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| ABLATE teaching points |
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| A (axial tumor diameter) |
| Local treatment failures increase with increasing tumor size. |
| Ablation-related bleeding complications increase with increasing tumor size |
| If the tumor is ≥3 cm in diameter, consider cryoablation. |
| If the tumor is ≥5 cm in diameter, consider preablation tumor embolization. |
| B (bowel proximity) |
| Ablation-related bowel injury may result in long-term catheter drainage or surgery. |
| If the tumor is ≤1 cm from the colon or small bowel, patient repositioning or bowel displacement maneuvers will likely be necessary. |
| L (location within kidney) |
| Ablation can be performed safely and effectively in locations other than just the posterior and lateral kidney. |
| If the tumor is in the anterior kidney, hydrodisplacement will likely be necessary to protect adjacent bowel. |
| If the tumor is in the anterolateral upper pole of the right kidney, a transhepatic approach may be necessary. |
| If the tumor is in the anteromedial upper pole of the kidney near the adrenal gland, close blood pressure monitoring and even preablation α-receptor blockade may be necessary. |
| If the tumor is in the medial lower pole of the kidney, displacement techniques may be required to protect the nerves that run along the anterior surface of the psoas muscle. |
| A (adjacency to ureter) |
| Ablation-related ureteral injuries may require long-term stenting or surgery. |
| If the tumor is ≤1 cm from the ureter, retrograde pyeloperfusion via an externalized ureteral stent or ureteral displacement maneuvers will likely be necessary. |
| T (touching renal sinus fat) |
| Local treatment failures are more common with treatment of central tumors (those that touch renal sinus fat). |
| Ablation-related renal collecting system injuries and major bleeding complications are more frequent with treatment of tumors that touch renal sinus fat. |
| If the tumor touches renal sinus fat, consider cryoablation. |
| E (endo/exophytic) |
| Local treatment failures are more common with treatment of endophytic tumors (those that are completely contained within the renal capsule) |
| If the tumor is completely endophytic, consider ultrasound guidance, fusion guidance, or IV administration of contrast agent immediately before ablation for better lesion localization. |
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