AUTHOR=Vento Vincenzo , Galosi Andrea Benedetto , Ranghino Andrea , Montecchiani Luca , Felici Luca , Loggi Silvia , Cerutti Elisabetta , Milanese Giulio , Franzese Carmine , Castellani Daniele , Gatta Emanuele 

TITLE=Case report: A hybrid technique for a safe nephrectomy in a giant kidney angiomyolipoma

JOURNAL=Frontiers in Surgery

VOLUME=Volume 9 - 2022

YEAR=2022

URL=https://www.frontiersin.org/journals/surgery/articles/10.3389/fsurg.2022.955932

DOI=10.3389/fsurg.2022.955932

ISSN=2296-875X

ABSTRACT=Background
Giant angiomyolipoma is usually associated with genetic syndromes and associated with complications (spontaneous rupture and bleeding, hematuria, hypertension) and with mass-related symptoms (flank and abdominal pain).
Case Presentation 
We present a case of a 20 years old woman suffering from tuberous sclerosis who was referred to our hospital with a giant angiomyolipoma causing abdominal pain. A contrast-enhanced computed tomography showed a left angiomyolipoma, measuring 28x17x27 centimeters. After a multidisciplinary team discussion, the patient was submitted for a nephrectomy. Percutaneous temporary occlusion of the main renal artery was achieved through a balloon endovascular catheter.  Through the balloon catheter guidewire, 2.500 I.U. of heparin were infused to reduce the risk of tumor veins thrombosis and venous embolism. This allowed a safe kidney manipulation through a left thoracoabdominal approach. The post-operatory course was uneventful. Pathology showed a 40x 30x 9 cm and 10 kilograms AML. One year after surgery the patient is on follow up and her estimated glomerular filtration is 120.5 ml/min/1,73m2
Conclusions
The present case showed that the endovascular control of the main renal artery could be considered a useful approach to manage safely huge renal masses when renal hilar control is expected to be very difficult.