Effect of Vessel Size on Creation of Hepatic Radiofrequency Lesions in  Pigs

Lu, David; Raman, Steven S.; Vodopich, Darko J.; Wang, Michael; Sayre, James; Lassman, Charles

doi:10.2214/ajr.178.1.1780047

Cited by 445 publications

(269 citation statements)

References 17 publications

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“…Portal vein thrombosis is a potentially fatal complication, with a 0.2% incidence [12] . Thrombosis and coagulation of vessels larger than 3 mm are rare when normal flow is granted [37] . Most of these thromboses are asymptomatic even in larger vessels and no further therapy is required [5,36] .…”

Section: Hepatic Vascular Damagementioning

confidence: 99%

Complications of radiofrequency ablation of hepatic tumors: Frequency and risk factors

Fonseca

Santin

Gomes

et al. 2014

WJH

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Radiofrequency ablation (RFA) has become an important option in the therapy of primary and secondary hepatic tumors. Surgical resection is still the best treatment option, but only a few of these patients are candidates for surgery: multilobar disease, insufficient liver reserve that will lead to liver failure after resection, extra-hepatic disease, proximity to major bile ducts and vessels, and co-morbidities. RFA has a low mortality and morbidity rate and is considered to be safe. Thus, complications occur and vary widely in the literature. Complications are caused by thermal damage, direct needle injury, infection and the patient's co-morbidities. Tumor type, type of approach, number of lesions, tumor localization, underlying hepatic disease, the physician's experience, associated hepatic resection and lesion size have been described as factors significantly associated with complications. The physician in charge should promptly recognize high-risk patients more susceptible to complications, perform a close post procedure follow-up and manage them early and adequately if they occur. We aim to describe complications from RFA of hepatic tumors and their risk factors, as well as a few techniques to avoid them. This way, others can decrease their morbidity rates with better outcomes.

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Section: Hepatic Vascular Damagementioning

confidence: 99%

Complications of radiofrequency ablation of hepatic tumors: Frequency and risk factors

Fonseca

Santin

Gomes

et al. 2014

WJH

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“…RFA is the treatment of choice for tumors less than 3 cm in size while TACE is used for tumors that exceed for 3 cm [Camma et al 2005;Livraghi et al 2000]. In addition, vessels can serve as a heat sink diminishing the effects of RFA, while proximity to other viscera can lead to extra-hepatic thermal injury [Livraghi et al 2003;Lu et al 2002] TACE is preferred in these cases. TACE cannot be performed in the presence of pre-existing portal vein thrombosis as it risks severely compromising the sole remaining hepatic blood supply, the hepatic artery.…”

Section: Locoregional Therapiesmentioning

confidence: 99%

Review: Current status of therapy for hepatocellular carcinoma

Corey

Pratt

2009

Therap Adv Gastroenterol

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The incidence of hepatocellular carcinoma (HCC) is increasing worldwide. A multidisciplinary approach is required for its management. Screening high-risk patients allows for earlier diagnosis and the use of potentially curative therapies. Current recommendations for HCC screening for patients with cirrhosis are an abdominal ultrasound and serum alpha fetoprotein level every 6 to 12 months. Treatment choice depends on tumor stage, liver function and the patient's overall functional status. Curative therapies include surgical resection, liver transplantation (LT), transarterial chemoembolization, and radiofrequency ablation (RFA). Surgical resection, either primary resection or LT, is the treatment most likely to result in cure of HCC. Which option to pursue is based on multiple factors. LT has the potential benefit of treating both HCC and the underlying cirrhosis; however, long wait times incur the risk of tumor progression. Firm recommendations regarding the role of living donor LT for HCC are not yet possible because of conflicting data. HCC recurrence after LT is 8-11% and several adjuvant therapies have been investigated to reduce this. Bridging therapy and tumor downsizing are techniques that also may be considered to deal with long waiting periods and qualification for LT, respectively. If neither LT nor primary resection is possible, locoregional therapies such as RFA and TACE should be considered. Systemic chemotherapies have proved disappointing for the treatment of HCC; however, newer targeted therapies such as sorafenib and cetuximab have provided new hope for the future.

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“…One possible explanation for this discrepancy is that hepatic blood flow may have a cooling effect and could thus have influenced the ablative state in the clinical cases. By contrast, ex vivo bovine liver was not perfused with blood flow (17)(18)(19). Previous studies have demonstrated that a reduction in blood supply, such as in transcatheter arterial chemoembolization, results in enlarged ablative volume (20)(21)(22).…”

Section: Discussionmentioning

confidence: 99%

Comparison between different thickness umbrella-shaped expandable radiofrequency electrodes (SuperSlim and CoAccess): Experimental and clinical study

Koda

Tokunaga

Matono

et al. 2011

Experimental and Therapeutic Medicine

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Abstract. The purpose of the present study was to compare the size and configuration of the ablation zones created by SuperSlim and CoAccess electrodes, using various ablation algorithms in ex vivo bovine liver and in clinical cases. In the experimental study, we ablated explanted bovine liver using 2 types of electrodes and 4 ablation algorithms (combinations of incremental power supply, stepwise expansion and additional low-power ablation) and evaluated the ablation area and time.In the clinical study, we compared the ablation volume and the shape of the ablation zone between both electrodes in 23 hepatocellular carcinoma (HCC) cases with the best algorithm (incremental power supply, stepwise expansion and additional low-power ablation) as derived from the experimental study. In the experimental study, the ablation area and time by the CoAccess electrode were significantly greater compared to those by the SuperSlim electrode for the single-step (algorithm 1, p=0.0209 and 0.0325, respectively) and stepwise expansion algorithms (algorithm 2, p=0.0002 and <0.0001, respectively; algorithm 3, p= 0.006 and 0.0407, respectively). However, differences were not significant for the additional low-power ablation algorithm. In the clinical study, the ablation volume and time in the CoAccess group were significantly larger and longer, respectively, compared to those in the SuperSlim group (p=0.0242 and 0.009, respectively). Round ablation zones were acquired in 91.7% of the CoAccess group, while irregular ablation zones were obtained in 45.5% of the SuperSlim group (p= 0.0428). In conclusion, the CoAccess electrode achieves larger and more uniform ablation zones compared with the SuperSlim electrode, though it requires longer ablation times in experimental and clinical studies.

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Effect of Vessel Size on Creation of Hepatic Radiofrequency Lesions in Pigs

Abstract: There appears to be a narrow transition zone for hepatic vessels at 2-4 mm, beyond which the heat sink effect was seen consistently and substantial vascular injury was rare.

Cited by 445 publications

References 17 publications

Complications of radiofrequency ablation of hepatic tumors: Frequency and risk factors

Complications of radiofrequency ablation of hepatic tumors: Frequency and risk factors

Review: Current status of therapy for hepatocellular carcinoma

Comparison between different thickness umbrella-shaped expandable radiofrequency electrodes (SuperSlim and CoAccess): Experimental and clinical study

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