Safety and Effectiveness of Transhepatic Access for Percutaneous Renal Mass Cryoablation: A Multicenter Cohort |
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Affiliation: | 1. Department of Vascular and Interventional Radiology, ChristianaCare, Newark, Delaware;2. Division of Interventional Radiology, University of Alabama Medical Center, Birmingham, Alabama;3. Division of Abdominal Imaging, Department of Radiology, Mayo Clinic, Rochester, Minnesota |
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Abstract: | PurposeTo establish transhepatic percutaneous cryoablation of renal masses as a safe and effective approach.Materials and MethodsA retrospective review of records from 3 separate medical centers was performed identifying 23 patients (median age, 63 years [range 41–84 years]; 12 female [52.2%]) who underwent percutaneous transhepatic cryoablation for right-sided renal masses (median diameter, 2.4 cm [1.5–4.6 cm]) between 2008 and 2021. The median radius, exophytic/endophytic, nearness to collecting system or sinus, anterior/posterior, and location relative to polar lines (RENAL) nephrometry score was 5 (4–10). Adverse events (AEs) were classified according to the Society of Interventional Radiology (SIR) and Clavien-Dindo (CD) classifications. Primary and secondary technical success of each procedure were recorded.ResultsRenal cell carcinoma (of any subtype) was found in 10 (71.5%) of the 14 masses that were biopsied. Tract cautery was used for transhepatic probes in 14 (63.6%) of 22 procedures. Three (13%) of 23 patients had postprocedural AEs. Two cases (8.6%) were hemorrhages related to transhepatic access (SIR moderate-2, CD 2; SIR severe-3, CD 1), and 1 case (4.4%) was related to bowel injury (SIR severe-3, CD 3a). There were no instances of pneumothorax. Tract cautery was used in the procedures that resulted in an AE. Primary technical success was achieved in 84.2% (16/19) of procedures, whereas secondary technical success was achieved in 2 additional patients. The secondary technical success rate was 94.7% (18/19). Four patients did not have imaging follow-up.ConclusionsThe transhepatic approach to cryoablation of renal masses appears to have an acceptable safety profile and technical success rate. Larger studies, preferably comparative to nontranshepatic approach, are recommended. |
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