Hepatic Arteriography and C-Arm CT-Guided Ablation (HepACAGA) to Improve Tumor Visualization, Navigation and Margin Confirmation in Percutaneous Liver Tumor Ablation

Maarten L.J. Smits*, Rutger C.G. Bruijnen, Philip Tetteroo, Evert jan P.A. Vonken, Martijn R. Meijerink, Jeroen Hagendoorn, Joep de Bruijne, Warner Prevoo

*Corresponding author for this work

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Abstract

Purpose: We present a technique that combines Hepatic Arteriography with C-arm CT-Guided Ablation (HepACAGA) to improve tumor visualization, navigation and margin confirmation for percutaneous ablation of liver tumors. Materials and Methods: All consecutive patients scheduled for HepACAGA between April 20th, 2021, and November 2nd, 2021, were included in this retrospective, cohort study. HepACAGA was performed in an angiography-suite under general anesthesia. The hepatic artery was catheterized for selective contrast injection. C-arm CT and guidance software were then used to visualize the tumor and the microwave antenna was inserted during apnea. Pre- and post-ablation C-arm CTs were performed and ablation margins assessed. Technical success, antenna placement deviation, number of repositions, tumor recurrence, and safety were evaluated. Technical success was defined as a tumor that was ablated according to the HepACAGA technique. Results: A total of 21 patients (28 tumors) were included. The main tumor type was colorectal cancer liver metastases (11/21, 52%), followed by hepatocellular carcinoma (7/21, 33%), neuroendocrine tumor metastases (1/21, 5%), and other tumor types (2/21, 10%). The technical success rate was 93% (26/28 tumors) with two small hypovascular lesions unable to be identified. A single microwave antenna was used in all patients. The median antenna placement deviation was 1 mm (range 0–6 mm). At a median follow-up time of 16 months (range 5–22 months), there was no tumor recurrence in any patient. Safety analysis showed a complication rate of 5% grade 2 and 5% grade 3. Conclusion: HepACAGA was demonstrated to be a safe and effective percutaneous ablation technique, without any local tumor recurrence in this study. Graphic Abstract: [Figure not available: see fulltext.]

Original languageEnglish
Pages (from-to)1365-1374
Number of pages10
JournalCardiovascular and Interventional Radiology
Volume46
Issue number10
DOIs
Publication statusPublished - Oct 2023

Keywords

  • Ablation
  • Catheter
  • Colorectal cancer
  • Cone beam CT
  • CTHA
  • Hepatocellular carcinoma
  • Liver
  • Microwave

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