S-55-5: CT GUIDED AND TRANSVENOUS RADIOFREQUENCY ABLATION FOR PRIMARY ALDOSTERONISM

Abstract

We are developing minimally invasive treatments for primary aldosteronism. In this presentation, we will introduce our research and clinical studies on percutaneous and transvenous radiofrequency ablation (RFA). Based on the preclinical studies, a protocol for ablating human adrenal glands and intraoperative blood pressure control methods were developed. First-in-human procedure was performed. Flexible RFA catheter was inserted into the upper lateral tributary of the left adrenal vein. The position of the RFA catheter was confirmed by CT. Ablations were performed while applying energy of 7000 J twice to each location, pulling back the catheter several millimeters in sequence. The aldosterone-producing adenoma was completely ablated to normalize the serum aldosterone level. CT-guided RFA was able to treat PA with a high success rate. However, approximately 50% of the left aldosterone producing adenomas were difficult to puncture due to anatomical reason, while most of the right adrenal adenoma could be treated by CT-guided RFA. The transvenous RFA catheter is much easier to insert into the left adrenal vein than into the right, suggesting that the two RFA methods have complementary roles. Furthermore, it may be possible to perform AVS diagnosis and RFA treatment in a single procedure.