Shota Yamamoto MD, Presenter: Nothing to Disclose

Jonathan Keon Park MD, Abstract Co-Author: Nothing to Disclose

Quazi Al-Tariq MD, Abstract Co-Author: Nothing to Disclose

Taryar Min Zaw MD, Abstract Co-Author: Nothing to Disclose

Steven Satish Raman MD, Abstract Co-Author: Consultant, Bayer AG Consultant, Covidien AG

David Shin-Kuo Lu MD, Abstract Co-Author: Consultant, Covidien AG Speaker, Covidien AG Consultant, Johnson & Johnson Research Grant, Johnson & Johnson Consultant, Bayer AG Research Grant, Bayer AG Speaker, Bayer AG

To assess radiofrequency (RF) ablation efficacy, as well as the patency of transjugular intrahepatic portosystemic shunts (TIPS), in patients undergoing RF ablation for hepatocellular carcinoma (HCC)

Retrospective database review of patients with pre-existing TIPS undergoing RF ablation for HCC was conducted over a 147-month period. TIPS patency before and after RF ablation was assessed by US, angiography and/or contrast-enhanced CT or MRI. CT and/or MRI were performed within 1 day of RF ablation. Assessment of ablation efficacy was performed according to an updated image-guided tumor ablation consensus statement. 

19 patients with 21 lesions undergoing 25 RF ablation sessions were included. Child-Pugh class A, B, and C scores were seen in 1, 13, and 5 patients. 11 patients ultimately underwent liver transplantation. All lesions (100%) demonstrated imaging evidence of HCC. All ablation sessions showed immediate technical success without residual tumor enhancement (100%). No patients (0%) suffered liver failure within 1 month of ablation. For 21 total ablated lesions, primary technical efficacy rate was 15/21 (71.4%). Local progression was seen in the 6 other lesions (28.6%); however, only 3/21 (14.6%) lesions demonstrated local progression without successful retreatment and/or transplant. Furthermore, only 2/6 of lesions demonstrating local progression (33%) were located within 1 cm of TIPS stent-graft. 1, 2, and 3-year survival for patients not undergoing transplantation (8/19, 42%) was 100%, 80%, and 67%.  Pre-ablation TIPS patency was demonstrated in 22/25 sessions (88%). In 7 cases, lesions ablated were within 1 cm of the TIPS. Of 22 cases with patent TIPS prior to ablation, post-ablation patency was demonstrated in 22/22 (100%) on immediate post-ablation imaging and in 21/22 (95%) at last follow-up. No immediate complications following RF ablation were observed. 

Ablation efficacy did not differ significantly from cited literature values for patients without TIPS. Furthermore, TIPS patency was preserved in the majority of cases. Patients with both portal hypertension and HCC are not uncommonly encountered, and a pre-existing TIPS does not appear to be a definite contraindication for RF ablation.

RF ablation for HCC in patients with TIPS can be performed with similar efficacy to standard patients while preserving TIPS patency. 

Yamamoto, S, Park, J, Al-Tariq, Q, Zaw, T, Raman, S, Lu, D, Radiofrequency Ablation for the Treatment of Hepatocellular Carcinoma in Patients with Transjugular Intrahepatic Portosystemic Shunts.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14016058.html