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



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.


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.


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.


Thermal ablation IVC Hepatic vein Hydrodissection Heat-sink effect 


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.


  1. 1.
    Van Cutsem E, Cervantes A, Adam R, Sobrero A, Van Krieken JH, Aderka D, et al. ESMO consensus guidelines for the management of patients with metastatic colorectal cancer. Ann Oncol. 2016;27(8):1386–422. Scholar
  2. 2.
    European Association For The Study Of The Liver; European Organisation For Research And Treatment Of Cancer. EASL-EORTC clinical practice guidelines: management of hepatocellular carcinoma. J Hepatol. 2012;56(4):908–43. (Erratum in: J Hepatol. 2012;56(6):1430).CrossRefGoogle Scholar
  3. 3.
    Lu DS, Raman SS, Vodopich DJ, Wang M, Sayre J, Lassman C. Effect of vessel size on creation of hepatic radiofrequency lesions in pigs: assessment of the “heat sink” effect. AJR Am J Roentgenol. 2002;178(1):47–51.CrossRefGoogle Scholar
  4. 4.
    Ringe KI, Lutat C, Rieder C, Schenk A, Wacker F, Raatschen H-J. Experimental evaluation of the heat sink effect in hepatic microwave ablation. PLoS ONE. 2015;10(7):e0134301. Scholar
  5. 5.
    Zorbas G, Samaras T. A study of the sink effect by blood vessels in radiofrequency ablation. Comput Biol Med. 2015;57:182–6. Scholar
  6. 6.
    Huang J, Li T, Liu N, Chen M, He Z, Ma K, et al. Safety and reliability of hepatic radiofrequency ablation near the inferior vena cava: an experimental study. Int J Hyperth. 2011;27(2):116–23. Scholar
  7. 7.
    Yu NC, Raman SS, Kim YJ, Lassman C, Chang X, Lu DS. Microwave liver ablation: influence of hepatic vein size on heat-sink effect in a porcine model. J Vasc Interv Radiol. 2008;19(7):1087–92. Scholar
  8. 8.
    Nishigaki Y, Tomita E, Hayashi H, Suzuki Y, Iritani S, Kato T, et al. Efficacy and safety of radiofrequency ablation for hepatocellular carcinoma in the caudate lobe of the liver. Hepatol Res. 2013;43(5):467–74. Scholar
  9. 9.
    van Tilborg AA, Scheffer HJ, de Jong MC, Vroomen LG, Nielsen K, van Kuijk C, et al. MWA versus RFA for perivascular and peribiliary CRLM: a retrospective patient- and lesion-based analysis of two historical cohorts. Cardiovasc Intervent Radiol. 2016;39(10):1438–46. Scholar
  10. 10.
    Deshazer G, Merck D, Hagmann M, Dupuy DE, Prakash P. Physical modeling of microwave ablation zone clinical margin variance. Med Phys. 2016;43(4):1764. Scholar
  11. 11.
    Distelmaier M, Barabasch A, Heil P, Kraemer NA, Isfort P, Keil S, et al. Midterm safety and efficacy of irreversible electroporation of malignant liver tumors located close to major portal or hepatic veins. Radiology. 2017;285(3):1023–31. Scholar
  12. 12.
    Takamura M, Murakami T, Shibata T, Ishida T, Niinobu T, Kawata S, et al. Microwave coagulation therapy with interruption of hepatic blood in- or outflow: an experimental study. J Vasc Interv Radiol. 2001;12(5):619–22.CrossRefGoogle Scholar
  13. 13.
    Ishida T, Murakami T, Shibata T, Inoue Y, Takamura M, Niinobu T, et al. Percutaneous microwave tumor coagulation for hepatocellular carcinomas with interruption of segmental hepatic blood flow. J Vasc Interv Radiol. 2002;13(2 Pt 1):185–91.CrossRefGoogle Scholar
  14. 14.
    de Baere T, Deschamps F, Briggs P, Dromain C, Boige V, Hechelhammer L, et al. Hepatic malignancies: percutaneous radiofrequency ablation during percutaneous portal or hepatic vein occlusion. Radiology. 2008;248(3):1056–66. Scholar
  15. 15.
    Garnon J, Cazzato RL, Caudrelier J, Nouri-Neuville M, Rao P, Boatta E, et al. Adjunctive thermoprotection during percutaneous thermal ablation procedures: review of current techniques. Cardiovasc Interv Radiol. 2018. Scholar
  16. 16.
    Garnon J, Koch G, Caudrelier J, Ramamurthy N, Rao P, Tsoumakidou G, et al. Percutaneous image-guided cryoablation of challenging mediastinal lesions using large-volume hydrodissection: technical considerations and outcomes. Cardiovasc Interv Radiol. 2016;39(11):1636–43. Scholar
  17. 17.
    Patel IJ, Davidson JC, Standards of Practice Committee, with Cardiovascular and Interventional Radiological Society of Europe (CIRSE) Endorsement. Consensus guidelines for periprocedural management of coagulation status and hemostasis risk in percutaneous image-guided interventions. J Vasc Interv Radiol. 2012;23(6):727–36.CrossRefGoogle Scholar
  18. 18.
    Campbell C, Lubner MG, Hinshaw JL, Muñoz del Rio A, Brace CL. Contrast media-doped hydrodissection during thermal ablation: optimizing contrast media concentration for improved visibility on CT images. AJR Am J Roentgenol. 2012;199(3):677–82.CrossRefGoogle Scholar
  19. 19.
    Kim S, Kim TU, Lee JW, Lee TH, Lee SH, Jeon TY, et al. The perihepatic space: comprehensive anatomy and CT features of pathologic conditions. Radiographics. 2007;27(1):129–43.CrossRefGoogle Scholar
  20. 20.
    Coffin A, Boulay-Coletta I, Sebbag-Sfez D, Zins M. Radioanatomy of the retroperitoneal space. Diagn Interv Imaging. 2015;96(2):171–86. Scholar
  21. 21.
    Chu H, Cao G, Tang Y, Du X, Min X, Wan C. Laparoscopic liver hanging maneuver through the retrohepatic tunnel on the right side of the inferior vena cava combined with a simple vascular occlusion technique for laparoscopic right hemihepatectomy. Surg Endosc. 2017. Scholar
  22. 22.
    Belghiti J, Guevara OA, Noun R, Saldinger PF, Kianmanesh R. Liver hanging maneuver: a safe approach to right hepatectomy without liver mobilization. J Am Coll Surg. 2001;193(1):109–11.CrossRefGoogle Scholar
  23. 23.
    Pillai K, Akhter J, Chua TC, Shehata M, Alzahrani N, Al-Alem I, et al. Heat sink effect on tumor ablation characteristics as observed in monopolar radiofrequency, bipolar radiofrequency, and microwave, using ex vivo calf liver model. Medicine (Baltimore). 2015;94(9):e580. Scholar
  24. 24.
    Singh S, Siriwardana PN, Johnston EW, Watkins J, Bandula S, Illing R, et al. Perivascular extension of microwave ablation zone: demonstrated using an ex vivo porcine perfusion liver model. Int J Hyperthermia. 2018;34(7):1114–20. Scholar
  25. 25.
    Chiang J, Hynes K, Brace CL. Flow-dependent vascular heat transfer during microwave thermal ablation. Conf Proc IEEE Eng Med Biol Soc. 2012;2012:5582–5. Scholar
  26. 26.
    Chiang J, Cristescu M, Lee MH, Moreland A, Hinshaw JL, Lee FT, et al. Effects of microwave ablation on arterial and venous vasculature after treatment of hepatocellular carcinoma. Radiology. 2016;281(2):617–24.CrossRefGoogle Scholar
  27. 27.
    Chiang J, Nickel K, Kimple RJ, Brace CL. Potential mechanisms of vascular thrombosis after microwave ablation in an in vivo liver. J Vasc Interv Radiol. 2017;28(7):1053–8. Scholar
  28. 28.
    Chiang J, Willey BJ, Del Rio AM, Hinshaw JL, Lee FT, Brace CL. Predictors of thrombosis in hepatic vasculature during microwave tumor ablation of an in vivo porcine model. J Vasc Interv Radiol. 2014;25(12):1965–71. Scholar

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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