Fatal arterial hemorrhage after microwave ablation of multiple liver metastases: The lessons learned

Abstract

We report the case of a 71-year-old female patient with previous history of rectal cancer. The primary cancer was resected and three cycles of chemotherapy were completed. Excision of metastatic lesions was also performed from the left liver lobe. Due to the presence of new liver lesions on the right lobe, intra-operative microwave ablation was decided. Three hours post ablation the patient bled massively and angiography revealed extravasation from a peripheral branch of the right hepatic artery. Successful embolization was performed; however, the patient died 5 days later on liver failure. We would like to present the case and discuss the technical options and the key points to help avoiding similar complications in the future.

Role of ablation therapy in conjunction with surgical resection for neuroendocrine tumors (NETs): Risks and benefits of multimodality surgical treatment for NETs involving liver

“…This finding is congruent with current literature of smaller case series [15]. Although there are isolated case reports of massive hemorrhage after ablation, they are unique cases that focus on extraneous factors contributing to the bleeding [21,22].…”

Analysis of feasibility, safety and effectiveness of ultrasound-guided percutaneous microwave ablation of splenic neoplasm

“…Moreover, the needle depth is not easy to be controlled, having an impact on the surrounding organs. What's more, the open microwave ablation surgery lasts longer and has larger trauma, which is likely to cause a variety of postoperative complications ( 18 ). On the other, the ultrasound-guided percutaneous microwave ablation can create the conditions for the single needle ablation of the specific coagulation volume, and accurately calculate the entry volumes, in which the condition, the ablation area overlapping can be avoided, resulting in relatively lower incidence of postoperative complications ( 19 ).…”

Preliminary results of ultrasound-guided laser ablation for unresectable metastases to retroperitoneal and hepatic portal lymph nodes

“…In most studies, it has been reported that the treatment of lesions close to the great vessels was more likely to result in residual tumor because of the heat-sink effect of blood flow [ 7 , 9 , 10 , 29 ]. In the current study, the lymph nodes either close to the aorta, inferior vena cava, or portal vein had a local response rate of 75.0 % and overall response rate of 62.5 %.…”

“…However, the metastases in the hepatic portal or retroperitoneal space are considered to be “critical lesions” and are difficult to be treated by radiofrequency and microwave ablation [ 9 , 10 ]. The main reason is that blood flow carries away part of the general heat resulting in the “heat-sink” effect [ 10 ].…”

“…However, the metastases in the hepatic portal or retroperitoneal space are considered to be “critical lesions” and are difficult to be treated by radiofrequency and microwave ablation [ 9 , 10 ]. The main reason is that blood flow carries away part of the general heat resulting in the “heat-sink” effect [ 10 ]. Residual tumor was observed in 100 % of tumors adjacent to the inferior vena cava, in 57 % of tumors adjacent to the portal vein, and in 33 % of tumors adjacent to the hepatic veins [ 11 ].…”