Diaphragmatic hernia: a rare complication of hepatic ablation

Macmillan, Maureen S.; Lim, Su Bin; Ireland, Hamish

doi:10.1177/0036933020941498

Cited by 4 publications

(4 citation statements)

References 10 publications

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“…In many of the reported cases, diaphragmatic injury presents as a delayed complication that occurs several months after treatment. [29][30][31] In many instances, patients present with new onset of shortness of breath and right shoulder pain. 32 A secondary complication of diaphragmatic injury can be herniation of bowel loops across the diaphragmatic defect.…”

Section: Diaphragmatic Injurymentioning

confidence: 99%

Complications Associated with Image-Guided Percutaneous Thermal Ablation of Liver Tumors

Arellano

2023

Digestive Disease Interventions

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Image-guided thermal ablation of liver cancer is a well-established treatment for patients with primary or secondary liver tumors. While the safety profile for liver ablations is high, several procedure-related complications can occur. An awareness of the potential complications, their recognition, and management are essential for the interventionist who performs liver ablation. This review will describe some of the most frequently encountered complications associated with image-guided thermal ablation of hepatic malignancies.

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Section: Diaphragmatic Injurymentioning

confidence: 99%

Complications Associated with Image-Guided Percutaneous Thermal Ablation of Liver Tumors

Arellano

2023

Digestive Disease Interventions

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“…While the existing literature suggests that MWA of subdiaphragmatic tumors is not associated with significantly higher complication rates, most of this concern is based on case reports describing diaphragmatic perforation and hernias following subdiaphragmatic tumor ablations. [ 6 , 7 ] Furthermore, data describing complications after transpleural approach during percutaneous liver ablation derive from RFA studies. Several RFA reports show high complication or LTP rates for these tumors compared with surgical approach.…”

Section: Mwa Of Liver Lesions Near the Diaphragmmentioning

confidence: 99%

Current perspectives on microwave ablation of liver lesions in difficult locations

Ozen

Raissi

2022

JCIS

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Microwave ablation (MWA) is becoming the standard of care in treating liver lesions smaller than 3 cm benefiting from a plethora of radiofrequency ablation (RFA) data in the literature. Some of the advantages of MWA compared to RFA are as follows: Faster ablations, more reproducible and predictable heating, better thermal conductivity in different liver tissue environments, and less susceptibility to heat-sink effect. Despite its many advantages, there are still concerns regarding MWA use in high-risk locations such as near portal veins, near the bile ducts, and near the heart. Some centers have historically considered these tumor locations as a contraindication to percutaneous thermal ablation. In this review, we summarize the current data on the safety of MWA of liver tumors in challenging locations. We also discuss several technical tips with examples provided.

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“…This limitation can lead to incomplete treatments and/or severe complications. [5][6][7] Locally delivered superparamagnetic iron oxide nanoparticles could enable more targeted ablation, as shown in Figure 1b. These particles undergo rapid oscillation in response to alternating magnetic fields when exposed to microwave energy, resulting in increased heat generation.…”

Section: Introductionmentioning

confidence: 99%

“…This heating cannot be well controlled or shaped to conform to a desired tumor shape or to avoid adjacent critical structures. This limitation can lead to incomplete treatments and/or severe complications 5–7 …”

Section: Introductionmentioning

confidence: 99%

Superparamagnetic iron oxide nanoparticle enhanced percutaneous microwave ablation: Ex‐vivo characterization using magnetic resonance thermometry

Bhagavatula,

Panikkanvalappil,

Tokuda

et al. 2024

Medical Physics

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BackgroundPercutaneous microwave ablation (pMWA) is a minimally invasive procedure that uses a microwave antenna placed at the tip of a needle to induce lethal tissue heating. It can treat cancer and other diseases with lower morbidity than conventional surgery, but one major limitation is the lack of control over the heating region around the ablation needle. Superparamagnetic iron oxide nanoparticles have the potential to enhance and control pMWA heating due to their ability to absorb microwave energy and their ease of local delivery.PurposeThe purpose of this study is to experimentally quantify the capabilities of FDA‐approved superparamagnetic iron oxide Feraheme nanoparticles (FHNPs) to enhance and control pMWA heating. This study aims to determine the effectiveness of locally injected FHNPs in increasing the maximum temperature during pMWA and to investigate the ability of FHNPs to create a controlled ablation zone around the pMWA needle.MethodsPMWA was performed using a clinical ablation system at 915 MHz in ex‐vivo porcine liver tissues. Prior to ablation, 50 uL 5 mg/mL FHNP injections were made on one side of the pMWA needle via a 23‐gauge needle. Local temperatures at the FHNP injection site were directly compared to equidistant control sites without FHNP. First, temperatures were compared using directly inserted thermocouples. Next, temperatures were measured non‐invasively using magnetic resonance thermometry (MRT), which enabled comprehensive four‐dimensional (volumetric and temporal) assessment of heating effects relative to nanoparticle distribution, which was quantified using dual‐echo ultrashort echo time (UTE) subtraction MR imaging. Maximum heating within FHNP‐exposed tissues versus control tissues were compared at multiple pMWA energy delivery settings. The ability to generate a controlled asymmetric ablation zone using multiple FHNP injections was also tested. Finally, intra‐procedural MRT‐derived heat maps were correlated with gold standard gross pathology using Dice similarity analysis.ResultsMaximum temperatures at the FHNP injection site were significantly higher than control (without FHNP) sites when measured using direct thermocouples (93.1 ± 6.0°C vs. 57.2 ± 8.1°C, p = 0.002) and using non‐invasive MRT (115.6 ± 13.4°C vs. 49.0 ± 10.6°C, p = 0.02). Temperature difference between FHNP‐exposed and control sites correlated with total energy deposition: 66.6 ± 17.6°C, 58.1 ± 8.5°C, and 20.8 ± 9.2°C at high (17.5 ± 2.2 kJ), medium (13.6 ± 1.8 kJ), and low (8.8 ± 1.1 kJ) energies, respectively (all pairwise p < 0.05). Each FHNP injection resulted in a nanoparticle distribution within 0.9 ± 0.2 cm radially of the injection site and a local lethal heating zone confined to within 1.1 ± 0.4 cm radially of the injection epicenter. Multiple injections enabled a controllable, asymmetric ablation zone to be generated around the ablation needle, with maximal ablation radius on the FHNP injection side of 1.6 ± 0.2 cm compared to 0.7 ± 0.2 cm on the non‐FHNP side (p = 0.02). MRT intra‐procedural predicted ablation zone correlated strongly with post procedure gold‐standard gross pathology assessment (Dice similarity 0.9).ConclusionsLocally injected FHNPs significantly enhanced pMWA heating in liver tissues, and were able to control the ablation zone shape around a pMWA needle. MRI and MRT allowed volumetric real‐time visualization of both FHNP distribution and FHNP‐enhanced pMWA heating that was useful for intra‐procedural monitoring. This work strongly supports further development of a FHNP‐enhanced pMWA paradigm; as all individual components of this approach are approved for patient use, there is low barrier for clinical translation.

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Diaphragmatic hernia: a rare complication of hepatic ablation

Cited by 4 publications

References 10 publications

Complications Associated with Image-Guided Percutaneous Thermal Ablation of Liver Tumors

Complications Associated with Image-Guided Percutaneous Thermal Ablation of Liver Tumors

Current perspectives on microwave ablation of liver lesions in difficult locations

Superparamagnetic iron oxide nanoparticle enhanced percutaneous microwave ablation: Ex‐vivo characterization using magnetic resonance thermometry

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