Microwave Ablation of Adrenal Tumors in Patients With Continuous Intra-Arterial Blood Pressure Monitoring Without Prior Alpha-Adrenergic Blockade: Safety and Efficacy

Abstract

Purpose

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.

Results

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%.

Conclusion

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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Funding

This study was not supported by any funding.

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Correspondence to John F. Swietlik.

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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.

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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

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Keywords

  • Ablation
  • Adrenal ablation
  • Interventional oncology