Microwave Ablation of Adrenal Tumors in Patients With Continuous Intra-Arterial Blood Pressure Monitoring Without Prior
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TECHNICAL NOTE
NON-VASCULAR INTERVENTIONS
Microwave Ablation of Adrenal Tumors in Patients With Continuous Intra-Arterial Blood Pressure Monitoring Without Prior Alpha-Adrenergic Blockade: Safety and Efficacy John F. Swietlik1 • Emily A. Knott1 • Katherine C. Longo1 • E. Jason Abel2 • Shane A. Wells1 • Meghan G. Lubner1 • Paul F. Laeseke1 • Timothy McCormick3 J. Louis Hinshaw1 • Fred T. Lee Jr.1,4 • Timothy J. Ziemlewicz1
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Received: 18 March 2020 / Accepted: 29 May 2020 Springer Science+Business Media, LLC, part of Springer Nature and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) 2020
Abstract Purpose Evaluate the safety and efficacy of adrenal microwave ablation performed with continuous intra-arterial blood pressure monitoring (IABPM) and without alpha-adrenergic blockade (AAB) as pretreatment. Material and Methods A single-center, retrospective review of all percutaneous adrenal microwave ablation performed between 2011 and 2018. Microwave ablation was completed on 11 patients, with a total of 15 adrenal tumors with a mean size of 3.3 cm (1.4–6.9 cm) treated metastatic RCC, HCC, esophageal carcinoma, adrenal adenoma. Cases were performed without prior AAB, but with continuous IABPM and rapid intervention using shortacting antihypertensive medications. Results There were no post-procedural episodes of hypertension, no neurological or cardiovascular complications, and no SIR moderate or worse adverse event complications. Mean intraprocedural maximum systolic blood pressure (SBP) was 211 mmHg (range: 132–288), with an average increase in SBP of 100 mmHg (range: 23–180). A hypertensive crisis (SBP C 180 and/or DBP C 120) occurred in 9 of the 15 procedures (60%) with a mean
& John F. Swietlik [email protected] 1
Department of Radiology, University of Wisconsin, 600 Highland Ave, Madison, WI 53792, USA
2
Department of Urology, University of Wisconsin, 1685 Highland Ave, Madison, WI 53705, USA
3
Department of Anesthesiology, University of Wisconsin, 600 Highland Ave, Madison, WI 53792, USA
4
Department of Biomedical Engineering, University of Wisconsin, 1550 Engineering Dr, Madison, WI 53706, USA
length of 3.0 min (range: 1–12). The technical success rate was 100% (15/15 procedures). The mean follow-up time was 2.4 years (range: 0.9–7.7 years), with primary and secondary efficacy rates of 77% and 87%, respectively, and an overall survival of 82%. Conclusion In this single-center retrospective study, microwave ablation of adrenal tumors without AAB was safe and effective when performed with continuous arterial line monitoring of vital signs and the use of short-acting, rapid-onset antihypertensive medications. Level of Evidence Level 4, Case Series. Keywords Ablation Adrenal ablation Interventional oncology
Introduction Percutaneous ablation has been shown to be safe and effective for treating adrenal tumors [1–4]. However, most adrenal MW ablation literature has reported using alphaadrenergic blockade (AAB) pretreatment, without continuous intra-arterial blood p
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