Venous Thrombosis After Radiofrequency Ablation for Hepatocellular Carcinoma

Department of Radiology, Samsung Medical Center, Sungkyunwan University School of Medicine, Kangnam-ku, Seoul, Republic of Korea.
American Journal of Roentgenology (Impact Factor: 2.73). 12/2011; 197(6):1474-80. DOI: 10.2214/AJR.11.6495
Source: PubMed


This study was designed to evaluate the frequency, morphological patterns, sequential changes, and clinical significance of venous thrombosis after radiofrequency ablation (RFA) for hepatocellular carcinoma (HCC).
A total of 1379 RFAs performed in 1046 patients with HCC (mean tumor size, 1.93 cm) were surveyed. We retrospectively reviewed all radiologic reports before and after RFA and selected 15 patients with newly developed procedure-related venous thrombosis. Procedure-related thrombosis was defined as being adjacent to the ablation zone and developing within 4 months after the procedure. We evaluated the frequency, morphological patterns, sequential changes, and clinical course of venous thrombosis (mean follow-up, 662.9 days). Four cases with local tumor progression were identified among the 15 patients, and their clinical implications were evaluated.
A total of 15 venous thromboses (1.08%; 12 portal and three hepatic veins) developed after RFA (range, 0-128 days; mean, 37 days). The thromboses were found in central (n = 10), peripheral (n = 4), and both central and peripheral (n = 1) locations in the ablation zones. Thrombosis was decreased in nine (69.2%), persisted in one (7.6%), and increased in three (23.0%) of 13 patients who underwent follow-up CT for more than 12 months. Local tumor progression was noted in four patients (26.6%); it abutted to venous thrombosis in two patients, separated from the venous thrombosis in one patient, and exhibited malignant thrombosis in one patient.
The development of portal or hepatic venous thromboses after RFA in patients with HCC is rare and usually is associated with favorable prognoses. Further investigation is warranted to elucidate whether venous thrombosis after RFA is related to local tumor progression around ablation zones.

7 Reads
  • [Show abstract] [Hide abstract]
    ABSTRACT: Little is known about portal vein thrombosis (PVT) after radiofrequency ablation (RFA) for hepatocellular carcinoma (HCC). We aimed to determine the incidence, background, and natural history of RFA-related PVT. This is a retrospective study of 317 patients (219 males and 98 females) with HCC treated by RFA. Clinical data were compared between patients with and without PVT detected by ultrasound/CT. The median follow-up period after RFA was 15.8 months. PVT was detected in 6 (1.9 %) of 317 patients, 6 (0.8 %) of 802 treatments for HCC, and 6 (0.6 %) of 964 sessions of RFA. Body mass index was significantly higher in patients with PVT (26.9 ± 3.1 kg/m(2)) than in those without (22.9 ± 3.5 kg/m(2), p = 0.0075). PVT was significantly more frequent in RFA for the left lobe of the liver (2.7 %) than for the other sites (0 %, p < 0.0001). Five of the six patients received no treatment for PVT, with natural outcomes of disappearance in one patient, improvement in one patient, and unchanged appearance in three patients. Anticoagulation was applied in the one remaining patient and resulted in a successful recanalization. In the six patients, there was no significant difference in hepatic functional reserve between baseline and time of detection of PVT. These results indicated that a high body mass index and RFA for HCC in the left lobe might be significant risk factors for PVT and that RFA-related PVT was rarely progressive with little influence on liver function.
    Hepatology International 10/2013; 7(4). DOI:10.1007/s12072-013-9470-z · 1.78 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: In recent years there has been an important change regarding the thrombotic risk estimation of patients with liver cirrhosis, underestimated in the past in favor of the hemorrhagic risk. The appearance of the hepatocarcinoma in the chronic liver diseases evolution increases the thrombotic risk of the patients. We have created a retrospective, multicentric clinical study, including 215 consecutive patients hospitalized in 3 university sites from Transylvania. We have analyzed the complete blood panel parameters, coagulation tests, the thrombotic risk score and the thrombotic and hemorrhagic events of the patients. Over a third of the patients presented thrombosis. The mean platelet volume and the other platelet parameters do not correlate with thrombotic events. The number of platelets correlates directly with the throm-botic risk score. The results are analyzed in the light of the physiopathologic disturbances induced to these patients.
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: 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.
    World Journal of Hepatology 03/2014; 6(3):107-113. DOI:10.4254/wjh.v6.i3.107
Show more