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Renal Ablation and Embolization
Joseph A. Ronsivalle, DO, FSIR; Ashraf Thabet, MD
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KEY FACTS

  • Preprocedure

    • Procedure

      • Post Procedure

        • Outcomes

          TERMINOLOGY

          • Definitions

            • Ablation: Percutaneous direct local tumor destruction
              • Energy-based ablation
                • Radiofrequency ablation (RFA): Heat based
                  • Initially most common modality used for renal ablation
                • Microwave ablation (MWA): Heat-based cytotoxicity
                  • Offers faster ablation times; less susceptibility to thermal heat sink effect
                • Cryoablation: Freezing/thawing cycle
                  • Frequently used modality for renal ablation
                  • Least risk of injury to renal collecting system
                • High-intensity focused US: Coagulation necrosis caused by high-intensity US beam focused on small tissue volume
                  • Respiratory motion/overlying ribs problematic
                • Irreversible electroporation: Electrical disruption of integrity of cell membrane
                  • Promising preliminary animal/human data, still investigational
              • Chemical ablation
                • Inconsistent cellular necrosis in renal tumors
                  • Not routinely used for renal ablation
            • Embolization: Transcatheter introduction of intravascular agent for devascularization/occlusion
              • Bland embolization: Transcatheter arterial embolization without chemotherapeutic agent
              • Transcatheter ethanol injection: Denatures cellular proteins/causes small vessel thrombosis
            • Thermal heat sink effect: Thermal energy needed to achieve cytotoxicity is dissipated
              • Convective heat transfer to adjacent structures
                • Blood flow in vessels abutting tumor prevents adequate heat generation for effective ablation
              • Possible with all modalities, but least risk with MWA

          PREPROCEDURE

          • Indications

            • Contraindications

              • Preprocedure Imaging

                • Getting Started

                  PROCEDURE

                  • Patient Position/Location

                    • Equipment Preparation

                      • Procedure Steps

                        • Alternative Procedures/Therapies

                          POST PROCEDURE

                          • Things to Avoid

                            • Postprocedure Imaging (Ablation)

                              OUTCOMES

                              • Complications

                                • Expected Outcomes

                                  Selected References

                                  1. Abdelsalam ME et al: Ablation of small renal masses. Tech Vasc Interv Radiol. 23(2):100674, 2020
                                  2. Mershon JP et al: Thermal ablation of the small renal mass: a critical analysis of current literature. Minerva Urol Nefrol. 72(2):123-34, 2020
                                  3. Zhong J et al: Renal ablation: current management strategies and controversies. Chin Clin Oncol. 8(6):63, 2019
                                  4. Sanchez A et al: Current management of small renal masses, including patient selection, renal tumor biopsy, active surveillance, and thermal ablation. J Clin Oncol. 36(36):3591-600, 2018
                                  5. Omodon M et al: Review of renal artery embolization for treatment of renal angiomyolipoma. Clin Nephrol Urol Sci. 3:1, 2016
                                  6. Potretzke AM et al: Re: Thompson RH et al. Comparison of partial nephrectomy and percutaneous ablation for cT1 renal masses. Eur Urol 2015;67:252-9. Eur Urol. 67(2):e19-20, 2015
                                  7. Moreland AJ et al: High-powered microwave ablation of t1a renal cell carcinoma: safety and initial clinical evaluation. J Endourol. 28(9):1046-52, 2014
                                  8. Sahni VA et al: Imaging management of incidentally detected small renal masses. Semin Intervent Radiol. 31(1):9-19, 2014
                                  9. Gervais DA: Cryoablation versus radiofrequency ablation for renal tumor ablation: time to reassess? J Vasc Interv Radiol. 24(8):1135-8, 2013
                                  10. Chan CK et al: The efficacy, safety and durability of selective renal arterial embolization in treating symptomatic and asymptomatic renal angiomyolipoma. Urology. 77(3):642-8, 2011
                                  11. Hong K et al. Percutaneous Tumor Ablation, Strategies and Techniques. Thieme, 2011
                                  12. Breen DJ et al: Minimally invasive treatment of small renal tumors: trends in renal cancer diagnosis and management. Cardiovasc Intervent Radiol. 33(5):896-908, 2010
                                  13. Thumar AB et al: Thermal ablation of renal cell carcinoma: triage, treatment, and follow-up. J Vasc Interv Radiol. 21(8 Suppl):S233-41, 2010
                                  14. Arellano RS et al: Percutaneous CT-guided radiofrequency ablation of renal cell carcinoma: efficacy of organ displacement by injection of 5% dextrose in water into the retroperitoneum. AJR Am J Roentgenol. 193(6):1686-90, 2009
                                  15. Gervais DA et al: Percutaneous image-guided therapy of intra-abdominal malignancy: imaging evaluation of treatment response. Abdom Imaging. 34(5):593-609, 2009
                                  16. Uppot RN et al: Imaging-guided percutaneous ablation of renal cell carcinoma: a primer of how we do it. AJR Am J Roentgenol. 192(6):1558-70, 2009
                                  17. Cantwell CP et al: Protecting the ureter during radiofrequency ablation of renal cell cancer: a pilot study of retrograde pyeloperfusion with cooled dextrose 5% in water. J Vasc Interv Radiol. 19(7):1034-40, 2008
                                  18. Lokken RP et al: Inflammatory nodules mimic applicator track seeding after percutaneous ablation of renal tumors. AJR Am J Roentgenol. 189(4):845-8, 2007
                                  19. Gervais DA et al: Radiofrequency ablation of renal cell carcinoma: part 1, indications, results, and role in patient management over a 6-year period and ablation of 100 tumors. AJR Am J Roentgenol. 185(1):64-71, 2005
                                  20. Gervais DA et al: Radiofrequency ablation of renal cell carcinoma: part 2, lessons learned with ablation of 100 tumors. AJR Am J Roentgenol. 185(1):72-80, 2005
                                  Related Anatomy
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                                  Related Differential Diagnoses
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                                  References
                                  Tables

                                  Tables

                                  KEY FACTS

                                  • Preprocedure

                                    • Procedure

                                      • Post Procedure

                                        • Outcomes

                                          TERMINOLOGY

                                          • Definitions

                                            • Ablation: Percutaneous direct local tumor destruction
                                              • Energy-based ablation
                                                • Radiofrequency ablation (RFA): Heat based
                                                  • Initially most common modality used for renal ablation
                                                • Microwave ablation (MWA): Heat-based cytotoxicity
                                                  • Offers faster ablation times; less susceptibility to thermal heat sink effect
                                                • Cryoablation: Freezing/thawing cycle
                                                  • Frequently used modality for renal ablation
                                                  • Least risk of injury to renal collecting system
                                                • High-intensity focused US: Coagulation necrosis caused by high-intensity US beam focused on small tissue volume
                                                  • Respiratory motion/overlying ribs problematic
                                                • Irreversible electroporation: Electrical disruption of integrity of cell membrane
                                                  • Promising preliminary animal/human data, still investigational
                                              • Chemical ablation
                                                • Inconsistent cellular necrosis in renal tumors
                                                  • Not routinely used for renal ablation
                                            • Embolization: Transcatheter introduction of intravascular agent for devascularization/occlusion
                                              • Bland embolization: Transcatheter arterial embolization without chemotherapeutic agent
                                              • Transcatheter ethanol injection: Denatures cellular proteins/causes small vessel thrombosis
                                            • Thermal heat sink effect: Thermal energy needed to achieve cytotoxicity is dissipated
                                              • Convective heat transfer to adjacent structures
                                                • Blood flow in vessels abutting tumor prevents adequate heat generation for effective ablation
                                              • Possible with all modalities, but least risk with MWA

                                          PREPROCEDURE

                                          • Indications

                                            • Contraindications

                                              • Preprocedure Imaging

                                                • Getting Started

                                                  PROCEDURE

                                                  • Patient Position/Location

                                                    • Equipment Preparation

                                                      • Procedure Steps

                                                        • Alternative Procedures/Therapies

                                                          POST PROCEDURE

                                                          • Things to Avoid

                                                            • Postprocedure Imaging (Ablation)

                                                              OUTCOMES

                                                              • Complications

                                                                • Expected Outcomes

                                                                  Selected References

                                                                  1. Abdelsalam ME et al: Ablation of small renal masses. Tech Vasc Interv Radiol. 23(2):100674, 2020
                                                                  2. Mershon JP et al: Thermal ablation of the small renal mass: a critical analysis of current literature. Minerva Urol Nefrol. 72(2):123-34, 2020
                                                                  3. Zhong J et al: Renal ablation: current management strategies and controversies. Chin Clin Oncol. 8(6):63, 2019
                                                                  4. Sanchez A et al: Current management of small renal masses, including patient selection, renal tumor biopsy, active surveillance, and thermal ablation. J Clin Oncol. 36(36):3591-600, 2018
                                                                  5. Omodon M et al: Review of renal artery embolization for treatment of renal angiomyolipoma. Clin Nephrol Urol Sci. 3:1, 2016
                                                                  6. Potretzke AM et al: Re: Thompson RH et al. Comparison of partial nephrectomy and percutaneous ablation for cT1 renal masses. Eur Urol 2015;67:252-9. Eur Urol. 67(2):e19-20, 2015
                                                                  7. Moreland AJ et al: High-powered microwave ablation of t1a renal cell carcinoma: safety and initial clinical evaluation. J Endourol. 28(9):1046-52, 2014
                                                                  8. Sahni VA et al: Imaging management of incidentally detected small renal masses. Semin Intervent Radiol. 31(1):9-19, 2014
                                                                  9. Gervais DA: Cryoablation versus radiofrequency ablation for renal tumor ablation: time to reassess? J Vasc Interv Radiol. 24(8):1135-8, 2013
                                                                  10. Chan CK et al: The efficacy, safety and durability of selective renal arterial embolization in treating symptomatic and asymptomatic renal angiomyolipoma. Urology. 77(3):642-8, 2011
                                                                  11. Hong K et al. Percutaneous Tumor Ablation, Strategies and Techniques. Thieme, 2011
                                                                  12. Breen DJ et al: Minimally invasive treatment of small renal tumors: trends in renal cancer diagnosis and management. Cardiovasc Intervent Radiol. 33(5):896-908, 2010
                                                                  13. Thumar AB et al: Thermal ablation of renal cell carcinoma: triage, treatment, and follow-up. J Vasc Interv Radiol. 21(8 Suppl):S233-41, 2010
                                                                  14. Arellano RS et al: Percutaneous CT-guided radiofrequency ablation of renal cell carcinoma: efficacy of organ displacement by injection of 5% dextrose in water into the retroperitoneum. AJR Am J Roentgenol. 193(6):1686-90, 2009
                                                                  15. Gervais DA et al: Percutaneous image-guided therapy of intra-abdominal malignancy: imaging evaluation of treatment response. Abdom Imaging. 34(5):593-609, 2009
                                                                  16. Uppot RN et al: Imaging-guided percutaneous ablation of renal cell carcinoma: a primer of how we do it. AJR Am J Roentgenol. 192(6):1558-70, 2009
                                                                  17. Cantwell CP et al: Protecting the ureter during radiofrequency ablation of renal cell cancer: a pilot study of retrograde pyeloperfusion with cooled dextrose 5% in water. J Vasc Interv Radiol. 19(7):1034-40, 2008
                                                                  18. Lokken RP et al: Inflammatory nodules mimic applicator track seeding after percutaneous ablation of renal tumors. AJR Am J Roentgenol. 189(4):845-8, 2007
                                                                  19. Gervais DA et al: Radiofrequency ablation of renal cell carcinoma: part 1, indications, results, and role in patient management over a 6-year period and ablation of 100 tumors. AJR Am J Roentgenol. 185(1):64-71, 2005
                                                                  20. Gervais DA et al: Radiofrequency ablation of renal cell carcinoma: part 2, lessons learned with ablation of 100 tumors. AJR Am J Roentgenol. 185(1):72-80, 2005