Pilot study of transcatheter arterial ethanol embolization under closed renal circuit for large renal cell carcinomas

Abstract

The safety of a new technique, designated "transcatheter arterial embolization (TAE) with aspiration via a balloon-occluded renal drainage vein" (TAE-ABOD), for the management of large renal cell carcinomas (RCCs). The subjects were 25 patients with RCC who underwent a total of 27 sessions of TAE-ABOD. This TAE-ABOD technique incorporates two procedures: balloon occlusion of renal drainage vein and infusion of absolute ethanol into the tumor-feeding arteries during aspiration of blood via a balloon catheter, thereby reducing leakage of absolute ethanol into the systemic circulation. Our primary endpoint was to establish a safe regimen for high-dose ethanol injection therapy, and our secondary endpoint was to assess global survival of the patients. The administered dose of ethanol ranged from 0.2 to 0.5 ml/kg [median: 0.34 (SD: 0.10) ml/kg], increased in a stepwise manner. The systemic ethanol concentration was measurable in 14 patients, and was less than 0.1 mg/ml in 12 and from 0.1 to less than 0.2 mg/ml in two. There were no major complications such as renal failure or renal abscess. TAE-ABOD can safely deliver a high dose of absolute ethanol for the treatment of large RCCs.

Endovascular embolization strategy for renal arteriovenous malformations

“…There is also a potential risk for pulmonary embolism (12) when treating high-flow lesions. Venous flow control techniques (7,8) were applied in this study and successfully prevented migration of liquid agents into systemic circulation. Test injections with contrast media are mandatory to adjust the expansion of the balloon catheter for optimal flow control (Fig.…”

“…Absolute ethanol. Alcohol ablation was performed using an emulsion of absolute ethanol and iodized oil (Lipiodol Ultra-Fluid; Guerbet, Aulnay Sous-Bois, France) (emulsion ratio 2:1), with a maximum ethanol dose of 0.4 mL/kg body weight (7,8). The emulsion was slowly injected via the afferent arteries.…”

Re: Pilot study of transcatheter arterial ethanol emolization under closed renal circuit for large renal cell carcinomas

“…Sir, It was with great interest that we read the excellent article published in European Radiology by Murata and co-workers entitled, "Pilot study of transcatheter arterial ethanol emolization under closed renal circuit for large renal cell carcinomas" [1]. In this article the authors presented data from their experiences with transcatheter arterial embolization with aspiration via a ballon-occluded renal drainage vein (TAE-ABOD), which they concluded to be an effective treatment for the management of large unresectable renal cell carcinomas (RCCs), although still requiring long-term survivial data.…”