Faced with a difficult-to-access lesion, Eric Aaltonen, MD, shows how IR ingenuity offers a safe, effective alternative to surgery for liver tumor ablation.
The Patient: During his Vascular/Interventional Case Review from the ARRS Annual Meeting, Dr. Aaltonen introduced us to a 68-year-old male with HCC, post-TACE x2, who presented with a new segment 7 lesion at the hepatic dome.
The Question: Given the obstructions, which approach would work best for microwave ablation (MWA)?
A. Bone
B. Bone
C. Lung
D. Heat (and cartilage)
…E. Call surgery?
Honestly, none of the above are particularly great. Bone is going to be hard, of course. No one wants to drill through the rib. You probably don’t want to go through the heart with an ablation probe either. You’ve got cartilage there, too.
The Solution: Instead of going through the lung—or, worse yet, calling surgery!—Aaltonen et al. opted to drop it. And by intentionally inducing a pneumothorax, they created a safe path to the lesion.
Even Better? After positioning the probe, performing MWA, reinflating the lung (and making sure it stayed up), you can see that they got their lesion…
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