Catecholamine Surge during Image-Guided Ablation of Adrenal Gland Metastases: Predictors, Consequences, and Recommendations for Management

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• 作者：Florian J. Fintelmann ; MD ; FRCPC^a ; ^{ffintelmann@partners.org" class="auth_mail" title="E-mail the corresponding author} ; Kemal Tuncali ; MD^b ; Stefan Puchner ; MD^a ; Debra A. Gervais ; MD^a ; Ashraf Thabet ; MD^a ; Paul B. Shyn ; MD^b ; Ronald S. Arellano ; MD^a ; Servet Tatli ; MD^b ; Peter R. Mueller ; MD^a ; Stuart G. Silverman ; MD^b ; Raul N. Uppot ; MD^a
• 关键词：GETA ; general endotracheal anesthesia ; HC ; hypertensive crisis ; MAC ; monitored anesthesia care ; RF ; radiofrequency ; SBP ; systolic blood pressure
• 刊名：Journal of Vascular and Interventional Radiology
• 出版年：2016
• 出版时间：March 2016
• 年：2016
• 卷：27
• 期：3
• 页码：395-402
• 全文大小：410 K

文摘

To identify retrospectively predictors of catecholamine surge during image-guided ablation of metastases to the adrenal gland.

Materials and Methods

Between 2001 and 2014, 57 patients (39 men, 18 women; mean age, 65 y ± 10; age range, 41–81 y) at two academic medical centers underwent ablation of 64 metastatic adrenal tumors from renal cell carcinoma (n = 27), lung cancer (n = 23), melanoma (n = 4), colorectal cancer (n = 3), and other tumors (n = 7). Tumors measured 0.7–11.3 cm (mean, 4 cm ± 2.5). Modalities included cryoablation (n = 38), radiofrequency (RF) ablation (n = 20), RF ablation with injection of dehydrated ethanol (n = 10), and microwave ablation (n = 4). Fisher exact test, univariate, and multivariate logistical regression analysis was used to evaluate factors predicting hypertensive crisis (HC).

Results

HC occurred in 31 sessions (43%). Ventricular tachycardia (n = 1), atrial fibrillation (n = 2), and troponin leak (n = 4) developed during HC episodes. HC was significantly associated with maximum tumor diameter ≤ 4.5 cm (odds ratio [OR], 26.36; 95% confidence interval [CI], 5.26&ndash;131.99; P < .0001) and visualization of normal adrenal tissue on CT or MR imaging before the procedure (OR, 8.38; 95% CI, 2.67&ndash;25.33; P < .0001). No HC occurred during ablation of metastases in previously irradiated or ablated adrenal glands.

Conclusions

Patients at high risk of catecholamine surge during ablation of non&ndash;hormonally active adrenal metastases can be identified by the presence of normal adrenal tissue and tumor diameter ≤ 4.5 cm on pre-procedure CT or MR imaging.