James Slattery MD, Presenter: Nothing to Disclose

Debra Ann Gervais MD, Abstract Co-Author: Nothing to Disclose

John Y. Kim MD, Abstract Co-Author: Nothing to Disclose

Ronald Steven Arellano MD, Abstract Co-Author: Nothing to Disclose

Michael M. Maher MD, Abstract Co-Author: Nothing to Disclose

Peter Raff Mueller MD, Abstract Co-Author: Nothing to Disclose

To determine the hemorrhagic complication rate in radiofrequency (RF) ablation of focal liver lesions, and to explore the utility and efficacy of blood products in RF candidates with coagulopathy.

A retrospective review of our electronic data archive was performed to identify RF procedures in patients with focal liver lesions. The underlying pathology, coagulation parameters and hemorrhagic complications were noted. Patients were regarded coagulopathic if platelet count was less than 50,000 or PT was greater than 15 seconds. Hemorrhagic complications were divided into major and minor categories. Major hemorrhagic complications included bleeding requiring transfusion or surgical intervention. Minor hemorrhagic complications were those exclusive of major.

168 RF procedures were performed in 96 patients (61 male, 35 female; age range 40-84, mean age 62) for metastatic disease (n=94) and hepatocellular carcinoma (HCC) [n=74]. A pre-procedure coagulopathy was present on 29 occasions (17.3%) for which corrective blood products were given. Most patients with a coagulopathy had HCC (n=19) and the remainder had metastatic disease (n=10). The overall hemorrhagic complication rate was 6.5 % (11/168). There were three major complications (3/168 = 1.8%) – intra-parenchymal hematoma requiring transfusion only (n=1), intra-peritoneal bleed resulting in patient death (n=1), intra-parenchymal bleed from pseudo aneurysm formation requiring embolisation (n=1). Two of three major complications occurred in patients with coagulopathy and a diagnosis of HCC while one occurred in a patient with normal coagulation and metastatic liver disease. There were 8 minor complications (8/168 = 4.8%) in 8 patients of whom 2 had coagulopathy. Major complication rate for patients with and without coagulopathy was 6.9 % (2/29) and 0.7 % (1/139) respectively. Minor complication rate for patients with and without coagulopathy was 6.9% (2/29) and 4.3 % (6/139) respectively.

Hemorrhagic complications in RF of focal liver lesions are relatively rare. A significant proportion of patients have coagulopathy, which is correctable by blood products allowing the procedure to be performed safely.

Slattery, J, Gervais, D, Kim, J, Arellano, R, Maher, M, Mueller, P, Hemorrhagic Complications in Radiofrequency Ablation of Focal Liver Lesions in Patients with and without Coagulopathy: Experience in 168 Cases.  Radiological Society of North America 2005 Scientific Assembly and Annual Meeting, November 27 - December 2, 2005 ,Chicago IL. http://archive.rsna.org/2005/4417305.html