Renal Arteriography and C-arm CT-Guided Ablation (RenACAGA) for Thermal Ablation of Challenging Renal Tumors.

Objective: We present a technique that combines Renal arteriography with C-arm CT-Guided Ablation (RenACAGA) to improve tumor visualization, navigation and margin confirmation for percutaneous ablation of renal tumors.

Methods: The RenACAGA technique was used for thermal ablation of challenging renal tumors (intraparenchymal or US-occult lesions). All patients treated with RenACAGA between January 1, 2022, and July 1, 2024, were retrospectively evaluated. Procedures were performed in the angiography suite, with catheterization of the renal artery for selective contrast infusion. C-arm CT and guidance software were used for tumor visualization and ablation needle placement. Pre- and post-ablation C-arm CTs were fused to assess ablation margins. Technical success and local tumor recurrence (LTR) rate were evaluated. Complications were graded according to the Common terminology criteria for adverse events (CTCAE) version 5.0.

Results: Seven patients with 10 tumors were treated using the RenACAGA technique. All tumors were successfully identified, punctured and ablated (technical success 100%). During a median follow-up period of 8 months (range 7-25 months), no signs of tumor recurrence at the ablation site were observed (LTR rate 0%). One CTCAE grade 3 periprocedural complication was observed (urinary leakage through the needle tract), along with two CTCAE grade 1 complications (genitofemoral neuralgia (n = 1), and asymptomatic partial splenic infarction (n = 1)).

Conclusions: The RenACAGA technique was successfully used for renal tumor ablation. Further studies are warranted to establish the potential benefits of this technique in terms of superior tumor visualization, targeting, ablation margin assessment, and combination with embolization.