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Copyright ©The Author(s) 2017.
World J Gastroenterol. Oct 21, 2017; 23(39): 7077-7086
Published online Oct 21, 2017. doi: 10.3748/wjg.v23.i39.7077
Table 1 Indications and contraindications of radiofrequency ablation for hepatic hemangiomas
Indications
The maximum diameter of hemangiomas > 5 cm
Tumor gaining an enlargement of more than 1 cm within 2 yr
Persistent hemangioma-related abdominal pain or discomfort
Consent to receive the RF ablation
Contraindications
Severe bleeding tendency, platelets < 50 × 109/L, international normalized ratio > 1.5, severe platelet function disorders (prothrombin time >18 s and prothrombin activity < 40%)
Malignant tumors
Kasabach-Merritt syndrome
Infection, especially biliary system inflammation
Low immune function
Severe primary organ failure such as the liver, kidney, heart, lung and/or brain
Table 2 Ablation-related complications and preventive measures
ComplicationPreventive measures
Bleeding at the electrode entry siteThe electrode needs to be advanced via a transhepatic approach to target the tumor and a needle tract ablation needs to be performed while withdrawing the electrode. Radiofrequency (RF) ablation should be launched from the exterior margin of the tumor from the beginning of a lower RF power.
Rupture of hepatic hemangiomaUnder the direct view of laparoscopy, hemostasis procedure can be applied to the bleeding site such as applying ablation to stop the bleeding. If it fails, a conversion to open surgery is advocated to achieve the hemostasis.
Puncture injury to adjacent organsThe high visibility of Cool-tip electrodes on computed tomography or ultrasonography images facilitates the insertion of the electrodes in the tumor without causing accidental injury to adjacent organs.
Thermal injury to the pleura and diaphragmLaparoscopic RF ablation should be used as the first-line treatment for hepatic hemangiomas abutting the diaphragm.
Thermal injury to the lungPre-ablation transcatheter arterial embolization as an adjuvant therapy or multiple ablation sessions is recommended to prevent the risk of acute respiratory distress syndrome.
HemolysisThe patients should be sufficiently hydrated before RF ablation and during the procedure. When any signs or symptoms indicating the hemolysis emerge in the course of ablation, the RF procedure should be terminated and a repeat RF ablation treatment may need to be rescheduled based on a comprehensive evaluation of the tumor.
Liver damageThe ablation-induced liver injury can resolve spontaneously without the need of any medication.
FeverPhysical cooling can be used to alleviate the discomfort of hyperthermia.
Skin burn injuryMultiple grounding pads can be applied or ice pad can be used to cool the skin with the contact of grounding pad.