The use of preoperative embolization as a method of preventing intraoperative hemodynamic disorders in a patient with pheochromocytoma

Aleksey I. Khripun; Gulmira B. Makhuova; Tatyana F. Avdeeva; Magomed P. Yusufov

doi:10.14341/serg12284

The use of preoperative embolization as a method of preventing intraoperative hemodynamic disorders in a patient with pheochromocytoma

Aleksey I. Khripun, Gulmira B. Makhuova, Tatyana F. Avdeeva, Magomed P. Yusufov

https://doi.org/10.14341/serg12284

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Abstract

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.

Keywords

pheochromocytoma, intraoperative hemodynamic instability, laparoscopic adrenalectomy, Endovascular embolization of preoperative, case report

About the Authors

Aleksey I. Khripun

The Russian National Research Medical University named after N.I. Pirogov
Russian Federation

MD, PhD, Professor

Gulmira B. Makhuova

The Russian National Research Medical University named after N.I. Pirogov; Moscow City Clinical Hospital named after V.M. Buyanov
Russian Federation

PhD, Docent, chief of surgical department

Tatyana F. Avdeeva

Moscow City Clinical Hospital named after V.M. Buyanov
Russian Federation

PhD, surgeon

Magomed P. Yusufov

The Russian National Research Medical University named after N.I. Pirogov; Moscow City Clinical Hospital named after V.M. Buyanov
Russian Federation

PhD student, surgeon

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Supplementary files

	1. Figure 1. Tumor of the left adrenal gland according to multispiral computed tomography of the abdominal organs (coronary and sagittal sections).
	Subject
	Type	Other
	View (475KB)	Indexing metadata ▾

	2. Figure 2. Arterial stage of endovascular intervention: A - selective angiography of the left middle adrenal artery; C - complete reduction of blood flow in the left middle adrenal artery after embolization with polyvinyl alcohol particles.
	Subject
	Type	Other
	View (249KB)	Indexing metadata ▾

	3. Figure 3. Venous phase of X-ray endovascular intervention: A - construction of the left renal vein and the mouth of the left adrenal vein; B - selective angiography of the central vein of the adrenal gland; C - contrasting of the left renal vein and central adrenal vein after implantation of the occluding coil; D - after implantation of the second coil, there is no contrasting of the central vein of the left adrenal gland.
	Subject
	Type	Other
	View (359KB)	Indexing metadata ▾

	4. Figure 4. Intraoperative data: A - tumor of the left adrenal gland; B - significantly dilated central adrenal vein; C - using a stapler with a vascular cassette for crossing the vein; D - transected central vein at the confluence with the left renal vein.
	Subject
	Type	Other
	View (715KB)	Indexing metadata ▾

	5. Figure 5. Intraoperative dynamics of systolic blood pressure and heart rate.
	Subject
	Type	Other
	View (371KB)	Indexing metadata ▾

	6. Figure 6. Dynamics of levels of methylated catecholamine derivatives before and after embolization of adrenal vessels, as well as 3 months after adrenalectomy.
	Subject
	Type	Other
	View (145KB)	Indexing metadata ▾

Review

For citations:

Khripun A.I., Makhuova G.B., Avdeeva T.F., Yusufov M.P. The use of preoperative embolization as a method of preventing intraoperative hemodynamic disorders in a patient with pheochromocytoma. Endocrine Surgery. 2020;14(1):22-29. (In Russ.) https://doi.org/10.14341/serg12284

This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (CC BY-NC-ND 4.0).

ISSN 2306-3513 (Print)
ISSN 2310-3965 (Online)

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	Title	Figure 1. Tumor of the left adrenal gland according to multispiral computed tomography of the abdominal organs (coronary and sagittal sections).
	Date	2020-01-25
Digital Object Identifier	https://doi.org/10.14341/serg12284-4889

	Title	Figure 2. Arterial stage of endovascular intervention: A - selective angiography of the left middle adrenal artery; C - complete reduction of blood flow in the left middle adrenal artery after embolization with polyvinyl alcohol particles.
	Date	2020-01-25
Digital Object Identifier	https://doi.org/10.14341/serg12284-4890

	Title	Figure 3. Venous phase of X-ray endovascular intervention: A - construction of the left renal vein and the mouth of the left adrenal vein; B - selective angiography of the central vein of the adrenal gland; C - contrasting of the left renal vein and central adrenal vein after implantation of the occluding coil; D - after implantation of the second coil, there is no contrasting of the central vein of the left adrenal gland.
	Date	2020-01-25
Digital Object Identifier	https://doi.org/10.14341/serg12284-4891

	Title	Figure 4. Intraoperative data: A - tumor of the left adrenal gland; B - significantly dilated central adrenal vein; C - using a stapler with a vascular cassette for crossing the vein; D - transected central vein at the confluence with the left renal vein.
	Date	2020-01-25
Digital Object Identifier	https://doi.org/10.14341/serg12284-4892

	Title	Figure 5. Intraoperative dynamics of systolic blood pressure and heart rate.
	Date	2020-01-25
Digital Object Identifier	https://doi.org/10.14341/serg12284-4893

	Title	Figure 6. Dynamics of levels of methylated catecholamine derivatives before and after embolization of adrenal vessels, as well as 3 months after adrenalectomy.
	Date	2020-01-25
Digital Object Identifier	https://doi.org/10.14341/serg12284-4894

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Endocrine Surgery

The use of preoperative embolization as a method of preventing intraoperative hemodynamic disorders in a patient with pheochromocytoma

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