endosergЭндокринная хирургияEndocrine Surgery2306-35132310-3965Типография «Печатных дел Мастер»10.14341/serg12284endoserg-12284Research ArticleКлинический случайClinical CaseПрименение предоперационной эмболизации в качестве метода профилактики интраоперационных нарушений гемодинамики у пациента с феохромоцитомойThe use of preoperative embolization as a method of preventing intraoperative hemodynamic disorders in a patient with pheochromocytomahttps://orcid.org/0000-0001-7669-0835ХрипунАлексей ИвановичKhripunAleksey I.

Доктор медицинских наук, профессор

MD, PhD, Professor

v.khabalonov@gmail.comhttps://orcid.org/0000-0002-2108-4587МахуоваГульмира БалтабековнаMakhuovaGulmira B.

Кандидат медицинских наук, доцент, заведующая 2 хирургическим отделением

PhD, Docent, chief of surgical department

gulmira1976@mail.ruhttps://orcid.org/0000-0002-9622-6789АвдееваТатьяна ФедеровнаAvdeevaTatyana F.

кандидат медицинских наук, врач-хирург

PhD, surgeon

v.khabalonov@gmail.comhttps://orcid.org/0000-0002-5552-3904ЮсуфовМагомед ПайзулаевичYusufovMagomed P.

Аспирант, врач-хирург

PhD student, surgeon

v.khabalonov@gmail.comРоссийский национальный исследовательский медицинский университет им. Н.И. ПироговаРоссияThe Russian National Research Medical University named after N.I. PirogovRussian FederationРоссийский национальный исследовательский медицинский университет им. Н.И. Пирогова; Городская клиническая больница им. В.М. БуяноваРоссияThe Russian National Research Medical University named after N.I. Pirogov; Moscow City Clinical Hospital named after V.M. BuyanovRussian FederationГородская клиническая больница имени В. М. БуяноваРоссияMoscow City Clinical Hospital named after V.M. BuyanovRussian FederationРоссийский национальный исследовательский медицинский университет им. Н.И. Пирогова; Городская клиническая больница им. В.М. БуяноваРоссияThe Russian National Research Medical University named after N.I. Pirogov; Moscow City Clinical Hospital named after V.M. BuyanovRussian Federation2020170820201412229Copyright © Хрипун А.И., Махуова Г.Б., Авдеева Т.Ф., Юсуфов М.П., 20202020Хрипун А.И., Махуова Г.Б., Авдеева Т.Ф., Юсуфов М.П.Khripun A.I., Makhuova G.B., Avdeeva T.F., Yusufov M.P.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.surg-endojournals.ru/jour/article/view/12284

Представлен клинический случай лечения пациента с крупной феохромоцитомой, осложненной острым нарушением мозгового кровообращения. Особенностью случая является выполнение предоперационной эмболизации сосудов надпочечника с целью профилактики интраоперационного кровотечения и интраоперационной нестабильности гемодинамики — независимых факторов риска периоперационных осложнений и летальности. Подобный подход позволил успешно выполнить лапароскопическую адреналэктомию с минимальной кровопотерей в условиях устойчивой гемодинамики.

Обсуждены вопросы лечения пациентов с феохромоцитомой, особое внимание уделено категории пациентов с крупными опухолями. Освещены технические особенности адреналэктомий у этой группы пациентов, современные представления о безопасности выполнения лапароскопических вмешательств. Затронуты темы эффективности предоперационной медикаментозной профилактики колебаний артериального давления, а также применения рентгенэндоваскулярных методов в лечении пациентов с катехоламинпродуцирующими опухолями.

A clinical case of treating a patient with large pheochromocytoma complicated by acute cerebrovascular accident is presented. Its peculiarity is the implementation of preoperative embolization of the adrenal vessels in order to prevent intraoperative bleeding and intraoperative hemodynamic instability — independent risk factors for perioperative complications and mortality. Such an approach allowed us to successfully perform laparoscopic adrenalectomy with minimal blood loss in conditions of stable hemodynamics.

The treatment of patients with pheochromocytoma was discussed, special attention was paid to the category of patients with large tumors. The technical features of adrenalectomy in this group of patients, modern ideas about the safety of laparoscopic interventions are highlighted. The topics of the effectiveness of preoperative drug prevention of blood pressure fluctuations, as well as the use of endovascular methods in the treatment of patients with catecholamine-producing tumors are discussed.

феохромоцитомаинтраоперационная нестабильность гемодинамикилапароскопическая адреналэктомиярентгенэндоваскулярная предоперационная эмболизацияклинический случайpheochromocytomaintraoperative hemodynamic instabilitylaparoscopic adrenalectomyEndovascular embolization of preoperativecase reportReferencesConzo G, Musella M, Corcione F, et al. Laparoscopic treatment of pheochromocytomas smaller or larger than 6 cm. A clinical retrospective study on 44 patients. Laparoscopic adrenalectomy for pheochromocytoma. Ann Ital Chir. 2013;84(4):417–422.Conzo G, Musella M, Corcione F, et al. Laparoscopic treatment of pheochromocytomas smaller or larger than 6 cm. A clinical retrospective study on 44 patients. Laparoscopic adrenalectomy for pheochromocytoma. Ann Ital Chir. 2013;84(4):417–422.Kwon SY, Lee KS, Lee JN, et al. Risk factors for hypertensive attack during pheochromocytoma resection. Investig Clin Urol. 2016;57(3):184–190. doi: 10.4111/icu.2016.57.3.184.Kwon SY, Lee KS, Lee JN, et al. Risk factors for hypertensive attack during pheochromocytoma resection. Investig Clin Urol. 2016;57(3):184–190. doi: 10.4111/icu.2016.57.3.184.Wang W, Li P, Wang Y, et al. Effectiveness and safety of laparoscopic adrenalectomy of large pheochromocytoma: a prospective, nonrandomized, controlled study. Am J Surg. 2015;210(2):230–235. doi: 10.1016/j.amjsurg.2014.11.012.Wang W, Li P, Wang Y, et al. Effectiveness and safety of laparoscopic adrenalectomy of large pheochromocytoma: a prospective, nonrandomized, controlled study. Am J Surg. 2015;210(2):230–235. doi: 10.1016/j.amjsurg.2014.11.012.Ippolito G, Palazzo F, Sebag F, et al. Safety of laparoscopic adrenalectomy in patients with large pheochromocytomas: a single institution review. World J Surg. 2007;32(5):840–844. doi: 10.1007/s00268-007-9327-5.Ippolito G, Palazzo F, Sebag F, et al. Safety of laparoscopic adrenalectomy in patients with large pheochromocytomas: a single institution review. World J Surg. 2007;32(5):840–844. doi: 10.1007/s00268-007-9327-5.Gagner M, Breton G, Pharand D, Pomp A. Is laparoscopic adrenalectomy indicated for pheochromocytomas? Surgery. 1996;120(6):1076–1080. doi: 10.1016/s0039-6060(96)80058-4.Gagner M, Breton G, Pharand D, Pomp A. Is laparoscopic adrenalectomy indicated for pheochromocytomas? Surgery. 1996;120(6):1076–1080. doi: 10.1016/s0039-6060(96)80058-4.Kercher KW, Park A, Matthews BD, et al. Laparoscopic adrenalectomy for pheochromocytoma. Surg Endosc. 2002;16(1):100–102. doi: 10.1007/s00464-001-8171-1.Kercher KW, Park A, Matthews BD, et al. Laparoscopic adrenalectomy for pheochromocytoma. Surg Endosc. 2002;16(1):100–102. doi: 10.1007/s00464-001-8171-1.Scholten A, Vriens M, Cromheecke G, et al. Hemodynamic instability during resection of pheochromocytoma in MEN versus non-MEN patients. Eur J Endocrinol. 2011;165(1):91–96. doi: 10.1530/eje-11-0148.Scholten A, Vriens M, Cromheecke G, et al. Hemodynamic instability during resection of pheochromocytoma in MEN versus non-MEN patients. Eur J Endocrinol. 2011;165(1):91–96. doi: 10.1530/eje-11-0148.Bruynzeel H, Feelders R, Groenland T, et al. Risk factors for hemodynamic instability during surgery for pheochromocytoma. J Clin Endocrinol Metab. 2010;95(2):678–685. doi: 10.1210/jc.2009-1051.Bruynzeel H, Feelders R, Groenland T, et al. Risk factors for hemodynamic instability during surgery for pheochromocytoma. J Clin Endocrinol Metab. 2010;95(2):678–685. doi: 10.1210/jc.2009-1051.Kinney M, Warner M, vanHeerden J, et al. Perianesthetic risks and outcomes of pheochromocytoma and paraganglioma resection. Anesth Analg. 2000;91(5):1118–1123. doi: 10.1097/00000539-200011000-00013.Kinney M, Warner M, vanHeerden J, et al. Perianesthetic risks and outcomes of pheochromocytoma and paraganglioma resection. Anesth Analg. 2000;91(5):1118–1123. doi: 10.1097/00000539-200011000-00013.Kiernan C, Du L, Chen X, et al. Predictors of hemodynamic instability during surgery for pheochromocytoma. Ann Surg Oncol. 2014;21(12):3865–3871. doi: 10.1245/s10434-014-3847-7.Kiernan C, Du L, Chen X, et al. Predictors of hemodynamic instability during surgery for pheochromocytoma. Ann Surg Oncol. 2014;21(12):3865–3871. doi: 10.1245/s10434-014-3847-7.Guerrero M, Schreinemakers J, Vriens M, et al. Clinical spectrum of pheochromocytoma. J Am Coll Surg. 2009;209(6):727–732. doi: 10.1016/j.jamcollsurg.2009.09.022.Guerrero M, Schreinemakers J, Vriens M, et al. Clinical spectrum of pheochromocytoma. J Am Coll Surg. 2009;209(6):727–732. doi: 10.1016/j.jamcollsurg.2009.09.022.Бондаренко В.О., Луцевич О.Э. Топографическая диагностика и хирургические вмешательства при гигантских феохромоцитомах надпочечника // Хирургия. Журнал им. Н.И. Пирогова. — 2011. — №3. — С. 13–18. [Bondarenko VO, Lutsevich OÉ. Topical diagnostics and surgical treatment of giant pheochromocytoma. Khirurgiia (Mosk). 2011;(3):13–18. (In Russ.)]Бондаренко В.О., Луцевич О.Э. Топографическая диагностика и хирургические вмешательства при гигантских феохромоцитомах надпочечника // Хирургия. Журнал им. Н.И. Пирогова. — 2011. — №3. — С. 13–18. [Bondarenko VO, Lutsevich OÉ. Topical diagnostics and surgical treatment of giant pheochromocytoma. Khirurgiia (Mosk). 2011;(3):13–18. (In Russ.)]Conzo G, Musella M, Corcione F, et al. Laparoscopic adrenalectomy, a safe procedure for pheochromocytoma. A retrospective review of clinical series. Int J Surg. 2013;11(2):152–156. doi: 10.1016/j.ijsu.2012.12.007.Conzo G, Musella M, Corcione F, et al. Laparoscopic adrenalectomy, a safe procedure for pheochromocytoma. A retrospective review of clinical series. Int J Surg. 2013;11(2):152–156. doi: 10.1016/j.ijsu.2012.12.007.Colson P, Ribstein J. [Simplified strategy for anesthesia of pheochromocytoma. (In French).] Ann Fr Anesth Reanim. 1991;10(5):456–462. doi: 10.1016/s0750-7658(05)80849-4.Colson P, Ribstein J. [Simplified strategy for anesthesia of pheochromocytoma. (In French).] Ann Fr Anesth Reanim. 1991;10(5):456–462. doi: 10.1016/s0750-7658(05)80849-4.Gill I. The case for laparoscopic adrenalectomy. J Urol. 2001;166(2):429–436. doi: 10.1097/00005392-200108000-00008.Gill I. The case for laparoscopic adrenalectomy. J Urol. 2001;166(2):429–436. doi: 10.1097/00005392-200108000-00008.Pederson L, Lee J. Pheochromocytoma. Curr Treat Options Oncol. 2003;4(4):329–337. doi: 10.1007/s11864-003-0008-9.Pederson L, Lee J. Pheochromocytoma. Curr Treat Options Oncol. 2003;4(4):329–337. doi: 10.1007/s11864-003-0008-9.Fernández-Cruz L, Taurá P, Sáenz A, et al. Laparoscopic approach to pheochromocytoma: hemodynamic changes and catecholamine secretion. World J Surg. 1996;20(7):762–768. doi: 10.1007/s002689900116.Fernández-Cruz L, Taurá P, Sáenz A, et al. Laparoscopic approach to pheochromocytoma: hemodynamic changes and catecholamine secretion. World J Surg. 1996;20(7):762–768. doi: 10.1007/s002689900116.Newell K, Prinz RA, Braithwaite S, et al. Pheochromocytoma crisis. Am J Hypertens. 1988;1(3 Pt 3):189S–191S. doi: 10.1093/ajh/1.3.189s.Newell K, Prinz RA, Braithwaite S, et al. Pheochromocytoma crisis. Am J Hypertens. 1988;1(3 Pt 3):189S–191S. doi: 10.1093/ajh/1.3.189s.Groeben H, Nottebaum BJ, Alesina PF, et al. Perioperative α-receptor blockade in phaechromocytoma surgery: an observational case series. Br J Anaesth. 2017;118(2):182–189. doi: 10.1093/bja/aew392.Groeben H, Nottebaum BJ, Alesina PF, et al. Perioperative α-receptor blockade in phaechromocytoma surgery: an observational case series. Br J Anaesth. 2017;118(2):182–189. doi: 10.1093/bja/aew392.Lentschener C, Gaujoux S, Tesniere A, Dousset B. Point of controversy: perioperative care of patients undergoing pheochromocytoma removal–time for a reappraisal? Eur J Endocrinol. 2011;165(3):365–373. doi: 10.1530/eje-11-0162.Lentschener C, Gaujoux S, Tesniere A, Dousset B. Point of controversy: perioperative care of patients undergoing pheochromocytoma removal–time for a reappraisal? Eur J Endocrinol. 2011;165(3):365–373. doi: 10.1530/eje-11-0162.Möbius E, Nies C, Rothmund M. Surgical treatment of pheochromocytomas. Surg Endosc. 1999;13(1):35–39. doi: 10.1007/s004649900893.Möbius E, Nies C, Rothmund M. Surgical treatment of pheochromocytomas. Surg Endosc. 1999;13(1):35–39. doi: 10.1007/s004649900893.Guazzoni G, Montorsi F, Bocciardi A, et al. Transperitoneal laparoscopic versus open adrenalectomy for benign hyperfunctioning adrenal tumors: a comparative study. J Urol. 1995;153(5):1597–1600. doi: 10.1016/s0022-5347(01)67471-8.Guazzoni G, Montorsi F, Bocciardi A, et al. Transperitoneal laparoscopic versus open adrenalectomy for benign hyperfunctioning adrenal tumors: a comparative study. J Urol. 1995;153(5):1597–1600. doi: 10.1016/s0022-5347(01)67471-8.Калинин А.П., Майстренко Н.А. Хирургия надпочечников. — М.: Медицина, 2000. — С. 122. [Kalinin AP, Maistrenko NA. Khirurgiya nadpochechnikov. Moscow: Meditsina; 2000. P. 122. (In Russ).]Калинин А.П., Майстренко Н.А. Хирургия надпочечников. — М.: Медицина, 2000. — С. 122. [Kalinin AP, Maistrenko NA. Khirurgiya nadpochechnikov. Moscow: Meditsina; 2000. P. 122. (In Russ).]Desmonts J, Marty J. Anaesthetic management of patients with pheochromocytoma. Br J Anaesth. 1984;56(7):781–789. doi: 10.1093/bja/56.7.781.Desmonts J, Marty J. Anaesthetic management of patients with pheochromocytoma. Br J Anaesth. 1984;56(7):781–789. doi: 10.1093/bja/56.7.781.Assalia A, Gagner M. Laparoscopic adrenalectomy. Br J Surg. 2004;91(10):1259–1274. doi: 10.1002/bjs.4738.Assalia A, Gagner M. Laparoscopic adrenalectomy. Br J Surg. 2004;91(10):1259–1274. doi: 10.1002/bjs.4738.Gagner M, Pomp A, Heniford B, et al. Laparoscopic adrenalectomy: lessons learned from 100 consecutive procedures. Ann Surg. 1997;226(3):238–247. doi: 10.1097/00000658-199709000-00003.Gagner M, Pomp A, Heniford B, et al. Laparoscopic adrenalectomy: lessons learned from 100 consecutive procedures. Ann Surg. 1997;226(3):238–247. doi: 10.1097/00000658-199709000-00003.Gumbs A, Gagner M. Laparoscopic adrenalectomy. Best Practice & Research Clinical Endocrinology & Metabolism. 2006;20(3):483-499. doi:10.1016/j.beem.2006.07.010Gumbs A, Gagner M. Laparoscopic adrenalectomy. Best Practice & Research Clinical Endocrinology & Metabolism. 2006;20(3):483-499. doi:10.1016/j.beem.2006.07.010Winfield H, Hamilton B, Bravo E, et al. Laparoscopic adrenalectomy: the preferred choice? A comparison to open adrenalectomy. J Urol. 1998;160(2):325–329. doi: 10.1097/00005392-199808000-00006.Winfield H, Hamilton B, Bravo E, et al. Laparoscopic adrenalectomy: the preferred choice? A comparison to open adrenalectomy. J Urol. 1998;160(2):325–329. doi: 10.1097/00005392-199808000-00006.Janetschek G, Neumann HP. Laparoscopic surgery for pheochromocytoma. Urol Clin North Am. 2001;28(1):97–105. doi: 10.1016/s0094-0143(01)80011-2.Janetschek G, Neumann HP. Laparoscopic surgery for pheochromocytoma. Urol Clin North Am. 2001;28(1):97–105. doi: 10.1016/s0094-0143(01)80011-2.Col V, de Canniere L, Collard E, et al. Laparoscopic adrenalectomy for phaeochromocytoma: endocrinological and surgical aspects of a new therapeutic approach. Clin Endocrinol (Oxf). 1999;50(1):121–125. doi: 10.1046/j.1365-2265.1999.00628.x.Col V, de Canniere L, Collard E, et al. Laparoscopic adrenalectomy for phaeochromocytoma: endocrinological and surgical aspects of a new therapeutic approach. Clin Endocrinol (Oxf). 1999;50(1):121–125. doi: 10.1046/j.1365-2265.1999.00628.x.Joris J, Hamoir E, Hartstein G, et al. Hemodynamic changes and catecholamine release during laparoscopic adrenalectomy for pheochromocytoma. Anesth Analg. 1999;88(1):16–21. doi: 10.1097/00000539-199901000-00004.Joris J, Hamoir E, Hartstein G, et al. Hemodynamic changes and catecholamine release during laparoscopic adrenalectomy for pheochromocytoma. Anesth Analg. 1999;88(1):16–21. doi: 10.1097/00000539-199901000-00004.Mann C, Millat B, Boccara G, et al. Tolerance of laparoscopy for resection of phaeochromocytoma. Br J Anaesth. 1996;77(6):795–797. doi: 10.1093/bja/77.6.795.Mann C, Millat B, Boccara G, et al. Tolerance of laparoscopy for resection of phaeochromocytoma. Br J Anaesth. 1996;77(6):795–797. doi: 10.1093/bja/77.6.795.Rose CE Jr, Althaus JA, Kaiser DL, et al. Acute hypoxemia and hypercapnia: increase in plasma catecholamines in conscious dogs. Am J Physiol. 1983;245(6):H924–H929. doi: 10.1152/ajpheart.1983.245.6.h924.Rose CE Jr, Althaus JA, Kaiser DL, et al. Acute hypoxemia and hypercapnia: increase in plasma catecholamines in conscious dogs. Am J Physiol. 1983;245(6):H924–H929. doi: 10.1152/ajpheart.1983.245.6.h924.Wittgen CM, Andrus CH, Fitzgerald SD, et al. Analysis of the hemodynamic and ventilatory effects of laparoscopic cholecystectomy. Arch Surg. 1991;126(8):997–1000. doi: 10.1001/archsurg.1991.01410320083011.Wittgen CM, Andrus CH, Fitzgerald SD, et al. Analysis of the hemodynamic and ventilatory effects of laparoscopic cholecystectomy. Arch Surg. 1991;126(8):997–1000. doi: 10.1001/archsurg.1991.01410320083011.Joris JL, Noirot DP, Legrand MJ, et al. Hemodynamic changes during laparoscopic cholecystectomy. Anesth Analg. 1993;76(5):1067–1071. doi: 10.1213/00000539-199305000-00027.Joris JL, Noirot DP, Legrand MJ, et al. Hemodynamic changes during laparoscopic cholecystectomy. Anesth Analg. 1993;76(5):1067–1071. doi: 10.1213/00000539-199305000-00027.Kazaryan AM, Kuznetsov NS, Shulutko AM, et al. Evaluation of endoscopic and traditional open approaches to pheochromocytoma. Surg Endosc. 2004;18(6):937–941. doi: 10.1007/s00464-003-9199-1.Kazaryan AM, Kuznetsov NS, Shulutko AM, et al. Evaluation of endoscopic and traditional open approaches to pheochromocytoma. Surg Endosc. 2004;18(6):937–941. doi: 10.1007/s00464-003-9199-1.Murphy MM, Witkowski ER, Ng SC, et al. Trends in adrenalectomy: a recent national review. Surg Endosc. 2010;24(10):2518–2526. doi: 10.1007/s00464-010-0996-z.Murphy MM, Witkowski ER, Ng SC, et al. Trends in adrenalectomy: a recent national review. Surg Endosc. 2010;24(10):2518–2526. doi: 10.1007/s00464-010-0996-z.Flávio Rocha M, Faramarzi-Roques R, Tauzin-Fin P, et al. Laparoscopic surgery for pheochromocytoma. Eur Urol. 2004;45(2):226–232. doi: 10.1016/j.eururo.2003.09.016.Flávio Rocha M, Faramarzi-Roques R, Tauzin-Fin P, et al. Laparoscopic surgery for pheochromocytoma. Eur Urol. 2004;45(2):226–232. doi: 10.1016/j.eururo.2003.09.016.Di Daniele N, Canale MP, Tesauro M, et al. Preoperative embolization reduces the risk of cathecolamines release at the time of surgical excision of large pelvic extra-adrenal sympathetic paraganglioma. Case Rep Endocrinol. 2012;2012:481328. doi: 10.1155/2012/481328.Di Daniele N, Canale MP, Tesauro M, et al. Preoperative embolization reduces the risk of cathecolamines release at the time of surgical excision of large pelvic extra-adrenal sympathetic paraganglioma. Case Rep Endocrinol. 2012;2012:481328. doi: 10.1155/2012/481328.Sormaz IC, Tunca F, Poyanlı A, Şenyürek YG. Preoperative adrenal artery embolization followed by surgical excision of giant hypervascular adrenal masses: report of three cases. Acta Chir Belg. 2017;118(2):113–119. doi: 10.1080/00015458.2017.1312080.Sormaz IC, Tunca F, Poyanlı A, Şenyürek YG. Preoperative adrenal artery embolization followed by surgical excision of giant hypervascular adrenal masses: report of three cases. Acta Chir Belg. 2017;118(2):113–119. doi: 10.1080/00015458.2017.1312080.Minato N, Yamaguchi Y, Koga M, et al. [Giant non-functioning adrenocortical carcinoma effectively treated with preoperative transarterial embolization: a case report. (In Japanese).] Hinyokika Kiyo. 2012;58(4):193–196.Minato N, Yamaguchi Y, Koga M, et al. [Giant non-functioning adrenocortical carcinoma effectively treated with preoperative transarterial embolization: a case report. (In Japanese).] Hinyokika Kiyo. 2012;58(4):193–196.Hrabovsky E, McLellan D, Horton J, et al. Catheter embolization: preparation of patient with pheochromocytoma. J Pediatr Surg. 1982;17(6):849–850. doi: 10.1016/s0022-3468(82)80455-7.Hrabovsky E, McLellan D, Horton J, et al. Catheter embolization: preparation of patient with pheochromocytoma. J Pediatr Surg. 1982;17(6):849–850. doi: 10.1016/s0022-3468(82)80455-7.O’Keeffe F, Carrasco C, Charnsangavej C, et al. Arterial embolization of adrenal tumors: results in nine cases. AJR Am J Roentgenol. 1988;151(4):819–822. doi: 10.2214/ajr.151.4.819.O’Keeffe F, Carrasco C, Charnsangavej C, et al. Arterial embolization of adrenal tumors: results in nine cases. AJR Am J Roentgenol. 1988;151(4):819–822. doi: 10.2214/ajr.151.4.819.Watanabe D, Tanabe A, Naruse M, et al. Transcatheter arterial embolization for the treatment of liver metastases in a patient with malignant pheochromocytoma. Endocr J. 2006;53(1):59–66. doi: 10.1507/endocrj.53.59.Watanabe D, Tanabe A, Naruse M, et al. Transcatheter arterial embolization for the treatment of liver metastases in a patient with malignant pheochromocytoma. Endocr J. 2006;53(1):59–66. doi: 10.1507/endocrj.53.59.Schwartz M, Smith E, Trost D, et al. Renal artery embolization: clinical indications and experience from over 100 cases. BJU Int. 2007;99(4):881–886. doi: 10.1111/j.1464-410x.2006.06653.x.Schwartz M, Smith E, Trost D, et al. Renal artery embolization: clinical indications and experience from over 100 cases. BJU Int. 2007;99(4):881–886. doi: 10.1111/j.1464-410x.2006.06653.x.Fowler A, Burda J, Kim S. Adrenal artery embolization: anatomy, indications, and technical considerations. AJR Am J Roentgenol. 2013;201(1):190–201. doi: 10.2214/ajr.12.9507.Fowler A, Burda J, Kim S. Adrenal artery embolization: anatomy, indications, and technical considerations. AJR Am J Roentgenol. 2013;201(1):190–201. doi: 10.2214/ajr.12.9507.Bunuan H, Alltree M, Merendino K. Gel foam embolization of a functioning pheochromocytoma. Am J Surg. 1978;136(3):395–398. doi: 10.1016/0002-9610(78)90304-5.Bunuan H, Alltree M, Merendino K. Gel foam embolization of a functioning pheochromocytoma. Am J Surg. 1978;136(3):395–398. doi: 10.1016/0002-9610(78)90304-5.

The authors declare that there are no conflicts of interest present.