Document Detail


Percutaneous image-guided adrenal cryoablation: procedural considerations and technical success.
MedLine Citation:
PMID:  20971772     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
PURPOSE: To assess safety, technical success, complications, and hemodynamic changes associated with the adrenal cryoablation procedure.
MATERIALS AND METHODS: This retrospective review was approved by the institutional review board, with waiver of informed consent, and was compliant with the Health Insurance Portability and Accountability Act. Adult patients with adrenal metastasis who were treated with adrenal cryoablation between May 2005 and October 2009 were eligible for this review. Twelve patients (undergoing 13 procedures) with single adrenal tumors were included in the analysis. For statistical analysis, hemodynamic data were averaged for the patient undergoing the procedure twice. Technical success, safety, and local control were analyzed according to standard criteria. Hemodynamic changes during the procedure were analyzed and compared with data from an unmatched cohort of patients who underwent kidney (not in the upper pole) cryoablation (Wilcoxon rank sum test). A further subanalysis of hemodynamic changes was performed on the basis of whether preprocedural α- or β-adrenergic blockade was used.
RESULTS: With adrenal cryoablation, local control was achieved following treatment in 11 (92%; 95% confidence interval: 65.1%, 99.6%) of 12 tumors. One patient with known adrenal insufficiency underwent conservative ablation and developed ipsilateral adrenal recurrence, which was retreated. Five patients developed hypertensive crisis during the final, active thaw phase of the cryoablation procedure, and one patient developed hypertensive crisis in the immediate postablation period. Patients undergoing adrenal cryoablation experienced a significant increase in systolic blood pressure (P = .005), pulse pressure (P = .02), and mean arterial pressure (P = .01) when compared with the cohort of kidney cryoablation patients. Adrenal cryoablation patients who were not premedicated with an α-blocker (n = 5) had a higher level of systolic blood pressure increase during the cryoablation procedure when compared with their counterparts who were premedicated (n = 7) (P = .034).
CONCLUSION: Adrenal cryoablation is technically feasible with a high rate of local control. Patients premedicated with the α-blocker phenoxybenzamine appear to have a reduced risk of hypertensive crisis.
Authors:
Brian T Welch; Thomas D Atwell; Douglas A Nichols; C Thomas Wass; Matthew R Callstrom; Bradley C Leibovich; Paul C Carpenter; Jayawant N Mandrekar; J William Charboneau
Publication Detail:
Type:  Journal Article     Date:  2010-10-22
Journal Detail:
Title:  Radiology     Volume:  258     ISSN:  1527-1315     ISO Abbreviation:  Radiology     Publication Date:  2011 Jan 
Date Detail:
Created Date:  2010-12-24     Completed Date:  2011-02-01     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0401260     Medline TA:  Radiology     Country:  United States    
Other Details:
Languages:  eng     Pagination:  301-7     Citation Subset:  AIM; IM    
Copyright Information:
© RSNA, 2010
Affiliation:
Mayo Medical School, Rochester, MN 55905, USA. Welch.brian@mayo.edu
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MeSH Terms
Descriptor/Qualifier:
Adrenal Gland Neoplasms / secondary,  surgery*
Aged
Aged, 80 and over
Antihypertensive Agents / administration & dosage
Biopsy
Cryosurgery*
Female
Hemodynamics
Humans
Male
Middle Aged
Neoplasm Recurrence, Local
Phenoxybenzamine / administration & dosage
Postoperative Complications
Radiography, Interventional
Retrospective Studies
Statistics, Nonparametric
Treatment Outcome
Chemical
Reg. No./Substance:
0/Antihypertensive Agents; 59-96-1/Phenoxybenzamine

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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