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Long-term renal function outcomes after renal cryoablation complicated by major hemorrhage requiring selective transarterial embolization

  • Interventional Radiology
  • Published:
Abdominal Radiology Aims and scope Submit manuscript

Abstract

Purpose

To determine long-term renal function outcomes after renal cryoablation complicated by major hemorrhage requiring transarterial embolization compared to patients who underwent uncomplicated renal cryoablation without major hemorrhage.

Methods

Utilizing a matched cohort study design, retrospective review identified 23 patients who underwent percutaneous image-guided renal cryoablation complicated by major hemorrhage requiring ipsilateral transarterial embolization (TAE group) and a control group of 23 patients who underwent uncomplicated renal cryoablation matched 1:1 by age, gender and RENAL Nephrometry score at a single institution from 1/1/2005 to 12/31/2019. Primary outcome parameters included change in creatinine (mg/dl) and estimated glomerular filtration rate (ml/min/1.73 m2; eGFR) from baseline and were compared between TAE and control group using a paired t-test.

Results

There was a significantly higher proportion of patients on pre-ablation anticoagulation in the TAE v. control group (30% v. 4%; p = 0.047), but all patients were off anticoagulation and with normal coagulation parameters at the time of cryoablation. Otherwise there were no significant differences in clinical, renal tumor, Charlson co-morbidity index, baseline renal function or cryoablation parameters between the TAE and control group. In the post-ablation period, there was trend toward greater increase in creatinine from baseline to worst post-ablation creatinine in the TAE v. the control group (+ 0.5 ± 0.7 mg/dl v. 0.2 ± 0.1 mg/dl; p = 0.056). However, at a mean follow-up of 42.7 ± 35.7 months, there was no significant difference between the TAE and control group in creatinine (p = 0.68), eGFR (p = 0.60) or change from baseline in creatinine (p = 0.28), eGFR (p = 0.80) or CKD stage (p = 0.74). No patient required initiation of hemodialysis.

Conclusion

Selective transarterial embolization for post-renal cryoablation hemorrhage does not significantly affect long-term renal function compared to cryoablation alone. Pre-ablation anticoagulation despite normal coagulation at time of ablation may be a risk factor for post-ablation hemorrhage, and warrants further evaluation when considering pre-ablation embolization.

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Authors and Affiliations

  1. Department of Radiology, Mayo Clinic, 200 1st St SW, Rochester, MN, 55905, USA

    Kevin M. McElroy, Christopher J. Reisenauer, Brian T. Welch, Edwin A. Takahashi, Richard G. Frimpong, Thomas D. Atwell, Chad J. Fleming & Scott M. Thompson

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  1. Kevin M. McElroy
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  2. Christopher J. Reisenauer
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McElroy, K.M., Reisenauer, C.J., Welch, B.T. et al. Long-term renal function outcomes after renal cryoablation complicated by major hemorrhage requiring selective transarterial embolization. Abdom Radiol 46, 4898–4907 (2021). https://doi.org/10.1007/s00261-021-03182-w

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  • DOI: https://doi.org/10.1007/s00261-021-03182-w

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