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Initial Results of Image-Guided Percutaneous Ablation as Second-Line Treatment for Symptomatic Vascular Anomalies

  • Clinical Investigation
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Abstract

Purpose

The purpose of this study was to determine the feasibility, safety, and early effectiveness of percutaneous image-guided ablation as second-line treatment for symptomatic soft-tissue vascular anomalies (VA).

Materials and Methods

An IRB-approved retrospective review was undertaken of all patients who underwent percutaneous image-guided ablation as second-line therapy for treatment of symptomatic soft-tissue VA during the period from 1/1/2008 to 5/20/2014. US/CT- or MRI-guided and monitored cryoablation or MRI-guided and monitored laser ablation was performed. Clinical follow-up began at one-month post-ablation.

Results

Eight patients with nine torso or lower extremity VA were treated with US/CT (N = 4) or MRI-guided (N = 2) cryoablation or MRI-guided laser ablation (N = 5) for moderate to severe pain (N = 7) or diffuse bleeding secondary to hemangioma–thrombocytopenia syndrome (N = 1). The median maximal diameter was 9.0 cm (6.5–11.1 cm) and 2.5 cm (2.3–5.3 cm) for VA undergoing cryoablation and laser ablation, respectively. Seven VA were ablated in one session, one VA initially treated with MRI-guided cryoablation for severe pain was re-treated with MRI-guided laser ablation due to persistent moderate pain, and one VA was treated in a planned two-stage session due to large VA size. At an average follow-up of 19.8 months (range 2–62 months), 7 of 7 patients with painful VA reported symptomatic pain relief. There was no recurrence of bleeding at five-year post-ablation in the patient with hemangioma–thrombocytopenia syndrome. There were two minor complications and no major complications.

Conclusion

Image-guided percutaneous ablation is a feasible, safe, and effective second-line treatment option for symptomatic VA.

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References

  1. Lowe LH, Marchant TC, Rivard DC, Scherbel AJ (2012) Vascular malformations: classification and terminology the radiologist needs to know. Semin Roentgenol 47(2):106–117

    Article  PubMed  Google Scholar 

  2. Kelly M (2010) Kasabach-Merritt phenomenon. Pediatr Clin North Am 57(5):1085–1089

    Article  PubMed  Google Scholar 

  3. van der Vleuten CJ, Kater A, Wijnen MH, Schultze Kool LJ, Rovers MM (2014) Effectiveness of sclerotherapy, surgery, and laser therapy in patients with venous malformations: a systematic review. Cardiovasc Intervent Radiol 37(4):977–989

    PubMed  Google Scholar 

  4. Kim AH, Ko HK, Won JY, Lee do Y (2009) Percutaneous radiofrequency ablation: a novel treatment of facial venous malformation. J Vasc Surg 50(2):424–427

    Article  PubMed  Google Scholar 

  5. Childs DD, Emory CL (2012) Successful treatment of intramuscular venous malformation with image-guided radiofrequency ablation. J Vasc Interv Radiol 23(10):1391–1393

    Article  PubMed  Google Scholar 

  6. Cornelis F, Neuville A, Labreze C et al (2013) Percutaneous cryotherapy of vascular malformation: initial experience. Cardiovasc Intervent Radiol 36(3):853–856

    Article  CAS  PubMed  Google Scholar 

  7. Cornelis F, Havez M, Labreze C et al (2013) Percutaneous cryoablation of symptomatic localized venous malformations: preliminary short-term results. J Vasc Interv Radiol 24(6):823–827

    Article  PubMed  Google Scholar 

  8. Flors L, Leiva-Salinas C, Maged IM et al (2011) MR imaging of soft-tissue vascular malformations: diagnosis, classification, and therapy follow-up. Radiographics 31(5):1321–1340 discussion 1340-1321

    Article  PubMed  Google Scholar 

  9. Woodrum DA, Kawashima A, Karnes RJ et al (2013) Magnetic resonance imaging-guided cryoablation of recurrent prostate cancer after radical prostatectomy: initial single institution experience. Urology 82(4):870–875

    Article  PubMed  Google Scholar 

  10. Woodrum DA, Mynderse LA, Gorny KR, Amrami KK, McNichols RJ, Callstrom MR (2011) 3.0T MR-guided laser ablation of a prostate cancer recurrence in the postsurgical prostate bed. J Vasc Interv Radiol 22(7):929–934

    Article  PubMed  Google Scholar 

  11. Sacks D, McClenny TE, Cardella JF, Lewis CA (2003) Society of Interventional Radiology clinical practice guidelines. J Vasc Interv Radiol 14(9 Pt 2):S199–S202

    Article  PubMed  Google Scholar 

  12. Ahmed M, Solbiati L, Brace CL et al (2014) Image-guided Tumor Ablation: standardization of Terminology and Reporting Criteria-A 10-Year Update. Radiology 273(1):241–260

    Article  PubMed  PubMed Central  Google Scholar 

  13. Gloviczki P, Duncan A, Kalra M et al (2009) Vascular malformations: an update. Perspect Vasc Surg Endovasc Ther 21(2):133–148

    Article  PubMed  Google Scholar 

  14. Alomari A, Dubois J (2011) Interventional management of vascular malformations. Tech Vasc Interv Radiol 14(1):22–31

    Article  PubMed  Google Scholar 

  15. Gurgacz S, Zamora L, Scott NA (2014) Percutaneous sclerotherapy for vascular malformations: a systematic review. Ann Vasc Surg 28(5):1335–1349

    Article  PubMed  Google Scholar 

  16. Blatt J, McLean TW, Castellino SM, Burkhart CN (2013) A review of contemporary options for medical management of hemangiomas, other vascular tumors, and vascular malformations. Pharmacol Ther 139(3):327–333

    Article  CAS  PubMed  Google Scholar 

  17. Enjolras O, Mulliken JB, Wassef M et al (2000) Residual lesions after Kasabach-Merritt phenomenon in 41 patients. J Am Acad Dermatol 42(2 Pt 1):225–235

    Article  CAS  PubMed  Google Scholar 

  18. Kurup AN, Morris JM, Schmit GD et al (2013) Neuroanatomic considerations in percutaneous tumor ablation. Radiographics 33(4):1195–1215

    Article  PubMed  Google Scholar 

  19. Philip A, Gupta S, Ahrar K, Tam AL (2013) A spectrum of nerve injury after thermal ablation: a report of four cases and review of the literature. Cardiovasc Intervent Radiol 36(5):1427–1435

    Article  PubMed  Google Scholar 

  20. Buy X, Tok CH, Szwarc D, Bierry G, Gangi A (2009) Thermal protection during percutaneous thermal ablation procedures: interest of carbon dioxide dissection and temperature monitoring. Cardiovasc Intervent Radiol 32(3):529–534

    Article  PubMed  Google Scholar 

  21. Tsoumakidou G, Garnon J, Ramamurthy N, Buy X, Gangi A (2013) Interest of electrostimulation of peripheral motor nerves during percutaneous thermal ablation. Cardiovasc Intervent Radiol 36(6):1624–1628

    Article  PubMed  Google Scholar 

  22. Kurup AN, Morris JM, Boon AJ et al (2014) Motor Evoked Potential Monitoring during Cryoablation of Musculoskeletal Tumors. J Vasc Interv Radiol 25(11):1657–1664

    Article  PubMed  Google Scholar 

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Acknowledgments

Scott M. Thompson thanks the Mayo Clinic MSTP for fostering an outstanding environment for physician-scientist training. This publication was supported by Center for Clinical and Translational Science (CCaTS) Grant Number TL1 TR000137 from the National Center for Advancing Translational Science (NCATS). Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the NIH.

Conflict of interest

Matthew R. Callstrom has received research Grants from Thermedical Inc., General Electric Company, Siemens AG and Galil Medical Ltd. Scott Thompson, Michael A. McKusick, and David A. Woodrum report no conflicts of interest related to the subject of this manuscript.

Statement of informed consent

A waiver of informed consent was granted by the local institutional review board in accordance with 45 CFR 46.116(d). For this type of retrospective study, formal consent is not required. All individual participants consented to use of their medical record for research purposes in accordance with Minnesota state law.

Statement of human rights

For this type of retrospective study, formal consent is not required.

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Correspondence to David A. Woodrum.

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Thompson, S.M., Callstrom, M.R., McKusick, M.A. et al. Initial Results of Image-Guided Percutaneous Ablation as Second-Line Treatment for Symptomatic Vascular Anomalies. Cardiovasc Intervent Radiol 38, 1171–1178 (2015). https://doi.org/10.1007/s00270-015-1079-2

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  • DOI: https://doi.org/10.1007/s00270-015-1079-2

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