Selective Arterial Embolization with N-Butyl Cyanoacrylate Prior to CT-Guided Percutaneous Cryoablation of Kidney Malignancies: A Single-Center Experience

Abstract

The study’s purpose was to assess the safety, feasibility and efficiency of selective arterial embolization (SAE) using N-butyl cyanoacrylate (NBCA) glue before percutaneous cryoablation (PCA) of renal malignancies in patients whose tumor characteristics and/or comorbidities resulted in an unacceptable risk of bleeding. In this single-center retrospective study of 19 consecutive high-risk patients (median age, 74 years) with renal malignancies managed in 2017–2020 by SAE with NBCA followed by PCA, data about patients, tumor and procedures characteristics, complications, renal function and hemoglobin concentration before and after treatment, as well as recurrence were collected. Charlson comorbidity index was ≥4 in 89.5% of patients. Ten patients were treated by antiplatelet and/or anticoagulant therapy. Median tumor largest diameter was 3.75 cm (range, 1–6.5 cm) and R.E.N.A.L. nephrometry score was ≥7 in 80%, indicating substantial tumor complexity. No major complications were recorded and minor complications occurred in 7 patients. No residual tumor was found at 6-week imaging follow-up in 18/19 patients. Tumor recurrence was visible in 1/16 patients at 6-month imaging follow-up. No significant difference was found for renal function after treatment (p = 0.07), whereas significant decrease in hemoglobin concentration was noted (p = 0.00004), although it was relevant for only one patient who required only blood transfusion and no further intervention. SAE prior to PCA is safe and effective for managing renal malignancies in high-risk patients.

Effect of lipiodol marking before CT-guided cryoablation on the outcome of sporadic renal cell carcinoma

“…Previous reports have also reported the usefulness of lipiodol marking and effective short-term local control. 18 , 19 , 20 , 21 Moreover, there have been no reports of mid- to long-term treatment effects compared with groups without lipiodol marking, as in this study, and the results of this study further support the usefulness of lipiodol marking in the therapeutic effects of cryoablation.…”

“…Complications were similar to those in previous reports, with most being minor (CTCAE grade 2 or lower) in groups with and without lipiodol marking. 8 , 9 , 10 , 18 , 19 , 20 , 21 The two complications that were grade 3 or higher in the group with lipiodol marking were an iliopsoas hematoma in a patient with severely impaired coagulation and a perioperative cerebral infarction in a patient on anticoagulation and platelet medication.…”

“…To address these limitations, preoperative transarterial lipiodol marking has been developed as a preoperative (1 or 2 days) procedure to enhance lesion visibility. 18 , 19 , 20 , 21 Although this technique has shown promising efficacy in small case series, its superiority compared with cryoablation without lipiodol marking remains inadequately established.…”

Selective Arterial Embolization of Ruptured Hepatocellular Carcinoma with N-Butyl Cyanoacrylate and Lipiodol: Safety, Efficacy, and Short-Term Outcomes

“…Whether any of these agents is superior to the others for treating rHCC is unknown, and the choice often rests on the usual practice and preferences of each operator and institution [27]. Liquid glues such as cyanoacrylate, although widely used for various peripheral TAE procedures to treat tumors and other conditions, do not seem to have been evaluated in rHCC [31][32][33][34]. Cyanoacrylate is a radiolucent liquid that polymerizes upon contact with ion-rich fluids such as water, saline, and blood.…”