Effect of iodized oil embolization on temperature change during cryoablation for renal cell carcinoma.

INTRODUCTION: We aimed to evaluate the effect of transcatheter arterial embolization (TAE) with iodized oil (Lipiodol) on temperature change during cryoablation (CA) for renal cell carcinoma (RCC). MATERIAL AND METHODS: We retrospectively reviewed patients receiving CA for RCC from February 2020 to July 2021, including those who received Lipiodol TAE prior to CA (TAE group) and those who underwent only CA with comparable clinical and tumor characteristics (non-TAE group). Clinical data and tumor characteristics of both groups were recorded. The temperature readings of each cryoprobe at every 15 s and 'time to -100 °C' were compared between the groups. RESULTS: A total of 17 patients with 18 RCCs were recruited (seven in the TAE group and 11 in the non-TAE group). The 'time to -100 °C' was significantly longer in the TAE group than in the non-TAE group (64.5 ± 24.3 s vs. 48.8 ± 9.7 s, p = 0.018). Positive correlation between 'time to -100 °C' and tumor maximal diameter, RENAL nephrometry and PADUA score were observed in the non-TAE group, while no corresponding correlation was found in the TAE group. CONCLUSIONS: Pre-embolization with iodized oil influences the temporal temperature changes during cryoablation by disrupting the positive correlation between the time to reach the target temperature and tumor characteristics.

Unusual case of left-sided portal hypertension induced variceal bleeding after pancreaticoduodenectomy treated with transplenic embolization.

With the advances in surgical technique and the accumulation of experiences, pancreatic cancer with portal-superior mesenteric vein (PV-SMV) invasion is no longer considered as an absolute contraindication for surgical resection. After resection of the PV-SMV confluence, congestion of the splenic vein (SV) may develop, resulting in splenomegaly and variceal formation, also known as left-sided portal hypertension (LPH). Along with improved postoperative prognosis, LPH induced varices are given enough time to develop and eventually bleed, which can be lethal. We present a 59-year-old woman who underwent pancreaticoduodenectomy (PD) for pancreatic cancer with a concomitant PV-SMV resection. Massive upper gastrointestinal bleeding and hypovolemic shock occurred 15 months after the surgery. Various exams, including endoscopy, dynamic computed tomography (CT) imaging, celiac, and superior mesenteric artery (SMA) angiography, were performed. However, the exact location of the bleeding could not be identified. LPH-induced varices bleeding was suspected and diagnosed by venography. The varices were embolized with n-BCA and lipiodol mixture by trans-splenic venous approach with complete cessation of bleeding. It is important to identify potential life-threatening LPH-induced varices bleeding, especially if certain clinical histories or classic imaging findings are presented. As for treatment, interventional radiology methods could be considered as the first choice.