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Review
. 2014 Jun;31(2):157-66.
doi: 10.1055/s-0034-1373790.

Renal ablation update

Vishal Khiatani  1 , Robert G Dixon  2
Affiliations
Review

Renal ablation update

Vishal Khiatani et al. Semin Intervent Radiol. 2014 Jun.

Abstract

Thermal ablative technologies have evolved considerably in the recent past and are now an important component of current clinical guidelines for the treatment of small renal masses. Both radiofrequency ablation and cryoablation have intermediate-term oncologic control that rivals surgical options, with favorable complication profiles. Studies comparing cryoablation and radiofrequency ablation show no significant difference in oncologic control or complication profile between the two modalities. Early data from small series with microwave ablation have shown similar promising results. Newer technologies including irreversible electroporation and high-intensity-focused ultrasound have theoretical advantages, but will require further research before becoming a routine part of the ablation armamentarium. The purpose of this review article is to discuss the current ablative technologies available, briefly review their mechanisms of action, discuss technical aspects of each, and provide current data supporting their use.

Keywords: cryoablation; interventional radiology; irreversible electroporation; microwave; radiofrequency; small renal mass.

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Figures

Figure 1
Figure 1
(A) Contrast-enhanced CT image shows an enhancing lesion (arrow) in the upper pole of the right kidney. (B) CT image during placement of cryoprobes using CT fluoroscopy. Ideally, cryoprobes are placed parallel to one another; however, in this case, the rib prevented ideal geometry. Therefore, the two probes inserted cephalad to this image were placed parallel, while these probes converged. Care was taken not to directly puncture the collecting system. (C) Images just cephalad to B show nearly parallel cryoprobes, with the hypodense ice ball (star) converging upon the contrast within the collecting system (arrow). (D) Hypodense region of cryoablation after removal of the probes seen with no contrast extravasation. (E) Follow-up MRI at 3 years shows no enhancement of the successfully ablated lesion (arrow). CT, computed tomography; MRI, magnetic resonance imaging.
Figure 2
Figure 2
(A) A 38-year-old woman with tuberous sclerosis and prior right nephrectomy for renal cell carcinoma found to have a 1.1-cm enhancing left renal mass (arrow). Note the immediately adjacent colon (star). (B) Insertion of 21-gauge needle allows hydrodissection to be performed with injection of sterile water (arrow) to displace the adjacent colon away from the targeted lesion. (C) RFA electrode positioned under CT guidance, just prior to final position across the lesion. (D) RFA electrode in final position across the lesion with colon successfully displaced. CT, computed tomography; RFA, radiofrequency ablation.
See this image and copyright information in PMC

References

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