Pneumodissection during Percutaneous Renal Ablation Resulting in Air Embolism: Percutaneous Management and a Review of the Literature

Kamil Arif; Andrew J. Gunn

doi:10.1055/s-0039-1688426

Seminars in Interventional Radiology, Table of Contents

Semin intervent Radiol 2019; 36(02): 120-125
DOI: 10.1055/s-0039-1688426

Review Article

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Pneumodissection during Percutaneous Renal Ablation Resulting in Air Embolism: Percutaneous Management and a Review of the Literature

Kamil Arif

¹Division of Interventional Radiology, Department of Radiology, University of Alabama at Birmingham, Birmingham, Alabama

,

Andrew J. Gunn

¹Division of Interventional Radiology, Department of Radiology, University of Alabama at Birmingham, Birmingham, Alabama

› Author Affiliations

Abstract

Percutaneous renal ablation is a nephron-sparing approach for selected patients with renal cell carcinoma. Common complications include hemorrhage, injury to the urinary collecting system, and abscess formation. The purpose of this article is to present a case of vascular air embolism as a complication of pneumodissection performed during percutaneous ablation of renal cell carcinoma, discuss its successful percutaneous management, review common complications of renal ablation, and outline steps physicians can take to lessen these complications.

Keywords

vascular air embolism - pneumodissection - renal ablation - complications - interventional radiology

Full Text

References

References
1 Siegel RL, Miller KD, Jemal A. Cancer statistics, 2018. CA Cancer J Clin 2018; 68 (01) 7-30
2 Znaor A, Lortet-Tieulent J, Laversanne M, Jemal A, Bray F. International variations and trends in renal cell carcinoma incidence and mortality. Eur Urol 2015; 67 (03) 519-530
3 Sun M, Thuret R, Abdollah F. , et al. Age-adjusted incidence, mortality, and survival rates of stage-specific renal cell carcinoma in North America: a trend analysis. Eur Urol 2011; 59 (01) 135-141
4 Capitanio U, Montorsi F. Renal cancer. Lancet 2016; 387 (10021): 894-906
5 Hollingsworth JM, Miller DC, Daignault S, Hollenbeck BK. Rising incidence of small renal masses: a need to reassess treatment effect. J Natl Cancer Inst 2006; 98 (18) 1331-1334
6 National Comprehensive Cancer Network. Kidney Cancer, Version 3.2019. Available at: https://www.nccn.org/professionals/physician_gls/PDF/kidney.pdf . Accessed February 11, 2019
7 Gunn AJ, Gervais DA. Percutaneous ablation of the small renal mass-techniques and outcomes. Semin Intervent Radiol 2014; 31 (01) 33-41
8 Hinshaw JL, Lubner MG, Ziemlewicz TJ, Lee Jr FT, Brace CL. Percutaneous tumor ablation tools: microwave, radiofrequency, or cryoablation--what should you use and why?. Radiographics 2014; 34 (05) 1344-1362
9 Talenfeld AD, Gennarelli RL, Elkin EB. , et al. Percutaneous ablation versus partial and radical nephrectomy for T1a renal cancer: a population-based approach. Ann Intern Med 2018; 169 (02) 69-77
10 Kurup AN. Percutaneous ablation for small renal masses-complications. Semin Intervent Radiol 2014; 31 (01) 42-49
11 Atwell TD, Carter RE, Schmit GD. , et al. Complications following 573 percutaneous renal radiofrequency and cryoablation procedures. J Vasc Interv Radiol 2012; 23 (01) 48-54
12 Mouli SK, McDevitt JL, Su YK. , et al. Analysis of the RENAL and mRENAL scores and the relative importance of their components in the prediction of complications and local tumor progression after percutaneous renal cryoablation. J Vasc Interv Radiol 2017; 28 (06) 860-867
13 Kutikov A, Uzzo RG. The R.E.N.A.L. nephrometry score: a comprehensive standardized system for quantitating renal tumor size, location and depth. J Urol 2009; 182 (03) 844-853
14 Ficarra V, Novara G, Secco S. , et al. Preoperative aspects and dimensions used for an anatomical (PADUA) classification of renal tumours in patients who are candidates for nephron-sparing surgery. Eur Urol 2009; 56 (05) 786-793
15 Schmit GD, Kurup AN, Weisbrod AJ. , et al. ABLATE: a renal ablation planning algorithm. AJR Am J Roentgenol 2014; 202 (04) 894-903
16 Yamakado K, Nakatsuka A, Kobayashi S. , et al. Radiofrequency ablation combined with renal arterial embolization for the treatment of unresectable renal cell carcinoma larger than 3.5 cm: initial experience. Cardiovasc Intervent Radiol 2006; 29 (03) 389-394
17 Arima K, Yamakado K, Kinbara H, Nakatsuka A, Takeda K, Sugimura Y. Percutaneous radiofrequency ablation with transarterial embolization is useful for treatment of stage 1 renal cell carcinoma with surgical risk: results at 2-year mean follow up. Int J Urol 2007; 14 (07) 585-590 , discussion 590
18 Nakasone Y, Kawanaka K, Ikeda O, Tamura Y, Yamashita Y. Sequential combination treatment (arterial embolization and percutaneous radiofrequency ablation) of inoperable renal cell carcinoma: single-center pilot study. Acta Radiol 2012; 53 (04) 410-414
19 Gunn AJ, Mullenbach BJ, Poundstone MM, Gordetsky JB, Underwood ES, Rais-Bahrami S. Transarterial embolization of renal cell carcinoma as an adjunctive therapy prior to cryoablation: a propensity score matching analysis. Diagn Interv Radiol 2018; 24 (06) 357-363
20 Cantwell CP, Wah TM, Gervais DA. , et al. Protecting the ureter during radiofrequency ablation of renal cell cancer: a pilot study of retrograde pyeloperfusion with cooled dextrose 5% in water. J Vasc Interv Radiol 2008; 19 (07) 1034-1040
21 Samadi K, Arellano RS. Ureteral protection during microwave ablation of renal cell carcinoma: combined use of pyeloperfusion and hydrodissection. Diagn Interv Radiol 2018; 24 (06) 388-391
22 Froemming A, Atwell T, Farrell M, Callstrom M, Leibovich B, Charboneau W. Probe retraction during renal tumor cryoablation: a technique to minimize direct ureteral injury. J Vasc Interv Radiol 2010; 21 (01) 148-151
23 Rhim H, Dodd III GD, Chintapalli KN. , et al. Radiofrequency thermal ablation of abdominal tumors: lessons learned from complications. Radiographics 2004; 24 (01) 41-52
24 Gervais DA, Arellano RS, McGovern FJ, McDougal WS, Mueller PR. Radiofrequency ablation of renal cell carcinoma: part 2, Lessons learned with ablation of 100 tumors. AJR Am J Roentgenol 2005; 185 (01) 72-80
25 Henretta MS, Anderson CL, Angle JF, Duska LR. It's not just for laparoscopy anymore: use of insufflation under ultrasound and fluoroscopic guidance by Interventional Radiologists for percutaneous placement of intraperitoneal chemotherapy catheters. Gynecol Oncol 2011; 123 (02) 342-345
26 Menes T, Spivak H. Laparoscopy: searching for the proper insufflation gas. Surg Endosc 2000; 14 (11) 1050-1056
27 McCarthy CJ, Behravesh S, Naidu SG, Oklu R. Air embolism: diagnosis, clinical management, and outcomes. Diagnostics (Basel) 2017; 7 (01) 5
28 McCarthy CJ, Behravesh S, Naidu SG, Oklu R. Air embolism: practical tips for prevention and treatment. J Clin Med 2016; 5 (11) 93
29 Shaikh N, Ummunisa F. Acute management of vascular air embolism. J Emerg Trauma Shock 2009; 2 (03) 180-185
30 Cadis AS, Velasquez CD, Brauer M, Hoak B. Intraoperative management of a carbon dioxide embolus in the setting of laparoscopic cholecystectomy for a patient with primary biliary cirrhosis: a case report. Int J Surg Case Rep 2014; 5 (11) 833-835
31 Donepudi S, Chavalitdhamrong D, Pu L, Draganov PV. Air embolism complicating gastrointestinal endoscopy: a systematic review. World J Gastrointest Endosc 2013; 5 (08) 359-365
32 Gordy S, Rowell S. Vascular air embolism. Int J Crit Illn Inj Sci 2013; 3 (01) 73-76