Venous Thrombosis After Radiofrequency Ablation for Hepatocellular Carcinoma
ABSTRACT 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.
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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
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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
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ABSTRACT: Purpose: To assess safety and effectiveness of percutaneous image-guided cryoablation of hepatic tumors adjacent to the gallbladder. Materials and methods: Twenty-one cryoablation procedures were performed to treat 19 hepatic tumors (mean size, 2.7 cm; range, 1.0-5.0 cm) adjacent to the gallbladder in 17 patients (11 male; mean age, 59.2 y; range, 40-82 y) under computed tomography (n = 15) or magnetic resonance imaging (n = 6) guidance in a retrospective study. All tumors (mean size, 2.67 cm; range, 1.0-5.0 cm) were within 1 cm (mean, 0.4 cm) of the gallbladder; seven (33%) were contiguous with the gallbladder. Primary outcomes included complication rate and severity and postprocedure gallbladder imaging findings. Secondary outcomes included technical success and technique effectiveness at 6 months. Results: Complications occurred in six of 21 procedures (29%); one (5%) was severe. Ice balls extended into the gallbladder lumen in 20 of 21 procedures (95%); no gallbladder-related complications occurred. The most common gallbladder imaging finding was mild, asymptomatic focal wall thickening after nine of 21 procedures (42%), which resolved on follow-up. Technical success was achieved in 19 of 21 sessions (90%). Six-month follow-up was available for 16 tumors; of these, all but two (87%) had no imaging evidence of local tumor progression. Conclusions: Percutaneous cryoablation of hepatic tumors adjacent to the gallbladder can be performed safely and successfully. Although postprocedural gallbladder changes are common, they are self-limited and clinically inconsequential, even when the ice ball extends into the gallbladder lumen.Journal of vascular and interventional radiology: JVIR 06/2014; 25(9). DOI:10.1016/j.jvir.2014.04.023 · 2.41 Impact Factor