Management of bleeding associated with radiofrequency ablation of benign thyroid nodules

Abstract

Objective This study was performed to explore the effective management of bleeding associated with radiofrequency ablation (RFA) of benign thyroid nodules. Methods Thirty-five patients with benign thyroid nodules who were treated with ultrasound-guided RFA from July 2015 to December 2016 at the Third Affiliated Hospital of Sun Yat-sen University were retrospectively reviewed. The technique efficacy, bleeding, and other complications were assessed during the follow-up period. Results The mean technique efficacy was 55.6%±22.8% at 1 month and 24.1%±17.1% at 6 months after the procedure. One case of an intranodular haematoma and two cases of voice change (>1 month) were observed. All patients recovered with corresponding treatment. Conclusion Although the incidence of haemorrhage is low, serious haematomas are life-threatening. Therefore, having a comprehensive understanding of the potential complications, an accurate clinical strategy, and adequate technical skills may prevent or help to properly manage these complications.

2022 Taiwan clinical multicenter expert consensus and recommendations for thyroid radiofrequency ablation

“…Hematoma is caused by mechanical or thermal injury to the vessels, which is revealed by a gradual enlargement of the hyperechoic area in or around the ablated nodules on US. The locations may include perithyroidal, subcapsular, and intranodular spaces [ 146 ]. Hematoma is usually managed effectively with direct compression of the neck for a period of 30 minutes to 2 hours [ 6 , 8 ], and most hematomas disappear within 1 to 2 weeks.…”

“…Careful evaluation of the peri-thyroidal vessels prior to insertion and after removal of the electrode is necessary. Active bleeding during needle puncture is visible as a rapidly expanding hypoechoic or anechoic signal, and can be blocked by direct ablation at the visible bleeding point [ 135 , 146 , 147 ]. Unlike bipolar electrodes, the use of monopolar electrodes is not suggested for pregnant women or patients with electrical devices such as a pacemaker, based on considerations of insufficient safety evidence [ 148 ].…”

Continuous, Large-Volume Hydrodissection to Protect Delicate Structures around the Thyroid throughout the Radiofrequency Ablation Procedure

“…Safety was defined as the incidence of complications and side effects. Major and minor complications and side effects were defined according to the criteria established by the Society of Interventional Radiology [9, [23][24][25][26].…”