Brian Timothy Welch BS, Presenter: Nothing to Disclose

Thomas Duncan Atwell MD, Abstract Co-Author: Nothing to Disclose

Douglas Allen Nichols MD, Abstract Co-Author: Nothing to Disclose

C. Thomas Wass, Abstract Co-Author: Nothing to Disclose

Matthew Raymond Callstrom MD, PhD, Abstract Co-Author: Research grant, Endocare, Inc Research grant, Siemens AG

J. William Charboneau MD, Abstract Co-Author: Nothing to Disclose

Bradley Leibovich MD, Abstract Co-Author: Nothing to Disclose

Paul Carpenter, Abstract Co-Author: Nothing to Disclose

Jaywant N. Mandrekar PhD, Abstract Co-Author: Nothing to Disclose

To review our experience performing adrenal cryoablations, with specific attention to safety, technical success, complications, and hemodynamic changes associated with the adrenal cryoablation procedure.

This is a retrospective review of adult patients with adrenal metastasis who were treated with adrenal cryoablation between May 2005 and October 2009. Twelve patients with single adrenal tumors were included in the analysis. Technical success, safety, and local control were determined. Hemodynamic changes during the procedure were statistically analyzed against an unmatched cohort of kidney cryoablation patients. A further sub-analysis of hemodynamic changes was performed based on pre-procedural adrenergic blockade.

Adrenal cryoablation achieved local control following treatment of 11/12 (92%) tumors. One patient with known adrenal insufficiency was conservatively ablated and developed ipsilateral adrenal recurrence, which was retreated. Four patients developed malignant hypertension during the final, active thaw phase of the cryoablation procedure. Patients undergoing adrenal cryoablation experienced a statistically significant increase in systolic blood pressure (SBP) (p=0.003), peripheral arterial pressure (PAP) (p=0.02), and mean arterial pressure (MAP) (p=0.01) when compared to the cohort of kidney patients. Adrenal cryoablation patients who were not premedicated with an alpha receptor antagonist had a higher level of SBP elevation during the cryoablation procedure when compared to their counterparts who had alpha blockade (p=0.045).

Adrenal cryoablation is technically feasible with a high rate of local control. Patients premedicated with the alpha receptor antagonist phenoxybenzamine appear to have a reduced risk of malignant hypertension.

Our case series is the first to statistically analyze hemodynamic change during percutaneous adrenal cryoablation while reporting our experience with the safety and technical success of the procedure.

Welch, B, Atwell, T, Nichols, D, Wass, C, Callstrom, M, Charboneau, J, Leibovich, B, Carpenter, P, Mandrekar, J, Percutaneous Image-guided Adrenal Cryoablation: Procedural Considerations and Technical Success.  Radiological Society of North America 2010 Scientific Assembly and Annual Meeting, November 28 - December 3, 2010 ,Chicago IL. http://archive.rsna.org/2010/9008823.html