Complications of Percutaneous Radiofrequency Ablation for Hepato-cellular Carcinoma: Imaging Spectrum and Management

Akahane, Masaaki; Koga, Hisao; Kato, Naoya; Yamada, Hideaki; Uozumi, Kazuhito; Tateishi, Ryosuke; Teratani, Takuma; Shiina, Shuichiro; Ohtomo, Kuni

doi:10.1148/rg.25si055505

Cited by 166 publications

(164 citation statements)

References 44 publications

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“…Although SHVE could be considered more thrombogenic, since it involves injurious manipulation of hepatic veins, the lack of confirmed cases of vein thrombosis in our study can be attributed to short warm ischemic time and sharp transection of the liver surface with the scalpel, a technique that is less traumatic to venous epithelium compared to other ablative techniques. Avoidance of radiofrequency ablation in our series may also have contributed to our favorable results, since this technique has been recently associated with damage to the liver remnant [18] and hepatic vein thrombosis [19] . Venous endothelial trauma has been known to cause platelet aggregation and degranulation, vasoconstriction, thrombin activation and diminished fibrinolysis [20] .…”

Section: Discussionmentioning

confidence: 85%

Does clamping during liver surgery predispose to thrombosis of the hepatic veins? Analysis of 210 cases

Arkadopoulos¹,

Stafyla²,

Marinis³

et al. 2009

WJG

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AIM:To test whether clamping during liver surgery predisposes to hepatic vein thrombosis. METHODS:We performed a retrospective analysis of 210 patients who underwent liver resection with simultaneous inflow and outflow occlusion. Intraoperatively, flow in the hepatic veins was assessed by Doppler ultrasonography during the reperfusion phase. Postoperatively, patency of the hepatic veins was assessed by contrast-enhanced CT angiography, when necessary after 3-6 mo follow up. RESULTS:Tw e l ve p a t i e n t s ( 5 .7 % ) d e ve l o p e d intraoperative liver remnant swelling. However, i n t ra o p e ra t i ve u l t ra s o n o g ra p hy d i d n o t re ve a l evidence of hepatic vein thrombosis. In three of these patients a kinking of the common trunk of the middle and left hepatic veins hindering outflow was recognized and was managed successfully by suturing the liver remnant to the diaphragm. Twenty three patients (10.9%) who developed signs of mild outflow obstruction postoperatively, had no evidence of thrombi in the hepatic veins or flow disturbances on ultrasonography and contrast-enhanced CT angiography, while hospitalized. Long term assessment of the patency of the hepatic veins over a 3-6 mo follow-up period did not reveal thrombi formation or clinical manifestations of outflow obstruction. CONCLUSION:Extrahepatic dissection and clamping of the hepatic veins does not predispose to clinically important thrombosis.

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Section: Discussionmentioning

confidence: 85%

Does clamping during liver surgery predispose to thrombosis of the hepatic veins? Analysis of 210 cases

Arkadopoulos¹,

Stafyla²,

Marinis³

et al. 2009

WJG

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“…10 Martin et al discovered several risk factors to be associated with adverse events of drug-eluting beads, including lack of pretreatment with hepatic arterial lidocaine, 3 or more treatments, achievement of complete stasis, treatment with > 100 mg DEBIRI in a single treatment, and bilirubin > 2.0 mg/dL with > 50% liver involvement. 11 Biloma formation is a well-known complication of several surgical and interventional procedures including biliary surgery, liver transplantation, percutaneous cholangiography, biliary drainage, liver biopsy, 12-14 chemoembolization, chemoinfusion therapy, radiofrequency ablation, [14][15][16][17][18][19][20][21][22][23][24][25][26] cholecystectomy, 14,27,28 endoscopic retrograde cholangiopancreatography (ERCP), percutaneous ethanol injection, 14 and radioembolization. 29 A biloma is an encapsulated bile collection outside the biliary tree due to bile leakage.…”

Section: Discussionmentioning

confidence: 99%

Chemoembolization with Drug-Eluting Beads Complicated by Intrahepatic Biloma

Naumann¹,

Gupta²

2011

Semin intervent Radiol

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Chemoembolization with drug-eluting beads is a type of locoregional therapy currently being used for the treatment of hepatocellular carcinoma and metastatic disease to the liver. This treatment has proven effectiveness in controlling tumor growth, extending survival time, and improving quality of life. Chemoembolization with drug-eluting beads have been shown to be safe, but like any other invasive procedure, can have associated complications. The authors present a case of intrahepatic biloma formation occurring as a result of treatment with drug-eluting beads.

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“…However, unintended collateral thermal injury during thermal energy-based ablation (when performing a percutaneous procedure) may be inevitable when the index tumor is located close to heat-vulnerable perihepatic structures like the abdominal wall or the diaphragm, gallbladder, or gastrointestinal tract [52]. In addition, hepatic dome lesions can complicate the optimal placement of an electrode.…”

Section: Artificial Materials Infusionmentioning

confidence: 99%

Recent Advances in Tumor Ablation for Hepatocellular Carcinoma

2015

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Image-guided tumor ablation for early stage hepatocellular carcinoma (HCC) is an accepted non-surgical treatment that provides excellent local tumor control and favorable survival benefit. This review summarizes the recent advances in tumor ablation for HCC. Diagnostic imaging and molecular biology of HCC has recently undergone marked improvements. Second-generation ultrasonography (US) contrast agents, new computed tomography (CT) techniques, and liver-specific contrast agents for magnetic resonance imaging (MRI) have enabled the early detection of smaller and inconspicuous HCC lesions. Various imaging-guidance tools that incorporate imaging-fusion between real-time US and CT/MRI, that are now common for percutaneous tumor ablation, have increased operator confidence in the accurate targeting of technically difficult tumors. In addition to radiofrequency ablation (RFA), various therapeutic modalities including microwave ablation, irreversible electroporation, and high-intensity focused ultrasound ablation have attracted attention as alternative energy sources for effective locoregional treatment of HCC. In addition, combined treatment with RFA and chemoembolization or molecular agents may be able to overcome the limitation of advanced or large tumors. Finally, understanding of the biological mechanisms and advances in therapy associated with tumor ablation will be important for successful tumor control. All these advances in tumor ablation for HCC will result in significant improvement in the prognosis of HCC patients. In this review, we primarily focus on recent advances in molecular tumor biology, diagnosis, imaging-guidance tools, and therapeutic modalities, and refer to the current status and future perspectives for tumor ablation for HCC.

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Complications of Percutaneous Radiofrequency Ablation for Hepato-cellular Carcinoma: Imaging Spectrum and Management

Cited by 166 publications

References 44 publications

Does clamping during liver surgery predispose to thrombosis of the hepatic veins? Analysis of 210 cases

Does clamping during liver surgery predispose to thrombosis of the hepatic veins? Analysis of 210 cases

Chemoembolization with Drug-Eluting Beads Complicated by Intrahepatic Biloma

Recent Advances in Tumor Ablation for Hepatocellular Carcinoma

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