Bleeding after Microwave Ablation in Hepatocellular Carcinoma: Successful Treatment with Percutaneous Ultrasound-Guided Cyanoacrylate Glue EmbolizationBlutungen nach Mikrowellenablation beim hepatozellulären Karzinom: Erfolgreiche Behandlung durch perkutane ultraschallgestützte Embolisation mit Cyanacrylat-Kleber
Percutaneous thermal ablation has become a first-line treatment modality for patients with small hepatocellular carcinoma (P.R. Galle et al. Journal of Hepatology 2018; 69: 182–236). Among the major adverse outcomes after thermal ablation, bleeding complications can be life threatening if diagnosis and treatment are delayed (J.W. Kim et al. Journal of Vascular and Interventional Radiology 2017; 28: 356–365). In our experience (Z. Sparchez et al. Journal of Gastrointestinal & Liver Diseases 2018; 27: 399–407), intraperitoneal hemorrhage after hepatic ablation can occur in up to 0.83 % of patients with HCC and liver cirrhosis. The best option for these particular situations would be transcatheter embolization (TAE) (J.W. Kim et al. Journal of Vascular and Interventional Radiology 2017; 28: 356–365). The largest study regarding the use of TAE for active bleeding after hepatic ablation included 14 patients with a success rate of 100 % (J.W. Kim et al. Journal of Vascular and Interventional Radiology 2017; 28: 356–365). The other option after unsuccessful TAE is surgical intervention. However, the presence of cirrhosis is a major surgical challenge (A.S. Befeler et al. Archives of Surgery 2005; 140: 650–654). The following is a report of an alternative approach to TAE and surgical intervention for bleeding complications after hepatic ablation, consisting of percutaneous ultrasound-guided cyanoacrylate glue embolization of the needle track. Cyanoacrylate glue is commonly used in endoscopy departments to treat gastric variceal bleeding. Treatment success can reach up to 100 % in these situations (M.R. Smruti et al. Journal of Hepatology 2011; 54: 1161–1167).
Received: 07 August 2019
Accepted: 29 October 2019
04 March 2020 (online)
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