Recurrent renal cell carcinoma post cryoablation secondary to splenorenal shunt thermal sink treated with venous obliteration and subsequent cryoablation.

Cryoablation is an effective treatment for T1a renal cell carcinoma but is subject to dissipation of ablative energy via adjacent blood vessel perfusion, known as thermal sink, which may reduce efficacy. Reduction of blood flow in structures responsible for thermal sink during ablations can limit this effect. We report a 55-year-old patient with cirrhosis complicated by portal hypertension and a recurrent left renal cell carcinoma after 2 cryoablations secondary to thermal sink from an abutting splenorenal shunt (SRS). He subsequently underwent transjugular intrahepatic portosystemic shunt creation done with SRS obliteration followed by cryoablation without recurrence. This case highlights a rare instance of thermal sink from an external vessel and demonstrates how addressing sources of thermal sink can improve ablation outcomes in select cases.