Percutaneous Image-Guided Cryoablation in Vascular Anomalies

Abstract

Understanding and management of vascular anomalies has always been intriguing. These disorders exhibit an expected pattern of clinical presentation and progression, and characteristic imaging findings. Significant progress in understanding and treating patients with vascular anomalies has been made in the past quarter century. Newer multidisciplinary domains for treating these disorders with medical drugs and less invasive image-guided or surgical procedures are constantly evolving. Vascular anomalies can exhibit aggressive tumor-like behavior resulting in recurrence or persistent symptoms after treatment. Thermal ablation has been widely used in tumor treatment. This has generated interest on using thermal ablation for treating vascular anomalies. Percutaneous image-guided cryoablation is increasingly used for this purpose as compared with other ablation technologies. Availability of small caliber cryoprobes and the ability to monitor the freeze zone in real time have made this an attractive option to interventional radiologists. These experiences are relatively new and limited. It is helpful to understand the emerging role of this technology in the treatment of vascular anomalies.

An overview of interventional radiology techniques for the diagnosis and management of vascular anomalies: Part 1

“…They typically present with persistent pain and muscle contracture, and these symptoms are an indication for treatment. Cryoablation has also been reported in the treatment of VMs, AVMs, and hemangiomas 28 …”

“…Due to the intramuscular nature of FAVA, orthopedics should be involved in treatment planning and follow‐up care. Factors associated with poor candidacy for cryoablation include lesional involvement of critical anatomic structures, such as the nerves, joints or acral area, pain, or significant muscle contracture 28 …”

Management of Venous Malformations

“…Adjunct techniques such as physiologic nerve monitoring for motor evoked potentials, temperature monitoring by thermocouple, or warm saline or CO 2 fluid dissection may be useful. [47][48][49] Due to pain caused by myositis, patients undergoing cryoablation of intramuscular extremity lesions may benefit from a nerve block for 1 to 2 days after the procedure.…”

Pediatric Lymphangiography: Imaging to Intervention

“…Cryoablation is a relatively newer percutaneous ablation technique that is increasingly utilized for treatment of low-flow vascular malformations. 30 This technique causes cell death within the malformation by rapid freezing and thawing. The availability of small cryoprobes and the ability to monitor treatment zones via visualization of ice balls in real time make cryoablation a particularly attractive ablative approach.…”

“…The availability of small cryoprobes and the ability to monitor treatment zones via visualization of ice balls in real time make cryoablation a particularly attractive ablative approach. 30 However, the potential risk of damaging nerves and exacerbating bleeding are limitations. Further investigations are needed to assess the efficacy and safety of cryoablation for treatment of LMs specifically.…”