SIR 2024
Interventional Oncology
Min Tae Kim, MD
Radiology Resident
Harbor-UCLA Medical Center
Financial relationships: Full list of relationships is listed on the CME information page.
Susie Park, MD
Physician
Harbor UCLA Medical Center
Financial relationships: Full list of relationships is listed on the CME information page.
Percutaneous microwave ablation is a leading therapy for the treatment of select liver malignancies. However, the size of the ablation can limit the efficacy of the treatment, particularly if the ablation is performed near a major vessel. In addition, actual ablation sizes have been found to be significantly smaller than the manufacturers’ referenced sizes. We present our initial experience using a balloon microcatheter for temporary occlusion of the hepatic artery during microwave ablation of liver masses.
Materials and Methods:
We reviewed medical charts for microwave ablations of liver masses where a balloon microcatheter was used for concurrent temporary proper hepatic artery occlusion during microwave ablation at a single institution from May 2021 to March 2023. Patient demographics, medical history, procedural details, outcomes and complications were reviewed. The procedures were performed in the IR suite with hepatic tumors visible under ultrasound. The proper hepatic artery was accessed with a balloon microcatheter. Ablation probe(s) were placed using ultrasound guidance. Under fluoroscopic guidance, the balloon microcatheter was insufflated to occlude the hepatic artery. Microwave ablation was then performed. The balloon was then deflated and a post-balloon occlusion arteriogram was performed. A post-procedure contrast enhanced CT was then used to use evaluate the ablation zone.
Results:
Four patient each underwent an ablation of a single hepatic tumor. Two patients had liver metastases and two patients had hepatocellular carcinoma. The measured ablation area exceeded the manufacturers referenced zones in all cases and in both the x and y dimensions. The mean measured ablation zone was 231% larger than expected. The mean measured long axis dimension (length) of ablation was 143% larger than expected. The mean measured short axis dimension (width) of ablation was 156% larger than expected. Interestingly, the largest disparities between measured and referenced measurements were when a single ablation probe was used, resulting in mean measured areas, lengths and widths of 324%, 157% and 205% of expected, respectively. The average fluoroscopy time was 4 minutes. There were no complications.
Conclusion:
We had a 100% technical success without any complications with our initial experience with using temporary proper hepatic artery occlusion during microwave ablation of liver tumors. The technique resulted in an average ablation area 231% larger than expected with a mean fluoroscopy time of only 4 minutes.