Angioembolisation is only indicated in very large Tumor masses (z.B. broad infiltration of the spine oder liver) or in a palliative situation - e.g. massive gross hematuria in patients with comorbidity. who cannot be operated.
The side effects of angioembolisation are quite high and overweigh the benefits before nephrectomy (fever, pain, etc.),
In general it would be better to do the nephrectomy primerily with a transabdominal transperitoneal approach and interdisciplinary setting (urology and gerneral surgery) and well balanced anaesthesia.
Thanks dear Theodor Klotz. If you decide to do RAE which time is the best before operation?
Dear Alireza,
I don't think I would agree with Dr.Theodor Klots, with regards to the timing of RAE.
One week is too early-ideally it is done just a day before surgery-sometimes even hours before.You want to operate before tumor lysis syndrome kicks in. Also, the longer one waits, the more edema and destruction of surgical planes is there, especially at the hilum.
In fact, there are a few papers, where a balloon catheter is threaded unto the renal artery, in the OR suite, and then left in. After opening, the balloon is inflated, to occlude the arterial inflow, in larger tumors, before ligating the renal artery.
One of the major problems during nephrectomies for very large vascular tumors, is the "venous hypertension"-especially in the presence of tumor thrombus or large collaterals.
Using RAE just prior to surgery, in that setting is useful.