Skip to main content


Log in

Efficacy of Tract Embolization After Percutaneous Pulmonary Radiofrequency Ablation

  • Clinical Investigation
  • Non-Vascular Interventions
  • Published:
CardioVascular and Interventional Radiology Aims and scope Submit manuscript



To evaluate the efficacy of tract embolization technique using gelatin sponge slurry with iodinated contrast medium (GSSI) to reduce the incidence of pneumothorax and chest tube placement after computed tomography-guided lung radiofrequency ablation (RFA).

Materials and Methods

In this single-institute retrospective study, we examined all patients with metastatic cancer treated from January 2016 to December 2019 by interventional radiologists with computed tomography-guided lung RFA. Since 2017 in our institution, we have applied a tract embolization technique using GSSI for all RFA. Patients were included into those who underwent lung RFA performed either with GSSI (Group A) or without GSSI (Group B). Univariate and multivariate analyses were performed between the two groups to identify risk factors for pneumothorax and chest tube placement, including patient demographics and lesion characteristics.


This study included 116 patients (54 men, 62 women; mean age, 65 ± 11 years) who underwent RFA. Group A comprised 71 patients and Group B comprised 45 patients. Patients who underwent tract embolization had a significantly lower incidence of pneumothorax (Group A, 34% vs. Group B, 62%; p < 0.001) and chest tube insertion (Group A, 10% vs. Group B, 29%; p < 0.01). No embolic complications occurred. The hospitalization stay was significantly shorter in patients who underwent tract embolization (mean, 1.04 ± 0.2 days; p = 0.02).


Tract embolization after percutaneous lung RFA significantly reduced the rate of post-RFA pneumothorax and chest tube placement and was safer than the standard lung RFA technique.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2

Similar content being viewed by others



Gelatin sponge slurry with iodinated contrast medium


Radiofrequency ablation


Computed tomography


  1. Hess KR, Varadhachary GR, Taylor SH, et al. Metastatic patterns in adenocarcinoma. Cancer. 2006;106(7):1624–33.

    Article  PubMed  Google Scholar 

  2. Herold CJ, Bankier AA, Fleischmann D. Lung metastases. Eur Radiol. 1996;6(5):596–606.

    Article  CAS  PubMed  Google Scholar 

  3. Ferlay J, Soerjomataram I, Dikshit R, et al. Cancer incidence and mortality worldwide: sources, methods and major patterns in GLOBOCAN 2012. Int J Cancer. 2015;136(5):E359–86.

    Article  CAS  PubMed  Google Scholar 

  4. Prud’hommeDeschampsMoulin CFB, et al. Image-guided lung metastasis ablation: a literature review. Int J Hyperth. 2019;36(2):37–45.

    Article  Google Scholar 

  5. de Baère T, Aupérin A, Deschamps F, et al. Radiofrequency ablation is a valid treatment option for lung metastases: experience in 566 patients with 1037 metastases. Ann Oncol. 2015;26(5):987–91.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Ambrogi MC, Fanucchi O, Cioni R, et al. Long-term results of radiofrequency ablation treatment of stage I non-small cell lung cancer: a prospective intention-to-treat study. J Thorac Oncol. 2011;6(12):2044–51.

    Article  PubMed  Google Scholar 

  7. Beland MD, Wasser EJ, Mayo-Smith WW, et al. Primary non-small cell lung cancer: review of frequency, location, and time of recurrence after radiofrequency ablation. Radiology. 2010;254(1):301–7.

    Article  PubMed  Google Scholar 

  8. de Baere T, Tselikas L, Catena V, Buy X, Deschamps F, Palussière J. Percutaneous thermal ablation of primary lung cancer. Diagn Interv Imaging. 2016;97(10):1019–24.

    Article  PubMed  Google Scholar 

  9. Fernando HC, De Hoyos A, Landreneau RJ, et al. Radiofrequency ablation for the treatment of non-small cell lung cancer in marginal surgical candidates. J Thorac Cardiovasc Surg. 2005;129(3):639–44.

    Article  PubMed  Google Scholar 

  10. Hiraki T, Gobara H, Iishi T, et al. Percutaneous radiofrequency ablation for clinical stage I non-small cell lung cancer: results in 20 nonsurgical candidates. J Thorac Cardiovasc Surg. 2007;134(5):1306–12.

    Article  PubMed  Google Scholar 

  11. Simon CJ, Dupuy DE, DiPetrillo TA, et al. Pulmonary radiofrequency ablation: long-term safety and efficacy in 153 patients. Radiology. 2007;243(1):268–75.

    Article  PubMed  Google Scholar 

  12. de Baere T, Tselikas L, Gravel G, Deschamps F. Lung ablation: best practice/results/response assessment/role alongside other ablative therapies. Clin Radiol. 2017;72(8):657–64.

    Article  PubMed  Google Scholar 

  13. Barral M, Auperin A, Hakime A, et al. Percutaneous thermal ablation of breast cancer metastases in oligometastatic patients. Cardiovasc Interv Radiol. 2016;39(6):885–93.

    Article  CAS  Google Scholar 

  14. Lanuti M, Sharma A, Digumarthy SR, et al. Radiofrequency ablation for treatment of medically inoperable stage I non-small cell lung cancer. J Thorac Cardiovasc Surg. 2009;137(1):160–6.

    Article  PubMed  Google Scholar 

  15. Okuma T, Matsuoka T, Yamamoto A, et al. Frequency and risk factors of various complications after computed tomography-guided radiofrequency ablation of lung tumors. Cardiovasc Interv Radiol. 2008;31(1):122–30.

    Article  Google Scholar 

  16. Palussière J, Marcet B, Descat E, et al. Lung tumors treated with percutaneous radiofrequency ablation: computed tomography imaging follow-up. Cardiovasc Interv Radiol. 2011;34(5):989–97.

    Article  Google Scholar 

  17. Hiraki T, Tajiri N, Mimura H, et al. Pneumothorax, pleural effusion, and chest tube placement after radiofrequency ablation of lung tumors: incidence and risk factors. Radiology. 2006;241(1):275–83.

    Article  PubMed  Google Scholar 

  18. Izaaryene J, Mancini J, Louis G, et al. Embolisation of pulmonary radio frequency pathway: a randomised trial. Int J Hyperth. 2017;33(7):814–9.

    Article  Google Scholar 

  19. de Baere T, Tselikas L, Woodrum D, Abtin F, Littrup P, Deschamps F, et al. Evaluating cryoablation of metastatic lung tumors in patients—safety and efficacy the ECLIPSE trial—interim analysis at 1 year. J Thorac Oncol. 2015;10(10):1468–74.

    Article  PubMed  Google Scholar 

  20. Lokhandwala T, Bittoni MA, Dann RA, et al. Costs of diagnostic assessment for lung cancer: a medicare claims analysis. Clin Lung Cancer. 2017;18(1):e27-34.

    Article  PubMed  Google Scholar 

  21. Lang EK, Ghavami R, Schreiner VC, Archibald S, Ramirez J. Autologous blood clot seal to prevent pneumothorax at CT-guided lung biopsy. Radiology. 2000;216(1):93–6.

    Article  CAS  PubMed  Google Scholar 

  22. Clayton JD, Elicker BM, Ordovas KG, Kohi MP, Nguyen J, Naeger DM. Nonclotted blood patch technique reduces pneumothorax and chest tube placement rates after percutaneous lung biopsies. J Thorac Imaging. 2016;31(4):243–6.

    Article  PubMed  Google Scholar 

  23. Malone LJ, Stanfill RM, Wang H, Fahey KM, Bertino RE. Effect of intraparenchymal blood patch on rates of pneumothorax and pneumothorax requiring chest tube placement after percutaneous lung biopsy. AJR Am J Roentgenol. 2013;200(6):1238–43.

    Article  PubMed  Google Scholar 

  24. Graffy P, Loomis SB, Pickhardt PJ, et al. Pulmonary intraparenchymal blood patching decreases the rate of pneumothorax-related complications following percutaneous CT-guided needle biopsy. J Vasc Interv Radiol. 2017;28(4):608-13.e1.

    Article  PubMed  Google Scholar 

  25. Maybody M, Muallem N, Brown KT, et al. Autologous blood patch injection versus Hydrogel plug in CT-guided lung biopsy: a prospective randomized trial. Radiology. 2019;290(2):547–54.

    Article  PubMed  Google Scholar 

  26. Engeler CE, Hunter DW, Castaneda-Zuniga W, Tashjian JH, Yedlicka JW, Amplatz K. Pneumothorax after lung biopsy: prevention with transpleural placement of compressed collagen foam plugs. Radiology. 1992;184(3):787–9.

    Article  CAS  PubMed  Google Scholar 

  27. Zaetta JM, Licht MO, Fisher JS, Avelar RL. Bio-seal study group: a lung biopsy tract plug for reduction of postbiopsy pneumothorax and other complications—results of a prospective, multicenter, randomized, controlled clinical study. J Vasc Interv Radiol. 2010;21(8):1235–43.

    Article  PubMed  Google Scholar 

  28. Grage RA, Naveed MA, Keogh S, Wang D. Efficacy of a dehydrated Hydrogel plug to reduce complications associated with computed tomography-guided percutaneous transthoracic needle biopsy. J Thorac Imaging. 2017;32(1):57–62.

    Article  PubMed  Google Scholar 

  29. Billich C, Muche R, Brenner G, et al. CT-guided lung biopsy: incidence of pneumothorax after instillation of NaCl into the biopsy track. Eur Radiol. 2008;18(6):1146–52.

    Article  PubMed  Google Scholar 

  30. Ahrar JU, Gupta S, Ensor JE, et al. Efficacy of a self-expanding tract sealant device in the reduction of pneumothorax and chest tube placement rates after percutaneous lung biopsy: a matched controlled study using propensity score analysis. Cardiovasc Interv Radiol. 2017;40(2):270–6.

    Article  Google Scholar 

  31. Renier H, Gérard L, Lamborelle P, Cousin F. Efficacy of the tract embolization technique with gelatin sponge slurry to reduce pneumothorax and chest tube placement after percutaneous CT-guided lung biopsy. Cardiovasc Interv Radiol. 2020;43(4):597–603.

    Article  Google Scholar 

  32. Izaaryene J, Cohen F, Souteyrand P, et al. Pathological effects of lung radiofrequency ablation that contribute to pneumothorax, using a porcine model. Int J Hyperth. 2017;33(7):713–6.

    Article  Google Scholar 

  33. MacDuff A, Arnold A, Harvey J. BTS pleural disease guideline group: management of spontaneous pneumothorax—British thoracic society pleural disease guideline 2010. Thorax. 2010;65(Suppl2):ii18–31.

    Article  PubMed  Google Scholar 

  34. Lignieres M, Roux N, Giorgi R, et al. Persistent pathways after lung radiofrequency ablation as a risk factor of drain placement. Int J Hyperth. 2017;33(6):659–63.

    Article  Google Scholar 

  35. Cousin F, Gérard L, Joskin J. Left cardiac migration of a lung fiducial marker. J Vasc Interv Radiol. 2019;30(3):445.

    Article  PubMed  Google Scholar 

  36. Farkas EA, Stoeckel DA, Nassif AS, Lim MJ, Naunheim KS. Intracoronary fiducial embolization after percutaneous placement for stereotactic radiosurgery. Ann Thorac Surg. 2012;93(5):1715–7.

    Article  PubMed  Google Scholar 

  37. Rott G, Boecker F. Influenceable and avoidable risk factors for systemic air embolism due to percutaneous CT-guided lung biopsy: patient positioning and coaxial biopsy technique-case report, systematic literature review, and a technical note. Radiol Res Pract. 2014;2014:349062.

    Article  PubMed  PubMed Central  Google Scholar 

  38. Hiraki T, Gobara H, Fujiwara H, et al. Lung cancer ablation: complications. Semin Interv Radiol. 2013;30(2):169–75.

    Article  Google Scholar 

  39. Kashima M, Yamakado K, Takaki H, et al. Complications after 1000 lung radiofrequency ablation sessions in 420 patients: a single center’s experiences. AJR Am J Roentgenol. 2011;197(4):W576–80.

    Article  PubMed  Google Scholar 

  40. Lyons GR, Askin G, Pua BB. Clinical outcomes after pulmonary cryoablation with the use of a triple freeze protocol. J Vasc Interv Radiol. 2018;29(5):714–21.

    Article  PubMed  Google Scholar 

  41. Jin GY, Lee JM, Lee YC, Han YM, Lim YS. Primary and secondary lung malignancies treated with percutaneous radiofrequency ablation: evaluation with follow-up helical CT. AJR Am J Roentgenol. 2004;183(4):1013–20.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations


Corresponding author

Correspondence to Michael Dassa.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Declaration of HELSINKI and its later amendments or comparable ethical standards. For this type of study formal consent is not required.

Informed Consent

Informed consent was obtained from all individual participants included in the study. This study has obtained IRB approval from the Paoli-Calmettes Institute, and the need for informed consent was waived.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Dassa, M., Izaaryene, J., Daidj, N. et al. Efficacy of Tract Embolization After Percutaneous Pulmonary Radiofrequency Ablation. Cardiovasc Intervent Radiol 44, 903–910 (2021).

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: