ARRS 2022 Abstracts

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1145. Safety and Effectiveness of Percutaneous Transhepatic Renal Mass Ablation: A Multicenter Cohort
Authors * Denotes Presenting Author
  1. Assaf Graif; ChristianaCare
  2. Husam El Khudari *; University of Alabama
  3. William Ryan; ChristianaCare
  4. Grant Schmit; Mayo Clinic - Rochester
  5. Andrew Gunn; University of Alabama
Objective:
This study aims to examine the safety and effectiveness of a transhepatic approach to percutaneous thermal ablation of renal masses.

Materials and Methods:
This study was a multicenter, retrospective review of patients who underwent percutaneous thermal renal ablation using a transhepatic approach between 2007-2021. Adverse events (AE) were classified according to Society of Interventional Radiology guidelines. Primary technical success was defined as lack of enhancement in the ablated mass on first imaging follow-up. Secondary technical success was defined as no residual enhancement on imaging achieved after more than a single procedure (with an imaging study demonstrating enhancement between procedures). Effectiveness was evaluated through local control, defined as a combination of the primary and secondary technical success rates.

Results:
Twenty-seven patients (median age: 64 years [range:41 - 84], 51.9% females) with a median tumor diameter of 2.3 cm (range: 1.5 - 4.6 cm) and a median RENAL nephrometry score of 5 (range: 4 - 10) were included. Cryoablation was performed in 23 (85.2%) patients, whereas radiofrequency ablation and microwave ablation were performed in one (3.7%) and three (11.1%) patients, respectively. Eight (29.6%) patients were treated in the prone position. A median of two (range: 1 - 5) probes were used in each procedure with a median of one (range: 1 - 3) probes placed via a transhepatic approach. The median probe size was 17G (range: 13 - 17). Tract cautery was used in 11/26 (42.3%) procedures. Three (11.1%) total AEs occurred. Two severe AEs (7.4%) included an intrahepatic hematoma requiring admission >24 hours and an intraabdominal abscess related to bowel injury. One (3.7%) moderate AE was a subcapsular hematoma. Five patients did not have any follow-up imaging. Primary technical success was achieved in 86.4% (19/22) of patients. Three patients underwent more than a single ablation procedure, and two (66.7%) of them achieved secondary technical success. Local control was achieved in 21/22 (95.5%) patients.

Conclusion:
A transhepatic approach to percutaneous renal mass thermal ablation is safe, with a severe adverse event rate (7.4%) similar to non-transhepatic approaches, and effective, achieving local control in 95.5% of patients.