Evaluate the safety and efficacy of adrenal microwave ablation performed with continuous intra-arterial blood pressure monitoring (IABPM) and without alpha-adrenergic blockade (AAB) as pretreatment.
Material and Methods
A single-center, retrospective review of all percutaneous adrenal microwave ablation performed between 2011 and 2018. Microwave ablation was completed on 11 patients, with a total of 15 adrenal tumors with a mean size of 3.3 cm (1.4–6.9 cm) treated metastatic RCC, HCC, esophageal carcinoma, adrenal adenoma. Cases were performed without prior AAB, but with continuous IABPM and rapid intervention using short-acting antihypertensive medications.
There were no post-procedural episodes of hypertension, no neurological or cardiovascular complications, and no SIR moderate or worse adverse event complications. Mean intraprocedural maximum systolic blood pressure (SBP) was 211 mmHg (range: 132–288), with an average increase in SBP of 100 mmHg (range: 23–180). A hypertensive crisis (SBP ≥ 180 and/or DBP ≥ 120) occurred in 9 of the 15 procedures (60%) with a mean length of 3.0 min (range: 1–12). The technical success rate was 100% (15/15 procedures). The mean follow-up time was 2.4 years (range: 0.9–7.7 years), with primary and secondary efficacy rates of 77% and 87%, respectively, and an overall survival of 82%.
In this single-center retrospective study, microwave ablation of adrenal tumors without AAB was safe and effective when performed with continuous arterial line monitoring of vital signs and the use of short-acting, rapid-onset antihypertensive medications.
Level of Evidence
Level 4, Case Series.
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This study was not supported by any funding.
Conflict of interest
SAW receives consultant fees from Ethicon, Inc. MGL receives grant funding from Phillips and Ethicon, Inc. PFL receives consultant fees from Ethicon, Inc; The author receives consultant fees and is a stockholder in Elucent Medical; The author is a stockholder in Histosonics, Inc, McGinley Orthopedic Innovations; The author receives grant funding from Siemens Medical. JLH- The author receives consultant fees from Ethicon, Inc. The author is a stockholder in Histosonics, Inc, Elucent Medical, LiteRay, Accure, and Cellectar. FTL Jr receives consultant fees from Ethicon, Inc. The author is a stockholder, is on board of directors, and receives research support from Histosonics, Inc. The author has patents with and receives royalties from Medtronic, Inc. The author is a stockholder and board observer in Elucent Medical. The author is a stockholder in Eximis Surgical. The author is a stockholder in Healthmyne, Inc. The author is a stockholder in ImageMover, Inc. The author is a stockholder in Zurex, Inc. TJZ receives consultant fees from Ethicon, Inc. The author is a stockholder in Histosonics, Inc. TM, JFS, EAK, KCL, and EJA declare that they have no conflicts of interest.
For this type of study, formal consent is not required and was performed under a waiver of informed consent by the University of Wisconsin Institutional Review Board.
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Swietlik, J.F., Knott, E.A., Longo, K.C. et al. Microwave Ablation of Adrenal Tumors in Patients With Continuous Intra-Arterial Blood Pressure Monitoring Without Prior Alpha-Adrenergic Blockade: Safety and Efficacy. Cardiovasc Intervent Radiol (2020). https://doi.org/10.1007/s00270-020-02547-w
- Adrenal ablation
- Interventional oncology