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.
References
Venkatesan AM, Locklin J, Dupuy DE, Wood BJ. Percutaneous ablation of adrenal tumors. Tech Vasc Interv Radiol. 2010;13(2):89–99. https://doi.org/10.1053/j.tvir.2010.02.004.
Fintelman FJ, et al. Catecholamine surge during image-guided ablation of adrenal gland metastases: predictors, consequences, and recommendations for management. J Vasc Interv Radiol. 2016;27:395–402.
Frenk NE, et al. Local control and survival after image-guided percutaneous ablation of adrenal metastases. J Vasc Interv Radiol. 2018;29(2):276–84. https://doi.org/10.1016/j.jvir.2017.07.026.
Hinshaw JL, Lubner MG, Ziemlewicz TJ, Lee FT, Brace CL. Percutaneous tumor ablation tools: microwave, radiofrequency, or cryoablation-what should you use and why? Radiographics. 2014;34(5):1344–62. https://doi.org/10.1148/rg.345140054.
Li X, Fan W, Zhang L, et al. CT-guided percutaneous microwave ablation of adrenal malignant carcinoma: preliminary results. Cancer. 2011;117(22):5182–8. https://doi.org/10.1002/cncr.26128.
Men M, Ye X, Fan W, et al. Short-term outcomes and safety of computed tomography-guided percutaneous microwave ablation of solitary adrenal metastasis from lung cancer: a multi-center retrospective study. Korean J Radiol. 2016;17(6):864–73. https://doi.org/10.3348/kjr.2016.17.6.864.
Ren C, et al. Percutaneous microwave ablation of adrenal tumours under ultrasound guidance in 33 patients with 35 tumours: a single-centre experience. Int J Hyperth. 2016;32(5):517–23. https://doi.org/10.3109/02656736.2016.1164905.
Wang Y, Liang P, Yu X, Cheng Z, Yu J, Dong J. Ultrasound-guided percutaneous microwave ablation of adrenal metastasis: Preliminary results. Int J Hyperth. 2009;25(6):455–61. https://doi.org/10.1080/02656730903066608.
Zheng L, et al. Hypertensive crisis during microwave ablation of adrenal neoplasms: a retrospective analysis of predictive factors. J Vasc Interv Radiol. 2019;30(9):1343–50. https://doi.org/10.1016/j.jvir.2019.01.016.
Beland MD, Mayo-Smith WW. Ablation of adrenal neoplasms. Abdom Imag. 2009;34(5):588–92. https://doi.org/10.1007/s00261-008-9462-y.
Atwell TD, Wass CT, Charboneau JW, Callstrom MR, Farrell MA, Sengupta S. Malignant hypertension during cryoablation of an adrenal gland tumor. J Vasc Interv Radiol. 2006;17(3):573–5. https://doi.org/10.1097/01.RVI.0000197370.83569.33.
Groeben H. Präoperative α-Rezeptoren-Blockade beim Phäochromozytom?—Kontra. Chirurg. 2012;83(6):551–4. https://doi.org/10.1007/s00104-011-2196-3.
VanValkinburgh D, McGuigan J. Inotropes and vasopressors, vol. 13. Treasure Island: StatPearls Publishing LLC; 2019.
Agrawal R, Mishra SK, Bhatia E, et al. Prospective study to compare peri-operative hemodynamic alterations following preparation for pheochromocytoma surgery by phenoxybenzamine or prazosin. World J Surg. 2014;38(3):716–23. https://doi.org/10.1007/s00268-013-2325-x.
Welch BT, Callstrom MR, Carpenter PC, et al. A single-institution experience in image-guided thermal ablation of adrenal gland metastases. J Vasc Interv Radiol. 2014;25(4):593–8. https://doi.org/10.1016/j.jvir.2013.12.013.
Ahmed M, Solbiati L, Brace CL, et al. Image-guided tumor ablation: standardization of terminology and reporting criteria—A 10-year update. J Vasc Interv Radiol. 2014;25(11):1691–1705.e4. https://doi.org/10.1016/j.jvir.2014.08.027.
Khalilzadeh O, et al. Proposal of a new adverse event classification by the Society of Interventional Radiology Standards of Practice Committee. J Vasc Interv Radiol. 2017;28(10):1432–1437.e3.
Loubser PG. Comparison of intra-arterial and automated oscillometric blood pressure measurement methods in postoperative hypertensive patients. Med Instrum. 20(5):255–259. https://www.ncbi.nlm.nih.gov/pubmed/3784934. Accessed 13 Nov, 2019.
Manios E, Vemmos K, Tsivgoulis G, et al. Comparison of noninvasive oscillometric and intra-arterial blood pressure measurements in hyperacute stroke. Blood Press Monit. 2007;12(3):149–56. https://doi.org/10.1097/MBP.0b013e3280b083e2.
Kinney MA, Warner ME, vanHeerden JA, et al. Perianesthetic risks and outcomes of pheochromocytoma and paraganglioma resection. Anesth Analg. 2000;91(5):1118–23. https://doi.org/10.1097/00000539-200011000-00013.
Boutros AR, Bravo EL, Zanettin G, Straffon RA. Perioperative management of 63 patients with pheochromocytoma. Cleve Clin J Med. 1990;57(7):613–7. https://doi.org/10.3949/ccjm.57.7.613.
Naranjo J, Dodd S, Martin YN. Perioperative Management of Pheochromocytoma. J Cardiothorac Vasc Anesth. 2017;31(4):1427–39. https://doi.org/10.1053/j.jvca.2017.02.023.
Chini EN, et al. Hypertensive crisis in a patient undergoing percutaneous radiofrequency ablation of an adrenal mass under general anesthesia. Anesthesia Analg. 2004;99:1867–9. https://doi.org/10.1213/01.ane.0000136803.54212.e1.
Funding
This study was not supported by any funding.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
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.
Ethical Approval
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.
Informed Consent
This study has obtained IRB approval from the University of Wisconsin Institutional Review Board and the need for informed consent was waived.
Consent of Publication
For this type of study, consent for publication is not required.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
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 43, 1384–1391 (2020). https://doi.org/10.1007/s00270-020-02547-w
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00270-020-02547-w