Ablation Sessions Research Articles

Successful outcome of performing CO2 laser ablation in a middle-aged female with angiokeratoma of Fordyce.

Angiokeratoma of Fordyce, a localized form of angiokeratoma, is commonly found on the scrotum but rarely affects the vulva. We have documented a case of angiokeratoma of Fordyce in a female patient. She was treated with two sessions of CO2 laser ablation, following which her lesions resolved.

Risk factors of complications after thermal ablation for hepatocellular carcinoma: the role of assessment of liver background.

To use an elastography technology and other clinical and radiological data for assessment of liver background and analyze risk factors of complications after thermal ablation in patients with hepatocellular carcinoma. Demographics, laboratory analyses, and radiological characteristics were collected from all patients. Main elastography-related indicators included F index (fibrosis index), A index (inflammation index), ATT (attenuation coefficient), E (kPa), AREA (area of blue parts), and CORR (correlation). All complications after thermal ablation were collected. Univariate analysis was performed to detect significant variables, which subsequently entered a stepwise logistic regression analysis (conditional forward selection) to identify independent variables. A total of 218 patients from October 2020 to June 2023 with 291 thermal ablation sessions were enrolled. 115 patients (52.8%) developed complications. Fifteen patients (6.9%) developed major complications. Minor complications included postoperative pain (20.6%), fever (19.3%), effusion (22.5%), and hyperammonemia (1.8%). AREA (P = 0.034), tumor size (P = 0.005), and abnormal aspartate aminotransferase (AST) (P = 0.018) were independent predictors for complications. F index (P = 0.021), tumor size (P < 0.001), and abnormal AST (P = 0.047) were independent predictors for effusion. The results of univariate analysis of infection showed that tumor size, CORR, ATT, diabetes, Child-Turcotte-Pugh grade, abnormal AST, total protein, and albumin were significant (all P < 0.05). Several radiological and combinational elastography indicators related to liver fibrosis, steatosis, or inflammation were significantly correlated with the occurrence of complications. Clinical assessment of the liver background should not be neglected in the management of postablation complications.

Surgical Management of Moderate Rhinophyma with Nasal Nodules: An Electrosurgery Approach

Introduction: Rhinophyma, a severe manifestation of rosacea, is characterized by hypertrophy of sebaceous glands and fibrosis of the nose, often leading to significant aesthetic and functional impairments. Surgical treatment is the preferred approach for advanced cases to restore nasal appearance and function. Case Report: We present the case of a 60-year-old man with moderate rhinophyma and nodules on the nostrils. Surgical management under local anesthesia involved the use of thermal loops for excision of the lesions and bipolar electrosurgery for hemostasis. The patient was also treated for rosacea with topical agents, including metronidazole and azelaic acid, and oral doxycycline for inflammatory lesions. Directed healing followed the surgery, along with LED phototherapy and ablative erbium laser sessions to optimize results. Discussion: The use of thermal loops and electrosurgery allowed for precise excision and control of bleeding. Postoperative care, including daily greasy vaseline dressings, facilitated rapid healing. Mild infection at the excision sites was treated with topical and prophylactic antibiotics. Six sessions of LED therapy combining four types of light (infrared, red, yellow, and blue) improved healing and reduced inflammation. Ablative erbium laser was proposed to further enhance the aesthetic outcome. Conclusion: A combined surgical approach and careful postoperative management yielded satisfactory results in the treatment of rhinophyma.

Image-guided percutaneous microwave ablation for unresectable pancreatic cancers: A multicenter retrospective study

ObjectiveThis study aims to assess the feasibility, effectiveness, and safety of image-guided percutaneous microwave ablation (PMWA) for unresectable pancreatic cancer. MethodsIn this retrospective study, 72 patients from four hospitals were enrolled between November 2009 and October 2022. Descriptive statistics were employed to describe the patients’ characteristics and prognostic factors. The primary endpoint compassed the complete ablation rate (CAR), incidence of complications and the pain relief rate (PRR). ResultsThe median age of the 72 patients was 61 (interquartile range (IQR) 52.5–67.0) years, with 62.5 % (45/72) being male. 26 cases received computed tomography (CT) guidance; 46 cases received ultrasound guidance. A total of 74 tumors were identified (2 in 2 patients), with 56.8 % (42/74) at the body and tail, and the rest at the head and neck. Overall, 73 ablation sessions were carried out, achieving a technical success rate (TSR) of 100 %. The CAR was 40.5 % (30/74). The median follow-up time was 4.6 (1–43.4) months. 50 % (36/72) of patients had died with a median overall survival (OS) of 5.6 (1–27) months. Regarding complications, 18.1 % (13/72) of cases were classified as grade I and II, and 9.8 % (7/72) as grade IIIa. Before surgery, 33 patients experienced pain symptoms, and the postoperative PRR was 96.7 % (32/33). The average pain score decreased from 6.3 (4–10) before surgery to 2.0 (0–8) after ablation (P<0.001). ConclusionsImage-guided PMWA for unresectable pancreatic cancer is safe and feasible, effectively relieving cancer pain and improving patients’ the quality of life.

Irreversible Electroporation in Treating Colorectal Liver Metastases in Proximity to Critical Structures

PurposeTo evaluate the safety, efficacy, and oncological outcomes of irreversible electroporation (IRE) of unresectable colorectal liver metastases (CRLMs) close to critical structures. Materials and MethodsThis is a single-center, institutional review board (IRB)–approved, retrospective analysis of patients who underwent percutaneous computed tomography (CT)–guided IRE of CRLM. Between August 2018 and October 2023, 26 patients had 46 tumors treated with percutaneous IRE in 30 ablation sessions. Primary end points were tumor response and local progression-free survival analyzed using Kaplan-Meier survival curves. Secondary end points were overall survival (OS), distant progression-free survival (DPFS) analyzed using Kaplan-Meier survival curves, adverse events rated according to the Common Terminology Criteria for Adverse Events (CTCAE), and length of hospital stay. ResultsAll tumors were close to critical structures, including the portal and hepatic veins, inferior vena cava, bile ducts, and gallbladder. All patients received preprocedural systemic therapy (median 10 cycles). Median length of hospital stay was 1 night. Adverse events occurred in 7 (23%) of 30 procedures, with four Grade 1 and two Grade 2 adverse events, including pleural effusions (n = 2), ileus (n = 1), small hematoma (n = 1), and pneumothorax (n = 2) requiring chest tube placements. Following IRE, the 1- and 2-year local tumor progression-free survival rates were 55.0% and 51.3%. The median DPFS was 3.5 months, with 1- and 2-year DPFS rates of 23.3% and 9.7%. Six patients (23.1%) died during follow-up, with a median OS of 40.4 months. The 1- and 2-year OS rates were 90.9% and 83.9%. ConclusionsIRE is a safe and viable option in the treatment of unresectable CRLMs in locations close to critical structures, but carries a risk of local recurrence.

Efficacy of Fractional Versus Fully Ablative CO2 Laser for Distolateral Onychomycosis: Experience With 20 Patients.

Oral antifungals are the treatment choice for onychomycosis, and topical therapies are favored in cases of limited nail involvement. Recently, carbon dioxide (CO2) laser treatment has emerged as an option to enhance the effectiveness of topical therapies. Our objective was to compare the efficacy of fractional ablative and fully ablative CO2 laser treatments for distolateral subungual onychomycosis affecting a single toenail and caused by dermatophytes. The records of 10 patients treated with a single fully ablative CO2 session were matched with those of 10 patients who underwent a single CO2 fractional treatment. All had previously failed topical antifungal lacquers and were discharged with the prescription of topical ciclopirox nail lacquer (8%) for 3 months. The clinical response rates were 80% for the fully ablative group and 60% for the fractional group. Additionally, the mean reduction in Onychomycosis Severity Index from baseline to 8.6±1.6 weeks after treatment completion was 6.9±5.4 in the fully ablative group and 3.6±6.6 in the fractional group. The relapse rate among responders was 12.5% in the fully ablative and 33.3% in the fractional group after a mean follow-up time of 29.4±2.3 weeks. Fractional and fully ablative CO2 laser in combination with ciclopirox lacquer could increase the response rate in onychomycosis resistant to topical antifungals when systemic therapy is contraindicated or not yet pursued. Fully ablative mode therapy is significantly more effective than fractional (P < 0.05). Further studies are needed to identify prognostic response factors and assess the long-term effectiveness of CO2 laser treatment.

10 Cases of Nonresponse to Laser Thermoablation from a Series of 187 Patients: Histological Outcomes after Surgery and Related Evaluations.

Thyroid thermoablative techniques have been developed as an alternative to surgery for the treatment of symptomatic benign nodes, with the advantage of being minimally invasive, repeatable, with a minimal complication rate, and avoiding the perioperative risks and irreversible consequences of surgery. A series of patients undergoing laser thermoablation by the same team of endocrinologists operating in 2 centers from May 2016 to December 2022 is presented. The procedure was performed in patients with compressive symptomatology determined by a thyroid node typed TIR 2, or TIR 3A with rejection of the surgical option. We analyzed cases that required surgery because of persistent compressive symptoms, reduction failure, or increase in volume. From May 2016 to December 2022, 207 thermoablative procedures were performed (187 patients). Single ablative session was unresolved in 28 patients (15%). The proportion of nodes with TIR 3A cytology was significantly higher (21.4 vs 7.0%). In this group, the response in terms of volumetric reduction 6 months after the procedure was significantly lower (5.7% vs 50%). Ten patients (5.3%) underwent surgery, whose histological outcome demonstrated malignancy in 50% of cases. Data show the importance of timely re-evaluation with referral to surgical treatment for patients presenting a less than 20% volume reduction 6 months after thermoablation, in order to ensure promptly effective treatment of misrecognized malignancies.

Image-Guided Thermal Ablation for Hepatic Epithelioid Hemangioendothelioma: A Multicenter Experience

PurposeTo investigate the feasibility, safety, and clinical outcomes of image-guided thermal ablation in patients with hepatic epithelioid hemangioendothelioma (HEHE). Materials and MethodsThis was a multicenter retrospective investigation of 18 patients (43.9 years [SD ± 14.8]; 6 men) who underwent image-guided thermal ablation for HEHE between January 2013 and February 2023. A total of 31 ablation sessions (24 involving microwave ablation and 7 involving radiofrequency ablation) were evaluated. The rates of technical success, adverse events, and outcomes were assessed. The Kaplan‒Meier method was used to estimate progression-free survival (PFS) and overall survival (OS) rates. The risk factors affecting PFS were investigated using Cox proportional hazard regression analysis. ResultsThe technical success rate was 93.5% (29/31). No major adverse events occurred. Local tumor progression occurred after 2 sessions (6.5%, 2/31), and intrahepatic distant metastasis occurred after 16 sessions (51.6%, 16/31). During the medium follow-up time of 37.2 months (range, 3–117 months), the OS and PFS rates were 87.6% and 62.2%, respectively, at 1 year; 75.5% and 37.4%, respectively, at 3 years; and 75.5% and 37.4%, respectively, at 5 years. The median OS and PFS were 90.5 months (95% CI: 68.1–112.8) and 23.8 months (95% CI: 15.4–32.2), respectively. According to the multivariate analysis, a larger tumor size (P = .026) was associated with shorter PFS. ConclusionsImage-guided thermal ablation is a feasible and safe treatment option for patients with HEHE that resulted in local tumor control and a favorable long-term prognosis.

Incidental Ring-hyperenhancing Liver Micronodules at CT Hepatic Arteriography-guided Percutaneous Thermal Ablation of Colorectal Liver Metastases.

CT during hepatic arteriography (CTHA) is a highly sensitive imaging method for detecting colorectal liver metastases (CLMs), which supports its use during percutaneous thermal liver ablation. In contrast to its high sensitivity, its specificity for incidental small CLMs not detected at preablation cross-sectional imaging is believed to be low given the absence of specific imaging signatures and the common presence of pseudolesions. In this retrospective study of 22 patients (mean age, 55 years ± 10.6 [SD]; 63.6% male, 36.4% female) with CLMs undergoing CTHA-guided microwave percutaneous thermal ablation between November 2017 and October 2022, the authors provided a definition of incidental ring-hyperenhancing liver micronodules (RHLMs) and investigated whether there is a correlation of RHLMs with histologic analysis or intrahepatic tumor progression at imaging follow-up after applying a biomechanical deformable image registration method. The analysis revealed 25 incidental RHLMs in 41.7% (10 of 24) of the CTHA images from the respective guided ablation sessions. Of those, four RHLMs were ablated. Among the remaining 21 RHLMs, 71.4% (15 of 21) were confirmed to be CLM with either histology (n = 3) or imaging follow-up (n = 12). The remaining 28.6% (six of 21) of RHLMs were not observed at follow-up imaging. This suggests that RHLMs at CTHA may be an early indicator of incidental small CLMs. Keywords: Colorectal Neoplasms, Liver, Angiography, CT, Incidental Findings, Ablation Supplemental material is available for this article. © RSNA, 2024.

Thermal ablation for local control of lung metastases and its effect on pulmonary function

Image-guided thermal ablation in the lung has consistently demonstrated preservation of lung function without permanent decline following treatment compared to other local treatment options, specifically surgical intervention or stereotactic radiation therapy. Here, we report a case of a 68-year-old female with mesonephric adenocarcinoma of the uterus metastatic to the lung, treated with primarily thermal ablation to manage her lung tumor burden. The patient underwent a hysterectomy and wedge resection of the left lower lobe in addition to first-line chemotherapy. To reduce the total lung tumor burden, in the absence of other more effective therapies and to strategically eradicate ultra-central lung tumors, the patient underwent multiple ablative therapies. In total, she underwent 45 ablation sessions, of which 42 were cryoablation with the rest conducted with microwave ablation, two stereotactic body radiation therapies, and one brachytherapy for 75 lung metastases. Pulmonary function tests were conducted before the start of serial ablation treatments and measured again after 32 ablation sessions which revealed minimal change in pulmonary function parameters while maintaining adequate functional status. We highlight the potential benefit of ablative therapies regarding pulmonary function compared to other local treatment options for metastatic lung cancer.

Ratio of P-Wave Duration to P-Wave Amplitude and Left Atrial Remodeling: Insights from Electrophysiological Findings and Myocardial Injury After Cryoballoon Ablation

The impact of the P-wave morphology on clinical outcomes post-catheter ablation (CA) and recurrent arrhythmia characteristics or electrophysiological findings in paroxysmal atrial fibrillation (PAF) patients remains unclear. PAF patients who underwent cryoballoon ablation were enrolled. In twelve-lead electrocardiography recorded within one-month before CA, the P-wave duration (Pd) and P-wave vector magnitude (Pvm) (square root of the sum of the squared P-wave amplitude in leads II, V6 and one-half of the P-wave amplitude in V2) were measured and divided into two groups; patients with high and low Pd/Pvm based on a statistically calculated cut-off value. We evaluated the incidence of late recurrence of AF (LRAF), myocardial injury (high-sensitive troponin I [hs-TnI]) and the electrophysiological findings in repeat ablation sessions. This study included 269 PAF patients. The median follow-up duration was 697 days. The cut-off value of the Pd/Pvm for predicting LRAF was 740.7ms/mV (AUC=0.81, sensitivity=58.2% and specificity=89.6%). Multivariable Cox proportional hazards analysis showed high Pd/Pvm (>740.7ms/mV) was significantly associated with LRAF (p<0.001). The hs-TnI level was significantly lower and ratio of DR-FLASH score>3 significantly higher in those with high than low Pd/Pvm (p=0.044, p=0.002, respectively). In the repeat ablation sessions, the Pd/Pvm in patients with atrial tachycardia (AT) induced or spontaneously occurring during the repeat CA sessions was significantly higher than in those without (p=0.009). There was a significant difference between the Pd/Pvm and low-voltage area (LVA) (p<0.001). In conclusion, the Pd/Pvm is significantly associated with LRAF after cryoballoon ablation in PAF patients and predicts left atrial LVAs and AT inducibility.

OGBN O01 Durability of Radiofrequency Ablation for Long-segment and Ultralong-segment Barrett’s Esophagus over 10 years

Abstract Background Long-term durability data for radiofrequency ablation(RFA) to prevent esophageal adenocarcinoma in long-segment(LSBE) and ultralong-segment Barrett’s esophagus(ULSBE) is lacking. This study aimed to determine 10-year cancer progression, eradication, and complication rates in LSBE and ULSBE patients treated with RFA. Methods Single surgeon prospective database of patients with LSBE (≥3 to &amp;lt;8cm) and ULSBE (≥8cm) who underwent RFA (2001-2021) were retrospectively analyzed. Ten-year cancer progression calculated with Kaplan-Meier analysis. Eradication rates, including complete remission of dysplasia (CR-D) and intestinal metaplasia (CR-IM), and rates of recurrence and complications, compared between LSBE and ULSBE groups. Results Ten years after starting treatment, the cancer rate was 14.3% in 56 patients. CR-D and CR-IM rates were 87.5% and 67.9%, respectively. Eradication rates for dysplasia in LSBE and ULSBE patients(90.6%versus83.3%) and IM(71.9%versus62.5%) were not significantly different. ULSBE patients required higher mean number of ablation sessions for IM eradication(4.7versus3.7,p=0.032), while complication rates including strictures(4.2%versus6.2%), perforation(0versus0) and bleeding(4.2%versus3.1%), were similar between ULSBE and LSBE patients, respectively. On multivariate analysis, shorter Barrett’s segment and baseline low grade dysplasia were associated with increased likelihood for eradication of IM and dysplasia. Conclusions RFA was durable in maintaining dysplasia and IM eradication in both LSBE and ULSBE over 10 years, and with low complication rates. IM eradication was more difficult to achieve in ULSBE. Late development of cancer occurred in 14.3%.

Abstract 17674: Serum Brain-Derived Neurotropic Factor Levels Predict the Recurrences of Atrial Fibrillation Following Catheter Ablation

Background: Brain-derived neurotropic factor (BDNF) is a growth factor with roles within the nervous system and cardiovascular system. It has been reported that serum BDNF is decreased in diseases related to persistent stress, such as chronic inflammation. Atrial fibrillation (AF) is also considered to be one of the diseases related to chronic inflammation, although the relationship between serum BDNF and AF remains unclear. Methods: This prospective study included 68 consecutive patients (44 men; 69 [58-69] years) who underwent first session of paroxysmal AF ablation. Before and 3 months after the ablation, blood samples were obtained to measure the several biomarkers that are known to be related to AF in addition to serum BDNF. AF recurrence was defined as the appearance of AF after 3 month blanking period following the ablation. Results: The serum BDNF levels before ablation were significantly increased after AF ablation (3.5 [1.6-16.6] ng/ml vs. 22.1 [16.2-27.4] ng/ml, p&lt;0.001). During follow-up period of 10±2 months, AF recurrence occurred in 5 (7%) patients. The serum BDNF at 3 months post-ablation were significantly lower in patients with recurrent AF than in those without (19.6 [13.8-20.8] ng/ml vs. 22.0 [17.5-27.1] ng/ml, p=0.019). Furthermore, the serum BDNF at 3 months post-ablation was an independent predictor of AF recurrence (odds ratio 0.912, 95% confidence interval 0.835-0.996, p=0.040). According to the ROC curve analysis, the serum BDNF at 3 months post-ablation &lt;22.0 ng/ml was associated with AF recurrence with 100% sensitivity and 54% specificity (area under the curve=0.817, p=0.019). Kaplan-Meier survival curve showed that the recurrence rate of AF was higher in the group L (the serum BDNF at 3 months post-ablation &lt;22.0 ng/ml) than the group H at 3 months post-ablation &gt;22.0 ng/ml) (p = 0.02) [figure 1]. Conclusions: Lower serum BDNF levels at 3 months after blanking period following the AF ablation might be a predictor of AF recurrence.

A novel feature extraction method for the localization of accessory pathways in patients with Wolff-Parkinson-White syndrome

Background and objectiveThe localization of accessory pathways (APs) in patients with Wolff-Parkinson-White (WPW) syndrome using surface electrocardiogram (ECG) is often entirely subjective. This study aimed to develop a novel, more automated, and non-invasive localization method to differentiate right and left APs. Materials and methodsThe participants were 31 patients (aged 8–69 y, mean age: 31.19 ± 14.69 y, 32.3 % women) with manifest WPW syndrome who were treated successfully in the first ablation session. The novel localization of APs was based on feature extraction using McSharry’s model, and SFS-LOV, a combination of three methods (sequential forward selection (SFS), leave-one-subject-out cross-validation (LOSO), and majority voting). The k-nearest neighbor (KNN) and support vector machine (SVM) classifier were separately used in the SFS-LOV method. In this method, the features were extracted from three segments of the ECG signals. Each segment was started from the onset of the P-wave and terminated with the offset of the T-wave. The majority voting was applied to the results of the classifier on the segments of each participant. ResultsThe proposed method differentiated the right from the left APs with an accuracy of 87% (sensitivity: 80%, specificity: 94%). This was achieved by feeding four selected parameters of McSharry’s model into the KNN classifier. These selected parameters were estimated from the lead V4 of the ECG signals. ConclusionThe parameters of McSharry’s model can semi-automatically localize the right and left APs in patients with manifest WPW syndrome.

Thermoablative Treatment of De Novo Tumor in Kidney Allograft.

The overall cancer risk increases in transplant patients, including in kidney allografts. This study aimed to analyze the outcome of patients with kidney allograft malignant tumors who underwent percutaneous thermal ablation. We included 26 renal allograft tumors, including 7 clear-cell renal cell carcinoma (RCCs), 16 papillary RCCs, 1 clear-cell papillary RCC, and 2 tubulocystic RCCs, treated in 19 ablation sessions. Outcomes of thermal ablation therapy were assessed, including technical success, adverse events, local tumor progression, development of metastases, survival after thermal ablation, and changes in renal function. Success rate was achieved in all ablation sessions (primary success rate: 96%; secondary success rate: 100%). No adverse events were observed in grades 3, 4, or 5. The median follow-up period was of 34 mo (15-69 mo). Two patients died during follow-up from a cause independent of renal cancer. The median decrease in estimated glomerular filtration rate 1 y after procedure was -4 (interquartile range, -7 to 0) mL/min/1.73 m 2 . One patient returned to dialysis within the year of the procedure. Percutaneous thermal ablation shows convincing results for treating malignant renal graft tumors and should be a useful treatment option. The shorter hospitalization time, the advantage of avoiding a potentially challenging dissection of the transplant, and the excellent preservation of allograft function appear encouraging to extend this indication.

Long-term follow-up of CT-guided percutaneous radiofrequency ablation of T1 renal cell carcinoma

BackgroundRadiofrequency ablation (RFA) has an established role in effective treatment of renal cell carcinomas (RCCs), as most of RCCs are diagnosed incidentally in early stages. Long-term follow-up is however important to consolidate the technique. Most of the literature contains series of short-term follow-ups of periods shorter than 2 years. This study in hand demonstrates the results of longer-term follow-up than the previously published series.ResultsData analysis of 31 patient records involved in this study demonstrated the high clinical efficacy of RFA for long term, 12-year follow-up, by following the absence of tumor recurrences, as shown on regular interval contrast enhanced computed tomography (CT) and or magnetic resonance imaging (MRI).ConclusionsRFA continues to prove its competent role in treating RCCs on longer-term follow-ups; the smaller the size of a tumor and the more peripheral the tumor is, the more effective the therapy. Even in larger early stages tumors, repeating the ablative sessions results in complete ablation without the need for more invasive surgical interventions.

Surgery for ventricular tachycardia originating from the left ventricular summit.

Ventricular tachycardia (VT) originating from the left ventricular summit region, the most superior region of the left ventricle surrounded by the major coronary arteries and veins, is frequently refractory to pharmacological therapies and endocardial and epicardial catheter ablation. Eleven patients with an age from 31 to 79 (median 56) years old, underwent map-guided surgery for left ventricular summit VT. All patients had undergone 1-5 unsuccessful sessions of catheter ablation for incessant VT, preoperatively. Five patients had suffered VT storm and 1 had a history of cardiopulmonary resuscitation. Four patients had implanted with a defibrillator. Epicardium to endocardium transmural cryothermia was applied at the VT origin determined by intraoperative epicardial mapping with electro-anatomical mapping system. Harmonic scalpel was used to remove the epicardial fat and cryothermia was applied directly to the myocardium, avoiding thermal or mechanical injuries to the coronary vessels. Additional endocardial cryothermia at the VT origin was performed by a cryoprobe introduced into the left ventricular cavity through an aortotomy. There was no surgical mortality or long-term mortality related to VT during a median follow-up period of 60 months (interquartile range: 34-82). Five-year freedom from preoperatively documented left ventricular summit VT and non-documented VT was 91% and 73%, respectively. All the patients with postoperative VT underwent successful catheter ablation. Other patients were free from VT during the follow-up period. Epicardial to endocardial transmural cryothermia at the VT origin guided by intraoperative electro-anatomical mapping with a close collaboration with electrophysiologists was crucial in successful surgery for left ventricular summit VT.

Double closed loop small bowel obstruction due to right diaphragmatic hernia after transcatheter arterial chemoembolization and microwave ablation for hepatocellular carcinoma.

64-Year-old male patient with hepatocellular carcinoma (HCC), liver cirrhosis, chronic hepatitis C infection, and glottic cancer presented with acute progressive abdominal pain and palpable mass in right upper quadrant of the abdomen. Despite treatment with hyoscine and tramadol, the symptoms persisted. He had received three sessions of Transcatheter arterial chemoembolization (TACE) and two sessions of microwave ablation (MWA) for HCC treatment, with the last session being TACE 11months prior. Plain film abdomen showed bowel gas pattern in the right hemithorax compatible with bowel obstruction. CT imaging revealed a right diaphragmatic hernia containing closed loop small bowel obstruction. An emergency exploratory laparotomy was performed. The patient improved and was discharged. There was no recurrence of diaphragmatic hernia or abdominal mass or pain at the 6-month follow-up visit. We herein demonstrate a catastrophic complication of TACE by using an IPA and MWA which leads to right diaphragmatic hernia.

Efficacy and durability of posterior wall isolation with ethanol infusion into the vein of Marshall.

Ethanol infusion into the vein of Marshall (EIVOM) is expected to be an adjunctive therapy for mitral isthmus (MI) ablation. Additionally, EIVOM can widely ablate the epicardium via the branches that extend to the left atrialposterior wall (LAPW) and facilitate LAPW isolation. This study aimed to investigate the efficacy and durability of LAPW isolation with EIVOM. Our cohort consisted of 413 patients with atrial fibrillation (AF)who underwent both LAPW and MI ablations. EIVOM was first attempted in 177 (35%) patients with adequate VOMs. The VOM was infused with 5 mL of ethanol with a double coaxial guiding catheter technique. Both ablations were performed only by radiofrequency ablation (the RF group) in the remaining 236 (57%) patients. EIVOM with 5 mL of ethanol was completely achieved in 106 patients (the EIVOM group). The application duration of LAPW isolation did not differ significantly between the two groups (718 ± 276 vs. 709 ± 288 s; p = .78). LAPW debulking ablation was required in 64/106 (60%) and 176/236 (75%) patients in the EIVOM and RF groups, respectively (p < .05). However, AF- or atrial tachycardia-free survival analyses revealed no significant differences between the two groups (log-rank p = .70). Among the cases of recurrence, 17 and 38 patients underwent subsequent ablation sessions; LAPW was reconnected in 9/17 (53%) and 25/38 (53%) patients (p = .36)in the EIVOM and RF groups, respectively. EIVOM reduced the number of cases that required LAPW debulking ablation but did not improve the durability of LAPW isolation or clinical outcomes.

Percutaneous ablative therapies for hepatocellular carcinoma in the caudate lobe of the liver: efficacy and outcome.

To assess the efficacy and outcomes of percutaneous ablative therapies for hepatocellular carcinoma (HCC) in the caudate lobe. Patients within Milan criteria, who underwent thermal ablation (RFA/MWA) for HCC were analyzed. Based on the inclusion-criteria, patients were categorized in two groups. Group-1 (caudate-lobe HCC) and Group-2 (non-caudate-lobe HCC). Both the groups were analyzed for technical success (TS), local tumor progression (LTP), disease-free survival (DFS), and overall survival (OS) were compared between both the groups. Predictive factors for LTP, DFS, or OS in the study cohort were analyzed using appropriate statistical analyses. Twenty-one patients qualified to be in Group-1 while 130 patients fulfilled the criteria for Group-2. TS of 90.5 and 97.7% was seen after the first session of ablation for Group-1 and group-2 respectively, while a TS of 95.2% (Group-1) and 100% (Group-2) was achieved after second session. The right-intercostal-approach was used in 66.7% (n = 14) and the anterior-epigastric-approach was used in 33.3% (n = 7) of patients having caudate-lobe HCC. Procedure-related complications in both the groups were comparable. Although, statistically insignificant, LTP in the Group-1 (19.5%, n = 4) was twice that of non-caudate lobe HCC (8.5%, n = 11). The cumulative DFS rate was better in Group-2 while OS in both groups were comparable. Multivariate analysis showed: tumor size and ablative margin of 5 mm being independent predictors of LTP after percutaneous-ablation of caudate-lobe HCC. Ablative therapies for HCC in caudate lobe is feasible and safe with comparable LTP and OS to non-caudate lobe HCC. Tumor size >2 cm and lack of 5 mm ablative margin are independent predictors of LTP. 1. Percutaneous ablation of caudate lobe HCC is feasible using anterior epigastric approach or right intercostal approach. 2. These approaches may allow a safe and effective ablation of caudate lobe HCC with results comparable to non-caudate HCC ablation.