Preoperative Angioinfarction of Localized Renal Cell Carcinoma Using Absolute Ethanol

Abstract

A total of 25 patients with renal cell carcinoma underwent angioinfarction of the tumor using absolute ethanol. An average of 15 ml. absolute ethanol was injected into the main renal artery through a balloon occlusion catheter. Complete cessation of renal arterial flow could be demonstrated in all cases. The post-embolization syndrome of pain, nausea, vomiting, hypertension and fever was minimal compared to other methods of renal artery occlusion. Of the patients 21 underwent post-infarction transabdominal radical nephrectomy without intraoperative or postoperative complications attributable to the injection of absolute ethanol. No damage to extrarenal tissue was noted at operation. Subsequent surgical dissection was facilitated, particularly in cases of large tumors when control of the renal pedicle often is difficult. Median blood loss was 725 ml. In light of recent reports concerning the benefit of angioinfarction and nephrectomy in metastatic disease a similar approach may be applicable to localized disease. This pilot study shows the safety of preoperative angioinfarction with absolute ethanol and may be used as a reference for future randomized prospective studies comparing angioinfarction and nephrectomy to nephrectomy alone for localized renal cell carcinoma.

Image-guided Percutaneous Radiofrequency Ablation and Incidence of Post–Radiofrequency Ablation Syndrome: Prospective Survey

“…The flulike symptoms were often more transient, with an earlier peak at day 3 and earlier resolution in the absence of fever. This finding compares similarly with the postembolization syndrome, with an incidence of 50%-89% (1)(2)(3)(4)(5).…”

“…This syndrome is well recognized and defined in the literature about embolization (1)(2)(3)(4)(5). In our study, post-RF ablation syndrome is defined as the presence of either fever or flulike symptoms or both after RF ablation.…”

“…seen in patients who have undergone preoperative embolization of liver tumors or renal tumors (1)(2)(3)(4)(5). It has been speculated that these symptoms may be the result of an inflammatory response to necrotic tissue, with cytokine production (6 -8).…”

Comparative Study of Transcatheter Renal Arterial Embolization with and without Closed Renal Circuit: Pharmacokinetic and Histologic Assessment in Pigs

“…Initial clinical reports suggested that an ethanol dose of 0.56 mL per kilogram of body weight was usually adequate to ensure complete renal ablation (10). However, in clinical reports over the last 2 decades, the dose of ethanol used has been approximately 0.2 mL/kg (6,7,(11)(12)(13) because of potential toxicity, including coagulopathy and acute alcohol intoxication (5,(14)(15)(16). Our clinical experience has shown that large RCCs are not adequately embolized by using TAE at this ethanol dose level.…”

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

“…Initial clinical reports suggested that an ethanol dose of 1 ml per 4 pounds (1.8 kg) body weight is usually adequate to ensure complete renal ablation [6]. However, in the light of clinical studies conducted over the last two decades, ethanol doses have been reduced to approximately 0.2 ml/kg body weight [7][8][9][10][11] because of potential toxicity, including coagulopathy and acute alcohol intoxication [12][13][14][15]. As our own clinical experience suggests that large RCCs are not adequately embolized by TAE with an ethanol dose of 0.2 ml/kg body weight, we have developed a new technique, referred to as "TAE during aspiration of blood with absolute ethanol via a balloon-occluded drainage vein" (TAE-ABOD), to permit the use of higher doses of ethanol.…”