Percutaneous renal cryoablation complicated by hemorrhage

Area of Science:

• Interventional Radiology
• Nephrology
• Vascular Surgery

Background:

• Percutaneous cryoablation is a minimally invasive treatment for renal cell carcinoma.
• Complications such as bleeding and arteriovenous fistula formation can occur post-procedure.
• Management of post-ablation vascular complications requires careful diagnostic and therapeutic strategies.

Purpose of the Study:

• To report a case of complex vascular complications following percutaneous renal cryoablation.
• To illustrate the diagnostic challenges and treatment pathway for post-procedural arteriovenous fistula and pseudoaneurysms.
• To highlight the importance of timely intervention in managing bleeding and hemodynamic instability.

Main Methods:

• Initial percutaneous cryoablation for suspected renal cell carcinoma.
• Diagnostic angiography revealing an arteriovenous (AV) fistula, followed by embolization with coils and Gelfoam.
• Follow-up computed tomography (CT) and repeat angiography demonstrating persistent hematoma, pseudoaneurysms, and a new AV fistula, leading to main renal artery embolization.

Main Results:

• An arteriovenous fistula was identified and initially treated successfully.
• Subsequent complications included a growing pararenal hematoma, multiple pseudoaneurysms, and a recurrent AV fistula.
• Final treatment involved coil embolization of the right main renal artery to control bleeding and vascular abnormalities.

Conclusions:

• Percutaneous cryoablation for renal masses can lead to significant vascular complications.
• Arteriovenous fistulas and pseudoaneurysms are potential sequelae requiring vigilant monitoring and interventional management.
• Complex vascular injuries may necessitate staged embolization strategies, including main renal artery occlusion.