CC BY-NC-ND 4.0 · The Arab Journal of Interventional Radiology 2018; 02(03): S10
DOI: 10.1055/s-0041-1730672
Abstract

Hematoma or Contrast Extravasation Posthepatic Tumor Ablation: Does It Require Intervention?

Almamoon I Justaniah
King Abdullah Medical City, Makkah, Saudi Arabia, US
,
Quang Nguyen
Beth Israel Deaconess Medical Center, Boston, US
,
Ammar Sarwar
Beth Israel Deaconess Medical Center, Boston, US
,
Muneeb Ahmed
King Abdullah Medical City, Makkah, Saudi Arabia, US
› Author Affiliations

Background: This study aimed to determine the incidence and management of clinically significant bleeding after radiofrequency ablation (RFA) of hepatic tumors and to evaluate the need for angiographic intervention in patients with active contrast extravasation on immediate postablation imaging. Methods: In this Institutional Review Board-approved, Health Insurance Portability and Accountability Act-compliant study, computed tomography (CT) and clinical data were retrospectively reviewed of consecutive patients (March 2006–September 2014) who underwent percutaneous image-guided ablation of hepatic tumors. Patients were evaluated for the need of care escalation and angiographic intervention for ablation-related bleeding within 30 days of the procedure. Results: A total of 339 patients (422 tumors) treated with percutaneous ablation were included. One hundred and nineteen patients required hospitalization following ablation with 74 (62.1%) and 10 (8.4%) patients having a perihepatic hematoma and active contrast extravasation/bleeding, respectively, on postablation imaging. Nine out of 119 patients (7.6%) required escalation of care to an Intensive Care Unit (ICU). The average hospital stay of patients with a perihepatic hematoma, bleeding, or lack of thereof on immediate postablation imaging was 2.5, 1.6, and 2 days, respectively (P = 0.47 and 0.28). Furthermore, 6/339 patients (1.7%) required angiography due to clinically significant bleeding with 1/339 (0.3%) death postprocedure (from progressive hypotension requiring ICU admission, angiographic intervention, and subsequent emergent laparotomy on postprocedure day 1 for delayed hemorrhage and disseminated intravascular coagulation). In comparison with a lack of hematoma, the presence of a perihepatic hematoma or active contrast extravasation on immediate postablation imaging did not increase the need for angiographic intervention for bleeding compared to patients without perihepatic hematoma on immediate imaging (P = 0.14 and 0.13, respectively). Conclusion: Perihepatic hematoma and/or active contrast extravasation seen on immediate contrast-enhanced CT after hepatic tumor ablation does not necessitate escalation of care, increased hospital stay, or angiographic intervention and can be managed conservatively. Specifically, postablation contrast extravasation does not equate to unstable bleeding and need for immediate angiography.



Publication History

Article published online:
11 May 2021

© 2018. The Arab Journal of Interventional Radiology. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

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