Balloon-occluded ethylene vinyl alcohol copolymer embolization of a hemorrhagic renal mass in an octogenarian initially unfit for nephrectomy.
4 affiliations
- 1Department of Radiology, Vascular and Interventional Radiology, NYU Langone Hospital-Suffolk, Patchogue, NY, USA.
- 2Department of Radiology, Vascular and Interventional Radiology, NYU Langone Hospital-Long Island, Mineola, NY, USA.
- 3Department of Pathology, NYU Langone Hospital-Long Island, Mineola, NY, USA.
- 4Department of Urology, NYU Langone Hospital-Long Island, Mineola, NY, USA.
Abstract
Palliative transarterial embolization is an established option for symptomatic renal tumors in patients who are poor surgical candidates, but conventional particle or coil techniques sacrifice uninvolved parenchyma and permit reflux-related non-target embolization. We report an 89-year-old man with atrial fibrillation, heart failure with preserved ejection fraction, and chronic obstructive pulmonary disease who presented with one month of gross hematuria, transfusion-requiring anemia, and acute kidney injury secondary to a 5.8 × 4.6 × 3.4 cm hypervascular right upper-pole renal mass extending into the collecting system. Deemed unfit for nephrectomy during the index admission, he underwent super-selective balloon-occluded embolization with ethylene vinyl alcohol copolymer delivered through a balloon-occlusion microcatheter. Hematuria resolved, hemoglobin stabilized without further transfusion, and creatinine returned to near baseline by post-procedure day 2. He remained free of hematuria for approximately 12 weeks despite resumption of apixaban. Recurrent intermittent bleeding from a persistent enhancing collecting-system component prompted readmission; surveillance imaging demonstrated a devascularized cortical tumor bed with an approximately 69% reduction in tumor volume and preserved parenchymal enhancement of the treated kidney. After interval stabilization, he underwent elective robotic nephrectomy with minimal blood loss. Pathology demonstrated clear cell renal cell carcinoma (grade 3, stage pT3a) with 50% tumor necrosis and post-embolization changes; urothelial carcinoma was excluded. Balloon-occluded ethylene vinyl alcohol copolymer embolization may provide effective temporizing hemostasis and histologically confirmed tumor devascularization in nonsurgical patients, serving in this case as a bridge to elective nephrectomy.
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BibTeX
@article{mohabir2026balloonoccluded,
title = {{Balloon-occluded ethylene vinyl alcohol copolymer embolization of a hemorrhagic renal mass in an octogenarian initially unfit for nephrectomy.}},
author = {Anthony D Mohabir and Leili Mirsadraei and Anthony Corcoran and Anuj Malhotra},
journal = {Radiology case reports},
year = {2026},
month = oct,
doi = {10.1016/j.radcr.2026.09.057},
url = {https://europepmc.org/article/MED/42921241},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Balloon-occluded ethylene vinyl alcohol copolymer embolization of a hemorrhagic renal mass in an octogenarian initially unfit for nephrectomy.
AU - Anthony D Mohabir
AU - Leili Mirsadraei
AU - Anthony Corcoran
AU - Anuj Malhotra
PY - 2026
DA - 2026/10/20
JO - Radiology case reports
DO - 10.1016/j.radcr.2026.09.057
UR - https://europepmc.org/article/MED/42921241
AB - Palliative transarterial embolization is an established option for symptomatic renal tumors in patients who are poor surgical candidates, but conventional particle or coil techniques sacrifice uninvolved parenchyma and permit reflux-related non-target embolization. We report an 89-year-old man with atrial fibrillation, heart failure with preserved ejection fraction, and chronic obstructive pulmonary disease who presented with one month of gross hematuria, transfusion-requiring anemia, and acute kidney injury secondary to a 5.8 × 4.6 × 3.4 cm hypervascular right upper-pole renal mass extending into the collecting system. Deemed unfit for nephrectomy during the index admission, he underwent super-selective balloon-occluded embolization with ethylene vinyl alcohol copolymer delivered through a balloon-occlusion microcatheter. Hematuria resolved, hemoglobin stabilized without further transfusion, and creatinine returned to near baseline by post-procedure day 2. He remained free of hematuria for approximately 12 weeks despite resumption of apixaban. Recurrent intermittent bleeding from a persistent enhancing collecting-system component prompted readmission; surveillance imaging demonstrated a devascularized cortical tumor bed with an approximately 69% reduction in tumor volume and preserved parenchymal enhancement of the treated kidney. After interval stabilization, he underwent elective robotic nephrectomy with minimal blood loss. Pathology demonstrated clear cell renal cell carcinoma (grade 3, stage pT3a) with 50% tumor necrosis and post-embolization changes; urothelial carcinoma was excluded. Balloon-occluded ethylene vinyl alcohol copolymer embolization may provide effective temporizing hemostasis and histologically confirmed tumor devascularization in nonsurgical patients, serving in this case as a bridge to elective nephrectomy.
SN - 1930-0433
ER -