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
Samuel Tesfalidet, MD: No financial relationships to disclose
Scott M. Thompson, MD., Ph.D: 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.