C-arm CT angiographically-assisted percutaneous cryoablation of liver metastases: Bleeding control and other benefits

This submission has open access
Submission ID :
GEST2021-67
Submission Topic
Purpose :
Percutaneous cryoablation (PC) is a promising method for treatment of liver metastases (LM) due to the painlessness and the possibility to create large ablation zones. However, the most serious disadvantage of PC is the significantly increased risk of massive bleeding. The aim of this study was to assess the feasibility of angiographically-assisted PC to control bleeding, as well as other advantages of using intra-arterial contrasting combined with C-arm CT.
Materials & Methods :
PC were performed using SeedNet Gold system (Galil Medical, USA) on Artis Zee Floor system with iGuide Needle Guidance (Siemens, Germany). After hepatic arteriography (HA) for the detection and targeting of very small (< 10 mm) LM C-arm CT during capillary phase of infusion HA (injection of 40 ml contrast material at a rate of 2 ml/second and scanning delay 22 seconds) was performed. For the assessment of ablation zone as well as the “tumor ghost” C-arm CT during interstitial phase of diffusion HA (40 ml contrast material at a rate of 20 ml/minute and scanning delay 300 seconds) was performed. In the end of PC HA was performed to exclude bleeding. In cases of severe bleeding (doesn't stop during 10 minutes compression of the puncture site), superselective embolization using gelatin sponge was done.
Results :
From 2017 to 2020, in 216 patients, 304 PC sessions were performed to treat colorectal (n=245) and non-colorectal (n=59) LM (1 to 5 sessions per patient). A total of 431 LM from 4 to 57 mm in diameter (mean 20.6 mm, median 19 mm) were ablated. Number of LM < 10 mm in diameter was 59 (37 not visualized on US and MDCT, 8.6%), 10-20 mm – 188, and > 30 mm – 184. During each PC procedure were treated from 1 to 8 (averaged 1.4, median – 1) LM using from 1 to 14 cryoprobes IceEDGE 13G or/and IceRod 17 G (average 3.4, median 3). The minimal ablative margin for each LM after PC ranged from 3 to 15 mm (mean 8.3 mm, median 8 mm). Bleeding was observed in 46 cases (15.1%), while massive bleeding requiring embolization was noted in 22 (7.2%). In four patients (1.3%), after embolization a liver abscess developed, and was successfully treated by percutaneous drainage placement.
Conclusions :
HA and embolization is a highly effective for control postprocedural bleeding with a few complications. The use of C-arm CT during HA significantly improves visualization, navigation and evaluation of immediate treatment response during PC and allows treating very small LM not visible on US and MDCT.
Head of the Department of Interventional Radiology
,
Saint-Petersburg clinical scientific and practical center of specialized types of medical care (oncological)
Saint-Petersburg clinical scientific and practical center of specialized types of medical care (oncological)
Saint-Petersburg clinical scientific and practical center of specialized types of medical care (oncological)
Saint-Petersburg clinical scientific and practical center of specialized types of medical care (oncological)
Saint-Petersburg clinical scientific and practical center of specialized types of medical care (oncological)
Saint-Petersburg clinical scientific and practical center of specialized types of medical care (oncological)

Similar Abstracts by Type

53 hits