Percutaneous ablation of the tumor feeding artery for hypervascular hepatocellular carcinoma before tumor ablation

Abstract

PAA appears to be an effective and safe technique for the treatment of hypervascular HCC, with a lower local tumor progression rate than that of conventional RFA.

Contrast-enhanced ultrasound-guided feeding artery ablation as add-on to percutaneous radiofrequency ablation for hypervascular hepatocellular carcinoma with a modified ablative technique and tumor perfusion evaluation

“…Because the additional ablation zone created by FAA was very small, we reasonably believed that FAA pretreatment enlarged the ablation size through decreasing perfusion-mediated cooling, rather than simply adding a tiny ablation zone. This result was similar to the findings of a previous report [15]. However, the previous researcher ablated the feeding artery as well as part of the tumor initially, which made it difficult to judge the independent effect of FAA on tumor perfusion and the ablation area.…”

“…The cumulative LTP rate was estimated as 4.2% at 3 years in our study. This result was comparable to the previous FAA study using CEUS guidance (8.5%) [15], and superior to others using Doppler guidance (13.5-17.6%) [12][13][14]. In general, cumulative LTP rates at 3 years ranged from 10.0% to 38.6% in conventional RFA of HCC [36][37][38].…”

“…For example, real-time 3 D-CEUS could provide richer and more intuitive information on feeding arteries [16], which facilitated the procedure of FAA. Some researchers inserted the electrodes to the area where the arteries surrounded or entered the tumor [11][12][13]15], and another even punctured the nearby blood vessel directly [14]. In fact, this kind of manipulation has a risk of vessel damage, causing occlusion, thrombus, bleeding, or fatal liver infarction [31,32].…”

“…Another way to reduce or block tumor perfusion is the direct ablation of the target blood vessel before conventional RFA, as a one-step strategy. Previous studies have demonstrated that ultrasound-guided feeding artery ablation (FAA) before conventional RFA, either through percutaneous or laparoscopic access, could safely decrease LTP after HCC ablation [11][12][13][14][15]. However, most of the researchers only use color Doppler imaging to evaluate feeding artery structure and tumor perfusion change [11][12][13][14], which are obviously not precise.…”

“…However, most of the researchers only use color Doppler imaging to evaluate feeding artery structure and tumor perfusion change [11][12][13][14], which are obviously not precise. Another major drawback of these previous studies is that operators do not make a clear distinction between feeding artery ablation and tumor ablation [11][12][13][14][15]. They usually insert one or more electrodes within the tumor and coagulate a relatively large amount of tissue including the feeding vessel, sometimes non-feeding vessels, and part of the tumor, which makes the accurate evaluation of perfusion change not possible and the independent effect of FAA confusing, or even worse, causes injury to non-feeding vessels and ischemia of normal liver parenchyma.…”