Abstract No. 411 - Surviving the interventional radiology ice-bucket challenge: percutaneous cryoablation of renal masses in difficult anatomic locations

Abstract

Renal masses in difficult anatomic locations can often be safely and appropriately treated with percutaneous image-guided cryoablation. The purpose of this exhibit is to describe and demonstrate adjunctive techniques that improve safety and technical success rates of percutaneous cryoablation of renal masses in difficult anatomic locations. Management strategies for the treatment of small renal masses include active surveillance, percutaneous ablation, or nephron-sparing surgery. The decision is made based on age of patient, medical history, surgical comorbidities, mass size and location, rate of growth, and patient preference. Percutaneous image-guided cryoablation is a well-accepted, minimally invasive therapy to treat small renal masses, particularly in patients who are poor surgical candidates due to multiple comorbidities, multiple tumors, or renal failure. Lesions typically considered more difficult to ablate include central lesions, size larger than 3 centimeters, upper pole location, endophytic, and adjacent to ureter, colon, or other organs. Some renal lesion locations have been classically described as more difficult to treat with percutaneous cryoablation due to risk of damaging adjacent critical structures, such as the ureter, renal pelvis, or adjacent bowel. Retrograde pyeloperfusion, hydrodissection, and angioplasty balloon interposition are three techniques that can be used to safely perform cryoablation in these difficult anatomic locations. In addition, choosing a patient position on the procedure table to create the safest treatment window is critical. These techniques can be used individually or in combination to improve safety when ablating renal masses in challenging anatomic locations. Maximizing patient positioning, retrograde pyeloperfusion, hydrodissection, and angioplasty balloon interposition are critical adjunctive techniques that can be used to improve safety when performing percutaneous image-guided cryoablation of small renal masses in difficult anatomic locations.