Bleeding Complications Requiring Therapeutic Trans-arterial Embolization Following Percutaneous Cryoablation for cT1b and cT2 Renal Masses without and with Pre-ablation Prophylactic Trans-arterial Embolization

Tuesday, March 7, 2023

4:03 PM – 4:12 PM

Location: Phoenix Convention Center, 221C

Presenting Author(s)

Samuel Tesfalidet, MD (he/him/his)

IR fellow
MAYO Clinic

Disclosure(s): No financial relationships to disclose

Author/Co-author(s)

Scott M. Thompson, MD, PhD (he/him/his)

Associate Professor of Radiology
Radiology, Mayo Clinic
BW

Brian Welch, MD

Staff Consultant
Mayo Clinic Rochester
RF

Richard Frimpong, MD

Staff Consultant
Mayo Clinic Rochester
CR

Chris J. Reisenauer, MD

Consultant - Radiology
Mayo Clinic
CF

Chad Flemming, MD

Staff Consultant
Mayo Clinic Rochester
MM

Michael Moynagh, MD

Staff Consultant
Mayo Clinic Rochester
GS

Grant Schmit, MD

Staff Consultant
Mayo Clinic Rochester
Thomas Atwell, MD (he/him/his)

Professor of Radiology
Mayo Clinic Rochester
ET

Edwin Takahashi, MD

Assistant Professor
Mayo Clinic

Disclosure(s):

Samuel Tesfalidet, MD: No financial relationships to disclose

Scott M. Thompson, MD, PhD: Boston Scientific: Consultant ()

Thomas Atwell, MD: Techsomed: Contracted Research (Terminated, January 5, 2023)

Purpose: To determine bleeding complications among patients undergoing percutaneous cryoablation for cT1b and cT2 renal masses without and with pre-cryoablation prophylactic trans-arterial embolization.

Materials and Methods: In this IRB-approved retrospective review, consecutive patients who underwent percutaneous cryoablation for cT1b and cT2 renal masses without (n=151; control) and with (n=50; pTAE) pre-cryoablation prophylactic transarterial embolization (pTAE) from 1/1/2003 to 1/31/2018 were evaluated. Demographic, clinical, laboratory procedural and post-ablation bleeding complication data were compared using Fisher’s exact test, t-test or Wilcoxon signed rank test.

Results: There was no significant difference (p > 0.05) in baseline age, gender, solitary kidney, prior surgery on ablated kidney, creatinine or GFR (between the pTAE and control groups. There was significantly lower baseline hemoglobin level (12.6±1.8 v. 13.3±1.7 g/dl; p=0.023), larger tumor size (5.7±1.3 v. 4.8±1.0 cm; p< 0.0001), higher RENAL Nephrometry score (8.6±1.6 v. 7.9±1.7; p=0.010) and greater number of cryoprobes used (6.6±2.6 v. 4.7±1.7; p< 0.0001) in the pTAE v. the control group. Although there was no significant difference in overall complication rate (38.0% v. 25.8%; p=0.11) and major complication rate (18% v. 17.2%; p=1.0) between the pTAE and control group, there were significantly fewer post-cryoablation bleeding/vascular complications requiring TAE in the pTAE v. control group (2.0% v. 11.3%; p=0.048) with a significantly higher proportion of patients in the control group developing active arterial bleeding necessitating therapeutic TAE (7.9% v. 0%; p=0.041). There was no significant difference in post-ablation anemia requiring transfusion (10% v. 6%; p=0.34) or hematuria requiring urologic intervention (0% v. 2%; p=0.57) between the pTAE v. control group.

Conclusion: In this cohort of patients with cT1b or cT2 renal masses undergoing percutaneous cryoablation, ablation-related hemorrhage requiring therapeutic TAE was less common among patients treated with pre-cryoablation prophylactic embolization, despite larger tumor size, more complex renal tumors and more cryoprobes associated with the prophylactic TAE group. These data suggest that pre-cryoablation prophylactic TAE may reduce the risk of post-cryoablation active arterial bleeding among patients with cT1b or cT2 renal masses undergoing percutaneous cryoablation and warrants further evaluation in prospective clinical trials.