients with autosomal dominant polycystic kidney disease (ADPKD) and end stage renal disease (ESRD). The combined use of TAE with subsequent delayed bilateral nephrectomy (NE) provides new opportunities in the treatment of patients with ESRD and ADPKD. Consideration of TAE of the kidneys as an alternative method of radical treatment of patients with symptomatic ADPD requires additional study today.

Material and methods. From 11/01/2022 to 05/01/2023, 12 patients underwent surgery in Urology Department of the City Clinical Hospital № 52 of the Moscow Healthcare Department. Patients were randomized into 2 groups. Patients of the group 1 (6 people) 3 months before laparoscopic bilateral NE underwent bilateral TAE (by one X-ray endovascular surgeon) in order to reduce the volume and symptoms, as well as to prevent the risk of hemorrhagic complications, because all patients were on program hemodialysis (PHD) for a long time. Patients of group 2 underwent laparoscopic bilateral NE without prior embolization.

Results. The combined use of TAE of the kidneys before the upcoming bilateral NE contributed to the reduction of symptoms of compression in 100% of cases, because the initial volume of the kidneys decreased after the TAE procedure by an average of 25.4% within 3 months. This circumstance made it possible to plan the surgical treatment of patients with adequate preoperative preparation. Operative support in patients with prior renal TAE significantly reduced the time of surgery, in this regard, we did not observe AVF thrombosis in patients; the risk of hyperkalemia significantly decreased, and a clinically significant decrease in blood loss was noted, which prevents the risks of hemorrhagic complications and the production of autoantibodies in case of possible transfusion donated blood. The reduction in the postoperative bed-day due to the smaller amount of surgical trauma in the early postoperative period in patients who underwent TAE caused activation on average 1–2 days earlier, which improves the economic results of treatment of such patients. There was a need for emergency NE in none of the cases during 3 month follow-up after TAE.

Conclusion. Indications for renal TAE have not yet been established. We perform renal TAE in anuric patients on PHD who are symptomatic and require renal TAE. Current research indicates that TAE is a successful and minimally invasive option for reducing kidney volume for transplant requirements and alleviating the symptoms of compression caused by enlarged kidneys. However, there are still no studies demonstrating the results of long-term follow-up of patients after TAE, which would show a pronounced contractile effect of this procedure, which would allow us to consider this method of treatment as an independent one.