Percutaneous Ablation for Small Renal Masses—Complications

 

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Abstract

Although percutaneous ablation of small renal masses is generally safe, interventional radiologists should be aware of the various complications that may arise from the procedure. Renal hemorrhage is the most common significant complication. Additional less common but serious complications include injury to or stenosis of the ureter or ureteropelvic junction, infection/abscess, sensory or motor nerve injury, pneumothorax, needle tract seeding, and skin burn. Most complications may be treated conservatively or with minimal therapy. Several techniques are available to minimize the risk of these complications, and patients should be appropriately monitored for early detection of complications. In the event of a serious complication, prompt treatment should be provided. This article reviews the most common and most important complications associated with percutaneous ablation of small renal masses.

• References

• 1 Atwell TD, Carter RE, Schmit GD , et al. Complications following 573 percutaneous renal radiofrequency and cryoablation procedures. J Vasc Interv Radiol 2012; 23 (1) 48-54
  CrossrefPubMedGoogle Scholar
• 2 Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 2004; 240 (2) 205-213
  CrossrefPubMedGoogle Scholar
• 3 Morgan M, Smith N, Thomas K, Murphy DG. Is Clavien the new standard for reporting urological complications?. BJU Int 2009; 104 (4) 434-436
  CrossrefPubMedGoogle Scholar
• 4 Common Terminology Criteria for Adverse Events (CTCAE) Version 4.0. In: U.S. Department of Health and Human Services
  PubMed
• 5 Sacks D, McClenny TE, Cardella JF, Lewis CA. Society of Interventional Radiology clinical practice guidelines. J Vasc Interv Radiol 2003; 14 (9 Pt 2) S199-S202
  CrossrefPubMedGoogle Scholar
• 6 Campbell SC, Novick AC, Belldegrun A , et al; Practice Guidelines Committee of the American Urological Association. Guideline for management of the clinical T1 renal mass. J Urol 2009; 182 (4) 1271-1279
  CrossrefPubMedGoogle Scholar
• 7 Johnson DB, Solomon SB, Su LM , et al. Defining the complications of cryoablation and radio frequency ablation of small renal tumors: a multi-institutional review. J Urol 2004; 172 (3) 874-877
  CrossrefPubMedGoogle Scholar
• 8 Hui GC, Tuncali K, Tatli S, Morrison PR, Silverman SG. Comparison of percutaneous and surgical approaches to renal tumor ablation: metaanalysis of effectiveness and complication rates. J Vasc Interv Radiol 2008; 19 (9) 1311-1320
  CrossrefPubMedGoogle Scholar
• 9 Gervais DA, McGovern FJ, Arellano RS, McDougal WS, Mueller PR. Radiofrequency ablation of renal cell carcinoma: part 1, Indications, results, and role in patient management over a 6-year period and ablation of 100 tumors. AJR Am J Roentgenol 2005; 185 (1) 64-71
  CrossrefPubMedGoogle Scholar
• 10 Hegarty NJ, Gill IS, Desai MM, Remer EM, O'Malley CM, Kaouk JH. Probe-ablative nephron-sparing surgery: cryoablation versus radiofrequency ablation. Urology 2006; 68 (1, Suppl): 7-13
  PubMedGoogle Scholar
• 11 Zagoria RJ, Traver MA, Werle DM, Perini M, Hayasaka S, Clark PE. Oncologic efficacy of CT-guided percutaneous radiofrequency ablation of renal cell carcinomas. AJR Am J Roentgenol 2007; 189 (2) 429-436
  CrossrefPubMedGoogle Scholar
• 12 Atwell TD, Farrell MA, Leibovich BC , et al. Percutaneous renal cryoablation: experience treating 115 tumors. J Urol 2008; 179 (6) 2136-2140 , discussion 2140–2141
  CrossrefPubMedGoogle Scholar
• 13 Gupta A, Allaf ME, Kavoussi LR , et al. Computerized tomography guided percutaneous renal cryoablation with the patient under conscious sedation: initial clinical experience. J Urol 2006; 175 (2) 447-452 , discussion 452–453
  CrossrefPubMedGoogle Scholar
• 14 Silverman SG, Tuncali K, vanSonnenberg E , et al. Renal tumors: MR imaging-guided percutaneous cryotherapy—initial experience in 23 patients. Radiology 2005; 236 (2) 716-724
  CrossrefPubMedGoogle Scholar
• 15 Atwell TD, Schmit GD, Boorjian SA , et al. Percutaneous ablation of renal masses measuring 3.0 cm and smaller: comparative local control and complications after radiofrequency ablation and cryoablation. AJR Am J Roentgenol 2013; 200 (2) 461-466
  CrossrefPubMedGoogle Scholar
• 16 Schmit GD, Thompson RH, Boorjian SA , et al. Percutaneous renal cryoablation in obese and morbidly obese patients. Urology 2013; 82 (3) 636-641
  CrossrefPubMedGoogle Scholar
• 17 Sutor AH, Bowie EJ, Owen Jr CA. Effect of temperature on hemostasis: a cold-tolerance test. Blut 1971; 22 (1) 27-34
  CrossrefPubMedGoogle Scholar
• 18 Schmit GD, Atwell TD, Callstrom MR , et al. Ice ball fractures during percutaneous renal cryoablation: risk factors and potential implications. J Vasc Interv Radiol 2010; 21 (8) 1309-1312
  CrossrefPubMedGoogle Scholar
• 19 Brashears III JH, Raj GV, Crisci A , et al. Renal cryoablation and radio frequency ablation: an evaluation of worst case scenarios in a porcine model. J Urol 2005; 173 (6) 2160-2165
  CrossrefPubMedGoogle Scholar
• 20 Janzen NK, Perry KT, Han KR , et al. The effects of intentional cryoablation and radio frequency ablation of renal tissue involving the collecting system in a porcine model. J Urol 2005; 173 (4) 1368-1374
  CrossrefPubMedGoogle Scholar
• 21 Cantwell CP, Wah TM, Gervais DA , et al. Protecting the ureter during radiofrequency ablation of renal cell cancer: a pilot study of retrograde pyeloperfusion with cooled dextrose 5% in water. J Vasc Interv Radiol 2008; 19 (7) 1034-1040
  CrossrefPubMedGoogle Scholar
• 22 Froemming A, Atwell T, Farrell M, Callstrom M, Leibovich B, Charboneau W. Probe retraction during renal tumor cryoablation: a technique to minimize direct ureteral injury. J Vasc Interv Radiol 2010; 21 (1) 148-151
  CrossrefPubMedGoogle Scholar
• 23 Park BK, Kim CK. Complications of image-guided radiofrequency ablation of renal cell carcinoma: causes, imaging features and prevention methods. Eur Radiol 2009; 19 (9) 2180-2190
  CrossrefPubMedGoogle Scholar
• 24 Gervais DA, Arellano RS, McGovern FJ, McDougal WS, Mueller PR. Radiofrequency ablation of renal cell carcinoma: part 2, Lessons learned with ablation of 100 tumors. AJR Am J Roentgenol 2005; 185 (1) 72-80
  CrossrefPubMedGoogle Scholar
• 25 Farrell MA, Charboneau JW, Callstrom MR, Reading CC, Engen DE, Blute ML. Paranephric water instillation: a technique to prevent bowel injury during percutaneous renal radiofrequency ablation. AJR Am J Roentgenol 2003; 181 (5) 1315-1317
  CrossrefPubMedGoogle Scholar
• 26 Kurup AN, Morris JM, Schmit GD , et al. Neuroanatomic considerations in percutaneous tumor ablation. Radiographics 2013; 33 (4) 1195-1215
  CrossrefPubMedGoogle Scholar
• 27 Bhayani SB, Allaf ME, Su LM, Solomon SB. Neuromuscular complications after percutaneous radiofrequency ablation of renal tumors. Urology 2005; 65 (3) 592
  PubMedGoogle Scholar
• 28 Boss A, Clasen S, Kuczyk M , et al. Thermal damage of the genitofemoral nerve due to radiofrequency ablation of renal cell carcinoma: a potentially avoidable complication. AJR Am J Roentgenol 2005; 185 (6) 1627-1631
  CrossrefPubMedGoogle Scholar
• 29 Lee SJ, Choyke LT, Locklin JK, Wood BJ. Use of hydrodissection to prevent nerve and muscular damage during radiofrequency ablation of kidney tumors. J Vasc Interv Radiol 2006; 17 (12) 1967-1969
  CrossrefPubMedGoogle Scholar
• 30 Silverman SG, Gan YU, Mortele KJ, Tuncali K, Cibas ES. Renal masses in the adult patient: the role of percutaneous biopsy. Radiology 2006; 240 (1) 6-22
  CrossrefPubMedGoogle Scholar
• 31 Lokken RP, Gervais DA, Arellano RS , et al. Inflammatory nodules mimic applicator track seeding after percutaneous ablation of renal tumors. AJR Am J Roentgenol 2007; 189 (4) 845-848
  CrossrefPubMedGoogle Scholar
• 32 Woodrum DA, Atwell TD, Farrell MA, Andrews JC, Charboneau JW, Callstrom MR. Role of intraarterial embolization before cryoablation of large renal tumors: a pilot study. J Vasc Interv Radiol 2010; 21 (6) 930-936
  CrossrefPubMedGoogle Scholar