Portal Vein Thrombosis Caused by Microwave Coagulation Therapy for Hepatocellular Carcinoma: Report of a Case

Abstract

Microwave coagulation therapy (MCT) is one of the treatment modalities for patients with hepatocellular carcinoma (HCC). A 67-year-old man with liver cirrhosis underwent MCT during a laparotomy for a deeply located HCC (2.5 cm in diameter) at the border of the anterior and posterior segments of the right hepatic lobe. Two weeks after MCT, he complained of abdominal fullness. Portal vein thrombosis (PVT) was diagnosed because he had massive ascites and an echogenic mass in the portal vein on abdominal ultrasonography. PVT was successfully treated by fibrinolytic therapy with a selective infusion of urokinase via the superior mesenteric artery (SMA). There have been few reports on PVT as a complication of MCT. Attention should be paid to the possible occurrence of PVT as a critical complication after MCT for liver tumors adjacent to the portal vein. Fibrinolytic therapy via the SMA is thus considered to be an effective approach for PVT after MCT.

Efficacy and safety of microwave ablation for primary and secondary liver malignancies: a systematic review

“…Problems related to bile duct injury were reported to occur in between 0 and 25.6% with an average of 11.7% [8,16,20,27,28,42]. Other frequently reported complications include pleural effusion, pneumothorax, liver abscess, skin burns, liver failure, haemorrhage, portal vein thrombosis and seeding of tumour cells along the needle track [18,[49][50][51][52][53][54][55]. Table 2 lists the common complications reported [8,16-19,21,26,28,30-32,34-39, 41,42,48].…”

Predictors of Thrombosis in Hepatic Vasculature during Microwave Tumor Ablation of an In Vivo Porcine Model

“…Excess thermal damage to portal veins can cause acute thrombosis, leading to liver decompensation and lobar infarcts - devastating consequences for patients with diminished liver reserve (5,6). In case reports of thrombus formations during microwave ablations, patients have needed to be treated with anti-coagulation therapy (7,8). …”

Liver ablation techniques: a review

“…The authors suggested a number of approaches to avoid bleeding, biloma formation and dissemination [80], but other less common complications including portal vein thrombosis [81] and post-ablation pneumothorax are reported and no solutions have been suggested [82]. Overall, however, the complication rates reported in large case series have been steadily reducing and consistently appear to be lower than those reported with RF and cryotherapy.…”