Hemostasis using re- radiofrequency ablation for hepatic tract bleeding after ultrasound- guided percutaneous radiofrequency ablation of hepatic tumors

Objective: To evaluate the hemostatic efficacy of re- radiofrequency ablation (re- RFA) for hepatic tract bleeding after ultrasound-guided RFA of hepatic tumors. Methods: A total of 4679 percutaneous ultrasound guided RFA procedures were performed for hepatic tumors at Samsung Medical Center between January 2012 and December 2020. We identified patients who had hepatic tract bleeding after RFA by reviewing radiologic reports and ultrasound images and investigated the measures taken to control the bleeding and their outcomes. We also identified patients who had a significant peritoneal hematoma on immediate post- RFA CT or underwent transarterial embolization to control hepatic bleeding after RFA of hepatic tumors. Results: In total, 91 patients with tract bleeding after RFA were identified. As initial measures to control the bleeding, external compression, re- RFA, and observation were performed in 71 (78%), 17 (19%), and 3 (3%) patients, respectively. Hemostasis using re- RFA was attempted to control tract bleeding in 40 patients as an initial measure or an additional measure after other initial efforts. In all 40 patients, the bleeding stopped after re- RFA on Doppler ultrasound, and there was no active bleeding on the immediate follow up CT. During the study period, in the years when re- RFA was performed frequently, the number of transarterial embolizations to control tract bleeding and significant peritoneal hematoma formation tended to be low. Conclusion: Hemostasis using re- RFA of the needle tract is effective in controlling tract bleeding after ultrasound guided RFA of hepatic tumors. Advances in knowledge: Re- RFA is a simple, safe, and effective method to control tract bleeding.