Long-term renal function outcomes after renal cryoablation complicated by major hemorrhage requiring selective transarterial embolization

• Published in: Abdominal imaging 2021-10, Vol.46 (10), p.4898-4907
• Main Authors: McElroy, Kevin M., Reisenauer, Christopher J., Welch, Brian T., Takahashi, Edwin A., Frimpong, Richard G., Atwell, Thomas D., Fleming, Chad J., Thompson, Scott M.
• Format: Article
• Language: English
• Subjects: Ablation; Anticoagulants; Coagulation; Creatinine; Embolization; Epidermal growth factor receptors; Gastroenterology; Glomerular filtration rate; Hemodialysis; Hemorrhage; Hepatology; Imaging; Interventional Radiology; Medicine; Medicine & Public Health; Morbidity; Parameters; Patients; Radiology; Renal function; Risk analysis; Risk factors
• ISSN: 2366-004X; 2366-0058
• DOI: 10.1007/s00261-021-03182-w

Purpose To determine long-term renal function outcomes after renal cryoablation complicated by major hemorrhage requiring transarterial embolization compared to patients who underwent uncomplicated renal cryoablation without major hemorrhage. Methods Utilizing a matched cohort study design, retrospective review identified 23 patients who underwent percutaneous image-guided renal cryoablation complicated by major hemorrhage requiring ipsilateral transarterial embolization (TAE group) and a control group of 23 patients who underwent uncomplicated renal cryoablation matched 1:1 by age, gender and RENAL Nephrometry score at a single institution from 1/1/2005 to 12/31/2019. Primary outcome parameters included change in creatinine (mg/dl) and estimated glomerular filtration rate (ml/min/1.73 m 2 ; eGFR) from baseline and were compared between TAE and control group using a paired t-test. Results There was a significantly higher proportion of patients on pre-ablation anticoagulation in the TAE v. control group (30% v. 4%; p  = 0.047), but all patients were off anticoagulation and with normal coagulation parameters at the time of cryoablation. Otherwise there were no significant differences in clinical, renal tumor, Charlson co-morbidity index, baseline renal function or cryoablation parameters between the TAE and control group. In the post-ablation period, there was trend toward greater increase in creatinine from baseline to worst post-ablation creatinine in the TAE v. the control group (+ 0.5 ± 0.7 mg/dl v. 0.2 ± 0.1 mg/dl; p  = 0.056). However, at a mean follow-up of 42.7 ± 35.7 months, there was no significant difference between the TAE and control group in creatinine ( p  = 0.68), eGFR ( p  = 0.60) or change from baseline in creatinine ( p  = 0.28), eGFR ( p  = 0.80) or CKD stage ( p  = 0.74). No patient required initiation of hemodialysis. Conclusion Selective transarterial embolization for post-renal cryoablation hemorrhage does not significantly affect long-term renal function compared to cryoablation alone. Pre-ablation anticoagulation despite normal coagulation at time of ablation may be a risk factor for post-ablation hemorrhage, and warrants further evaluation when considering pre-ablation embolization.