Successful interventional treatment for arterioportal fistula caused by radiofrequency ablation for hepatocellular carcinoma.

Abstract

Radiofrequency ablation (RFA) is commonly used as a treatment for small hepatocellular carcinoma (HCC). Although several complications such as intraperitoneal bleeding are often observed after RFA, hepatic arterioportal fistula (APF) is a less frequently occurring complication. In this study, we describe two cases of APF caused by RFA, which was successfully occluded by an interventional approach. Case 1 involved a 68-year-old man with solitary HCC in segment VIII of the liver. Both contrast-enhanced computed tomography and color Doppler sonography indicated an APF between the anterosuperior branch of the right hepatic artery (A8) and the portal branch (P8). Concordant with these findings, digital subtraction angiography (DSA) revealed an APF in segment VIII of the liver. Subsequently, the APF was successfully occluded by transarterial embolization (TAE) using gelatin sponge particles. Case 2 involved a 67-year-old man with solitary HCC in segment VII of the liver. Although he developed obstructive jaundice because of hemobilia after RFA, it was improved by endoscopic nasobiliary drainage and the systemic administration of antibiotics. In addition, color Doppler sonography revealed a disturbed flow of the right branch of the portal vein. Similar to case 1, DSA showed an APF between A8 and P8. The APF was successfully embolized by TAE using microcoils. In conclusion, it appears that the formation of APF should be checked after RFA. It is preferable to treat RFA-induced APF promptly by an interventional approach to avoid secondary complications such as portal hypertension and liver dysfunction.

AI evidence extraction

Main findings

Two cases of hepatic arterioportal fistula occurring after radiofrequency ablation for hepatocellular carcinoma were identified by imaging (CT/Doppler/DSA) and were successfully occluded using transarterial embolization (gelatin sponge particles in one case; microcoils in the other). The authors recommend checking for APF after RFA and prompt interventional treatment to prevent secondary complications.

Outcomes measured

• Hepatic arterioportal fistula (APF) after radiofrequency ablation
• Successful occlusion/embolization of APF via transarterial embolization (TAE)
• Complications after RFA (e.g., hemobilia, obstructive jaundice)

Limitations

• Case report design with only two patients
• No quantitative exposure parameters for radiofrequency energy (e.g., frequency, power, duration) reported in abstract
• No comparator group; cannot estimate incidence or risk

Suggested hubs

• other (0.2)
  Medical radiofrequency ablation complication case report; not environmental EMF exposure.

{
    "study_type": "case_report",
    "exposure": {
        "band": null,
        "source": "radiofrequency ablation (medical procedure)",
        "frequency_mhz": null,
        "sar_wkg": null,
        "duration": null
    },
    "population": "Patients with solitary hepatocellular carcinoma treated with radiofrequency ablation",
    "sample_size": 2,
    "outcomes": [
        "Hepatic arterioportal fistula (APF) after radiofrequency ablation",
        "Successful occlusion/embolization of APF via transarterial embolization (TAE)",
        "Complications after RFA (e.g., hemobilia, obstructive jaundice)"
    ],
    "main_findings": "Two cases of hepatic arterioportal fistula occurring after radiofrequency ablation for hepatocellular carcinoma were identified by imaging (CT/Doppler/DSA) and were successfully occluded using transarterial embolization (gelatin sponge particles in one case; microcoils in the other). The authors recommend checking for APF after RFA and prompt interventional treatment to prevent secondary complications.",
    "effect_direction": "harm",
    "limitations": [
        "Case report design with only two patients",
        "No quantitative exposure parameters for radiofrequency energy (e.g., frequency, power, duration) reported in abstract",
        "No comparator group; cannot estimate incidence or risk"
    ],
    "evidence_strength": "very_low",
    "confidence": 0.7800000000000000266453525910037569701671600341796875,
    "peer_reviewed_likely": "yes",
    "keywords": [
        "radiofrequency ablation",
        "hepatocellular carcinoma",
        "arterioportal fistula",
        "transarterial embolization",
        "digital subtraction angiography",
        "Doppler sonography",
        "complication"
    ],
    "suggested_hubs": [
        {
            "slug": "other",
            "weight": 0.200000000000000011102230246251565404236316680908203125,
            "reason": "Medical radiofrequency ablation complication case report; not environmental EMF exposure."
        }
    ]
}

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