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CardioVascular and Interventional Radiology

, Volume 42, Issue 1, pp 137–144 | Cite as

Hydrodissection of the Retrohepatic Space: A Technique to Physically Separate a Liver Tumour from the Inferior Vena Cava and the Ostia of the Hepatic Veins

  • Julien GarnonEmail author
  • Guillaume Koch
  • Jean Caudrelier
  • Emanuele Boatta
  • Pramod Rao
  • Maud Nouri-Neuville
  • Nitin Ramamurthy
  • Roberto Luigi Cazzato
  • Afshin Gangi
Technical Note
  • 108 Downloads

Abstract

Objective

To report a technique of percutaneous retrohepatic hydrodissection, highlighting its potential to physically separate liver tumours from the inferior vena cava (IVC) and the ostia of the hepatic veins (HV).

Materials and Methods

Between December 2017 and April 2018, hydrodissection of the retrohepatic IVC was performed in 5 patients (5 females; mean age 64.5 years) undergoing percutaneous ablation of 5 liver metastases (mean size: 3.6 cm) located adjacent to the IVC. Number of hydrodissection needles, volume of hydrodissection, separation of tumour/liver parenchyma from IVC/HV post-hydrodissection; technical success of ablation; and complications were tabulated.

Results

Two to three 22G spinal needles were required per case for adequate dissection. Mean volume to obtain sufficient hydrodissection was 410 ml on average. Physical separation of the IVC and tumour/hepatic parenchyma was successful in all cases, by 9 mm on average (range 5–12 mm). It also leaded to physical separation of the ostia of the right and middle HV in all cases. There was no early or delayed complication, notably no venous thrombosis in the post-operative period. All lesions but one were completely ablated after one session at 3-month follow-up. The patient with residual tumour was successfully retreated.

Conclusion

Retrohepatic hydrodissection is a feasible technique to separate a tumour from the IVC and/or ostia of the HV. This could potentially limit the heat-sink effect/reduce the risk of thrombosis. Larger follow-up studies are required to assess efficacy on a long-term basis.

Keywords

Thermal ablation IVC Hepatic vein Hydrodissection Heat-sink effect 

Notes

Compliance with Ethical Standards

Conflict of interest

Julien Garnon is a proctor for Galil Medical and received fees for presentations for Canon and Medtronic. Roberto Luigi Cazzato received fees for oral presentation for Medtronic. Afshin Gangi is a proctor for Galil Medical.

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) 2018

Authors and Affiliations

  • Julien Garnon
    • 1
    Email author
  • Guillaume Koch
    • 1
  • Jean Caudrelier
    • 1
  • Emanuele Boatta
    • 1
  • Pramod Rao
    • 2
  • Maud Nouri-Neuville
    • 1
  • Nitin Ramamurthy
    • 3
  • Roberto Luigi Cazzato
    • 1
  • Afshin Gangi
    • 1
  1. 1.Department of Interventional RadiologyNouvel Hôpital CivilStrasbourg CedexFrance
  2. 2.Laboratoires ICube, CNRSUniversité de StrasbourgIllkirch-GraffenstadenFrance
  3. 3.Department of RadiologyNorfolk and Norwich University HospitalNorwichUK

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