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

详细信息    查看全文

• 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], 5.26–131.99; P < .0001) and visualization of normal adrenal tissue on CT or MR imaging before the procedure (OR, 8.38; 95% CI, 2.67–25.33; 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–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.