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Selective renal artery embolization
Selective renal artery embolization (SRAE) is a minimally invasive procedure that blocks blood flow to one targeted part of the kidney to stop bleeding or shrink a tumor. It is done through a thin catheter, so most people avoid open surgery.
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Briefly about this treatment
Indications
Bleeding or at-risk kidney tumors such as angiomyolipoma, kidney bleeding after injury, biopsy or surgery, tumors that need a smaller blood supply before an operation, and cases where surgery is not an option.
Risks
Post-embolization syndrome (fever, flank pain, nausea), strain on the kidneys from contrast dye, infection, and puncture-site problems. Risks are minimized by superselective technique and an experienced interventional radiology team.
Pre-procedure
Blood tests (kidney function, clotting), CT or MR angiography, a contrast-dye allergy check, a medicine review (especially blood thinners), and fasting per hospital protocol.
Follow-up
A check-up appointment after discharge, then follow-up scans (CT or ultrasound) and kidney-function tests at intervals set by your team to confirm the treated vessel stays closed.
What is Selective renal artery embolization? An expert explains
Your kidney is fed by a tree of arteries that branch into smaller and smaller vessels. During SRAE, the interventional radiologist threads a thin, flexible catheter through an artery, usually in the groin and sometimes the wrist, up into the kidney’s blood supply. Working from live X-ray images, they steer the catheter into just the small branch feeding the area that needs treating, then release tiny particles, coils, medical glue, or occasionally medical-grade alcohol through it to seal that branch off. Cut off from its blood supply, the target tissue shrinks or stops bleeding, while the surrounding healthy kidney tissue is generally spared. „Selective” and „superselective” describe how far down that branching tree the radiologist works: the more selective, the smaller and more precise the area treated, and the more normal kidney tissue is preserved.
Signs it may be time for Selective renal artery embolization
Symptoms you may notice
SRAE is recommended for a specific reason, not as a routine step. Many kidney tumors cause no symptoms at all and are found by chance on a scan, and the classic combination of flank pain, a lump and blood in the urine appears in fewer than half of people with an angiomyolipoma. If you do notice changes, these are the ones that most often lead doctors to consider embolization:
- Blood in your urine. It may look pink, red or brown, and it can keep coming back, especially after a kidney biopsy, surgery or injury.
- Pain in your side or back. A dull ache or a sudden sharp pain under the ribs on one side can come from a growing tumor or a bleeding vessel.
- Sudden severe pain with dizziness, paleness or a racing heart. This can be a sign of internal bleeding and needs emergency care.
- Tiredness and looking pale over weeks. Slow, hidden blood loss can lower your blood count.
- A feeling of fullness or a lump in your side. This is less common and may point to a larger kidney or tumor.
These signs have many possible causes. Having one does not mean you need this procedure.
Conditions linked to selective renal artery embolization
Your care team may suggest SRAE when one of these conditions is causing, or could cause, bleeding or pain:
- Angiomyolipoma is a benign tumor made of fat, muscle and blood vessels. Larger ones, or ones with a bulging vessel inside, can bleed, and this is one of the most common reasons for SRAE.
- Renal Cell Carcinoma (RCC) is kidney cancer. Embolization can reduce bleeding before an operation, or ease pain and bleeding when surgery is not possible, but it does not cure the cancer on its own.
- Renal Trauma means a kidney injury. When it causes active bleeding, embolization can stop the bleed while keeping the kidney.
- Polycystic Kidney Disease (PKD) can leave the kidneys very enlarged. In selected people, embolization is used for symptoms or before transplantation.
- Tuberous Sclerosis Complex often causes several angiomyolipomas in the kidneys, which is why embolization is considered in this condition.
When to consult a specialist
Noticing one of these signs is a good reason to get checked, and it is usually less worrying than it feels. Many of them have common, treatable causes, and a simple urine test, a blood test for kidney function (creatinine and eGFR) and an ultrasound can often show what is going on. If a kidney tumor or bleeding vessel is found, there are several ways to manage it, and embolization is only one of them. If you ever have sudden severe pain with fainting or heavy blood in your urine, go to emergency care straight away. Otherwise, you do not have to work this out alone: a kidney specialist can look at your results and explain your options.
How a session works
SRAE is performed by an interventional radiologist in an X-ray (angiography) suite rather than an operating theater. You lie on your back, usually awake but relaxed, while a nurse monitors your blood pressure, breathing and oxygen levels. The radiologist guides a catheter to the kidney using live X-ray images, seals off the targeted vessel, and then closes the small puncture site.
Session duration
1–2 hours
recorded for this treatment
Cost verify
$7000–$12500
indicative range
Anesthesia
Local
recorded for this treatment
Remember: The exact steps, duration and preparation can vary with your indication, health and care setting. Confirm the current plan with your treating team.
Benefits
The main advantage of SRAE is that it treats a kidney problem from inside the blood vessels, so there is no large incision and usually less time in hospital than after an operation. For many people it also keeps the kidney in place, which matters when every bit of kidney function counts.
- No open surgery. A catheter is guided through the blood vessels, so there is a small puncture rather than a surgical wound, with less pain and a quicker return to normal life for most people.
- Fast control of bleeding. In published series, embolization stops acute kidney bleeding in roughly 85 to 95% of cases.
- Kidney tissue is spared. Superselective technique treats only the branch feeding the problem area, which helps protect healthy tissue.
- A safer operation later. Shrinking a tumor’s blood supply before surgery can reduce blood loss during the operation.
- An option when surgery is risky. It can ease pain or bleeding if you are not well enough for an operation, or if the tumor cannot be removed.
- It keeps other options open. Embolization does not rule out surgery or other treatment later if you need it.
Risks & side effects
The treatment has risks and trade-offs to discuss with your care team. The information below is drawn from published clinical sources on this treatment.
Post-embolization syndrome, strain on the kidneys from contrast dye, infection, and puncture-site problems. Risks are minimized by superselective technique and an experienced interventional radiology team.
Common side effects
Most side effects come from the treated tissue settling down after its blood supply is cut off. They are expected, usually mild, and tend to ease within days.
- Post-embolization syndrome. This is a mix of fever, flank or back pain, nausea and feeling generally unwell, usually starting 1 to 3 days after the procedure. It was reported in roughly half to two-thirds of patients in small series, and it settles with rest, fluids and simple medicines.
- Back or side pain. You may need regular painkillers for a few days.
- Tiredness and a slightly raised temperature. You may feel flu-like and tired for the first few days.
- Bruising or tenderness where the catheter went in.
Who it may not suit:
These are general cautions, not a personal verdict. People who take blood thinners or have a clotting problem, who are allergic to the contrast dye, or whose kidney function is already low may need extra precautions or a different approach. A qualified clinician must assess your full medical picture before recommending or delaying treatment.
What happens during & after
Before: Your team will usually order blood tests (including kidney function and clotting), review your CT or MRI scans, and ask about allergies, especially to the contrast dye. You will be told which regular medicines to pause (blood thinners in particular) and when to stop eating and drinking beforehand.
During: You lie on your back on the X-ray table. After numbing the skin at the groin (or sometimes the wrist), the radiologist inserts a small plastic tube (catheter) into the artery and, guided by live X-ray and contrast dye that lights up your blood vessels, steers it into the specific kidney branch that needs treating. Tiny coils, particles, glue or another embolic agent are injected through the catheter to seal that branch. The radiologist checks with more dye that the vessel is blocked, removes the catheter, and closes the puncture with pressure or a small closure device.
Immediately after: You return to a ward or recovery area, where nurses check your blood pressure and the puncture site often and ask you to rest for at least 4 hours so the artery can seal. You may have some pain for a day or two, and your team will give you painkillers. Most people stay in hospital overnight, and sometimes for a day or two longer.
Possible complications
Complications are less common than the side effects above, and modern superselective techniques make most of them unlikely. They are worth knowing about so you can ask your team how they apply to you.
- Embolic material reaching a nearby vessel. If particles or glue block a vessel they were not meant to, healthy kidney tissue or a neighboring organ can lose blood supply. Rare older case reports describe bowel or spinal cord injury. Careful catheter placement is the main protection.
- Infection or abscess. The treated tissue can become infected, which may need antibiotics or drainage. Teams often check a urine sample beforehand to lower this risk.
- Strain on the kidneys from contrast dye. Kidney function can dip for a few days, more so if it was already reduced, so your team checks blood tests before and after and encourages fluids.
- A bigger loss of kidney function than expected. Rarely, the treated kidney shrinks (atrophy) and function falls, which is why long-term monitoring matters.
- Puncture-site problems. A large bruise, a bulge in the artery wall (pseudoaneurysm) or bleeding where the catheter went in can occur.
- Bleeding that returns or treatment that needs repeating. In one small series of 35 patients, 6 needed a repeat embolization.
Remember:
New or severe symptoms require prompt medical advice. Do not wait for a routine appointment if you feel seriously unwell.
Recovery
Most people feel tired and a little sore for the first few days and then steadily improve. Recovery depends on what was treated and how large the area was, so your team will give you a personal timeline.
What to expect
- First 1 to 2 days: Many people stay overnight, sometimes up to two nights. Fever, flank pain and nausea (post-embolization syndrome) often peak now and are managed with painkillers, anti-sickness medicine and fluids.
- First week at home: Tiredness, mild side pain and a low fever can linger while the treated tissue settles. Rest and paracetamol (acetaminophen) usually help; follow your team’s advice.
- Return to activity: Your team will tell you when to go back to work, driving and exercise. Avoid heavy lifting until you are cleared.
- Follow-up: You will have a check-up appointment, often a CT or ultrasound to see the result, and kidney-function blood tests. Regular scans may continue if a tumor was treated.
Looking after yourself
Keep the puncture site clean and dry, drink plenty of fluids unless told otherwise, and restart paused medicines (such as blood thinners) only when your team says so.
When to call your care team
Contact your team, or seek urgent care, if you have:
- A fever above 38.5°C (101.3°F) that does not settle with paracetamol (acetaminophen), or lasts more than 2 to 3 days
- Pain that gets worse instead of better
- Bleeding, swelling or a growing lump at the catheter site
- Much less urine than usual, or heavy blood in your urine
- Fainting, severe weakness or shortness of breath
Clinics offering Selective renal artery embolization
Verified kidney centres linked to this treatment in the KidneyGlobal directory.
University Hospital
Urologic Oncology & Robotic Surgery
ISO 9001European Urology Boardda Vinci Robotic Center
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Academic Medical Center
Minimally Invasive Urologic Surgery
Joint CommissionNCI Cancer CenterRobotic Surgery Excellence
✓ 24/7 ER✓ ICU✓ Insurance
Public Hospital
Dialysis & Chronic Kidney Disease
Joint CommissionLevel I Trauma CenterESRD Network Certified
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Good questions
Most Common Questions
Is selective renal artery embolization a cure for kidney cancer?
Not by itself. The tumor is not removed, so the cancer can still spread. Embolization is used to ease symptoms such as pain or bleeding, or to make a later operation safer.
How is it different from having a kidney removed (nephrectomy)?
Nephrectomy removes all or part of the kidney through surgery. Embolization leaves the kidney in place and only blocks blood flow to the targeted area. It is sometimes used instead of surgery when an operation is too risky, and sometimes before surgery to reduce bleeding.
Will I lose kidney function?
A small, planned loss in the treated area is expected, because that tissue loses its blood supply. Superselective technique aims to protect the rest of the kidney, and your team will check your kidney function afterward.
Does it hurt?
The skin is numbed and you are given sedation, so the procedure itself should not be painful. Aching in your side or back for a day or two afterward is common and can be treated with painkillers.
Can it be repeated if the problem comes back?
Sometimes. If bleeding returns or a tumor is not fully treated, doctors may repeat embolization or choose another treatment, which is why follow-up scans are part of care.
Who performs the procedure?
An interventional radiologist, a doctor trained in image-guided, catheter-based treatment, usually working with your nephrologist or urologist.
Sources
- Blocking the blood supply for kidney cancer (renal artery embolisation)Cancer Research UK
- Arterial embolisation for kidney cancerMacmillan Cancer Support
- Renal Artery Embolization (Sauk & Zuckerman, 2011)Seminars in Interventional Radiology (Thieme)
- Renal Artery Embolization for Neoplastic Conditions (Lionberg et al., 2020)Seminars in Interventional Radiology (Thieme)
- Renal embolization (Grenier et al., 2016)Néphrologie & Thérapeutique (Elsevier Masson)
- An update on recent developments in rupture of renal angiomyolipomaPubMed Central (peer-reviewed article)
- High success rate after arterial renal embolisationDanish Medical Journal
- Renal Atrophy Following Selective Transcatheter Arterial Embolization for Angiomyolipoma as an Uncommon but Significant ComplicationPubMed Central (peer-reviewed case report and review)
- Renal Angiomyolipoma EmbolizationThe Urology Group Virginia
- Procedure price lookup, CPT 37243Medicare.gov (US Centers for Medicare & Medicaid Services)
- Nationwide rates for HCPCS 37243Tynbil (insurer price-transparency data)