Fast hemostasis: a win–win strategy for ultrasound and microwave ablation

Figures & data

Table 1 The basic characteristics of patient with hemorrhage

Case	Sex	Age (years)	Primary disease	Bleeding organ	Cause	Puncture needle type	Hb (g/L)	HP (mmHg)	HR (beats/min)	Sonography	Contrast-enhanced	Velocity (cm/s)	Free fluid	Hematoma
1	Male	19	Thrombocytopenia	Spleen	Biopsy	18G	100	90/60	115	−	+	105	Yes	Yes
2	Male	53	Spleen multiple tumors	Spleen	Biopsy	18G	120	126/75	92	−	+	100	Yes	Yes
3	Male	67	Obstruction of the biliary tract	Liver	PTCD	18G	131	97/56	103	−	+	113	Yes	No
4	Male	47	Hepatic tumor	Liver	Biopsy	18G	149	147/86	88	−	+	78	Yes	Yes
5	Female	60	Thyroid node	Thyroid	Biopsy	23G	115	112/90	96	+	+	82	Yes	Yes
6	Female	58	Thyroid node	Thyroid	Biopsy	23G	127	130/85	75	+	+	77	Yes	Yes
7	Female	69	Bilateral pleural effusion	Thoracic wall	Thoracocentesis	18G	40	75/40	123	+	+	61	Yes	No

Abbreviations: Hb, hemoglobin; HP, blood pressure; HR, heart rate; PTCD, percutaneous transhepatic cholangial drainage.

Figure 1 (A) Crescent-shaped hematoma around the spleen as detected by sonography (arrowheads). (B) Enhanced hemorrhage of puncture tract on contrast-enhanced ultrasound (CEUS). (C) Ultrasound (US)-guided microwave electrode was set into the hemorrhage region (arrowhead). (D) After ablation, enhancement was not detected in the ablation zone (arrowheads).

Figure 2 (A and B) Active bleeding originated from the puncture tract with a velocity of 1.13 m/s (arrowheads). (C) A 1.3 cm crescent-shaped free fluid was detected by sonography around the liver (arrowheads). (D) After microwave ablation, contrast-enhanced sonography did not show any microbubble extravasation inside the liver (arrowheads).

Figure 3 (A) Active bleeding lesion was detected along with small bleeding vessels leaking to the thyroid surface (arrowhead). (B) Contrast-enhanced sonography showed an irregular hematoma measuring 2.6×1.6 cm around the right thyroid (arrowheads). (C and D) Irregular hematoma was detected around the right thyroid, and ablation region showed no enhancement on contrast-enhanced sonography (arrowheads).

Figure 4 (A and B) Active bleeding originated from a branch of thoracic wall artery (arrowheads). (C) Ultrasound (US)-guided microwave ablation (MWA) (arrowhead). (D) Visible microbubbles extravasation was not observed in this section of hemostasis.

Table 2 The detailed description in the procedures of microwave ablation (MWA) for hemostasis

Case	Parenchymal/vessel injury	Power (W)	Time (min)	Follow-up (days)	Ablation area
1	Spleen parenchymal	100	4	28	Decreased
2	Spleen parenchymal	80	6	36	Decreased
3	Liver parenchymal	100	4	22	Stable
4	Liver parenchymal	100	5	18	Decreased
5	Thyroid vessel	40	2	26	Decreased
6	Thyroid vessel	40	2	30	Decreased
7	Thoracic wall vessel	40	1	13	Stable

Table 3 Summary of 12 published literatures about hemostasis in animal and clinical experiments

Author	Year	Country	Object of study	Characteristics of patients	Treatment method	Patients (no of tumors)	Male/female	Mean age (range)	Prognosis	Complication	Ablation time (min)	Energy (kJ)
Yekuo et al^Citation11	2009	China	Porcine	10 liver trauma	CEUS-guided RFA	10	NA	NA	Success		8.5 ± 4.5	86 ± 51 (16–150)
Sun et al^Citation12	2013	China	Dog	21 renal bleeding	CEUS-guided percutaneous MWA	21	NA	NA	Success	NA	(a) subcapsular artery: 2.1 ± 0.3; (b) interlobar arteries: 3.1 ± 0.6; (c) section artery: 5.2 ± 0.7	80 W
Bin et al^Citation13	2014	China	Porcine	8 spleen bleeding	US-guided MWA	8	NA	NA	Success	NA	10	80 W
Aytekin et al^Citation14	2010	Turkey	Human	1 massive multifocal bleeding from subcapsular hematoma	Angiographic PEI	1	0/1	55	Success	Left flank pain from subcapsular hematoma	NA	NA
Chapa et al^Citation15	2010	America	Human	2 acute uterine hemorrhage	Thermal balloon ablation	2	0/2	43	Success	No	NA	NA
Nakayama et al^Citation16	2011	Japan	Human	7 uterine hemorrhage	US-guided MEA	7	0/7	45.1 ± 5.4	Success	No	46.6 ± 24.5 (0.83)	70 W
Maroulis et al^Citation17	2013	Greece	Human	2 liver bleeding during laparotomy	RFA	2	2/0	29	Success	No	3–5	180–200 W
Weigt et al^Citation18	2014	Germany	Human	1 bleeding through the ampulla of Vater	Endoscopic intraductal RFA	1	0/1	83	Success	No	NA	NA
Zhou et al^Citation19	2015	China	Human	6 solid-organ bleeding (5 in liver and 1 in spleen)	4 US-guided percutaneous MWA, 2 US-guided percutaneous RFA	6	3/3	32.8 ± 16.8	4 success, 2 failure	No	38.7 ± 20.1	70–90 W
Ogura et al^Citation20	2016	Japan	Human	1 bleeding from the ampulla of Vater	Endoscopic intraductal RFA	1	1/0	80	Success	No	1.5	10 W
Wai et al^Citation21	2016	China	Human	1 biopsy liver hemorrhage	US-guided percutaneous MWA	1	1/0	61	Success	NA	6	140
Pope et al^Citation22	2016	America	Human	1 liver hemorrhage following 2 failed embolizations	US-guided PEI	1	1/0	42	Success	NA	NA	NA

Abbreviations: CEUS, contrast-enhanced ultrasound; MEA, microwave endometrial ablation; MWA, microwave ablation; PEI, percutaneous ethanol injection; RFA, radiofrequency ablation; NA, not available; US, ultrasound.

YekuoLShashaWFengHMultipolar radiofrequency ablation in controlling hemorrhage from blunt liver traumaAm J Emerg Med200927219720119371528

 PubMed Web of Science ®Google Scholar

SunYZhangGDongLStudy of percutaneous coagulation therapy of 915 MHz microwave for the renal artery injury guided by contrast ultrasound in vivo dogsChin J Clin2013221464436447 Available from: http://www.wanfangdata.com.cn/details/detail.do?_type=perio&id=zhlcyszz201314053#Accessed February 28, 2018 Chinese

 Google Scholar

BinXNingmingZWeitianCExperimental study of ultrasound-guided cold circulation microwave ablation in treating splenic traumaChn J Ultra Med20143016971 Available from: http://www.wanfangdata.com.cn/details/detail.do?_type=perio&id=zgcsyxzz201401022Accessed February 28, 2018 Chinese

 Google Scholar

AytekinCYildirimUMOzyerUHarmanHBoyvatFEmergency renal ablation for life-threatening hemorrhage from multiple capsular branches during renal artery stentingCardiovasc Intervent Radiol20103366366619957179

 PubMed Web of Science ®Google Scholar

ChapaHOAntonettiAGSandateJSilverLEmergent thermal balloon ablation for acute uterine hemorrhage: a report of 2 casesJ Reprod Med20105551151321291039

 PubMed Web of Science ®Google Scholar

NakayamaKRahmanMTRahmanMMicrowave endometrial ablation is a highly efficacious way to emergently control life-threatening uterine hemorrhageArch Gynecol Obstet201128351065106820464408

 PubMed Web of Science ®Google Scholar

MaroulisISpyropoulosCKalogeropoulouCKaraviasDUse of radiofrequency ablation for controlling liver hemorrhage in the emergency setting; report of two cases and review of the literatureTurk J Trauma Emerg Surg2013192167172

 Google Scholar

WeigtJKandulskiAMalfertheinerPEndoscopic intraductal radiofrequency ablation of remnant intrapapillary mucinous neoplasm with acute hemorrhage after incomplete surgical resectionEndoscopy201446S 01E489E49025314212

 PubMed Web of Science ®Google Scholar

ZhouLKuangMXuZXieXLuMContrast-enhanced sonographically guided thermal ablation for treatment of solid-organ hemorrhage preliminary clinical resultsJ Ultrasound Med20153490791525911724

 PubMed Web of Science ®Google Scholar

OguraTTakagiWUenoSTakeuchiTFukunishiSHiguchiKEndoscopic hemostasis for tumor bleeding using intraductal radiofrequency ablationEndoscopy201648S 01E328E32927741528

 PubMed Web of Science ®Google Scholar

WaiOKNgLFYuPSChanJCPost biopsy liver hemorrhage successfully controlled by ultrasound-guided percutaneous microwave ablationJ Clin Imaging Sci201663427833776

 PubMed Web of Science ®Google Scholar

PopeMCBallardDHStickerALAhujaCD’AgostinoHBEthanol ablation in postbiopsy liver hemorrhage following two failed embolizationsClin Imaging201640115616026454615

 PubMed Web of Science ®Google Scholar