Percutaneous image-guided adrenal cryoablation: Procedural considerations and technical success

Purpose: To assess safety, technical success, complications, and hemodynamic changes associated with the adrenal cryoablation procedure. Materials and: This retrospective review was approved by the institu-Methods: tional review board, with waiver of informed consent, and was compliant with the Health Insurance Portability and Accountability Act. Adult patients with adrenal metastasis who were treated with adrenal cryoablation between May 2005 and October 2009 were eligible for this review. Twelve patients (undergoing 13 procedures) with single adrenal tumors were included in the analysis. For statistical analysis, hemodynamic data were averaged for the patient undergoing the procedure twice. Technical success, safety, and local control were analyzed according to standard criteria. Hemodynamic changes during the procedure were analyzed and compared with data from an unmatched cohort of patients who underwent kidney (not in the upper pole) cryoablation (Wilcoxon rank sum test). A further subanalysis of hemodynamic changes was performed on the basis of whether preprocedural a-or b-adrenergic blockade was used. Results: With adrenal cryoablation, local control was achieved following treatment in 11 (92%; 95% confidence interval: 65.1%, 99.6%) of 12 tumors. One patient with known adrenal insufficiency underwent conservative ablation and developed ipsilateral adrenal recurrence, which was retreated. Five patients developed hypertensive crisis during the final, active thaw phase of the cryoablation procedure, and one patient developed hypertensive crisis in the immediate postablation period. Patients undergoing adrenal cryoablation experienced a significant increase in systolic blood pressure (P =.005), pulse pressure (P =.02), and mean arterial pressure (P =.01) when compared with the cohort of kidney cryoablation patients. Adrenal cryoablation patients who were not premedicated with an α-blocker (n = 5) had a higher level of systolic blood pressure increase during the cryoablation procedure when compared with their counterparts who were premedicated (n = 7) (P =.034). Conclusion: Adrenal cryoablation is technically feasible with a high rate of local control. Patients premedicated with the α-blocker phenoxybenzamine appear to have a reduced risk of hypertensive crisis.