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CardioVascular and Interventional Radiology

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01-01-2019 | Technical Note

Hydrodissection of the Retrohepatic Space: A Technique to Physically Separate a Liver Tumour from the Inferior Vena Cava and the Ostia of the Hepatic Veins

Authors: Julien Garnon, Guillaume Koch, Jean Caudrelier, Emanuele Boatta, Pramod Rao, Maud Nouri-Neuville, Nitin Ramamurthy, Roberto Luigi Cazzato, Afshin Gangi

Published in: CardioVascular and Interventional Radiology | Issue 1/2019

Abstract

Objective

To report a technique of percutaneous retrohepatic hydrodissection, highlighting its potential to physically separate liver tumours from the inferior vena cava (IVC) and the ostia of the hepatic veins (HV).

Materials and Methods

Between December 2017 and April 2018, hydrodissection of the retrohepatic IVC was performed in 5 patients (5 females; mean age 64.5 years) undergoing percutaneous ablation of 5 liver metastases (mean size: 3.6 cm) located adjacent to the IVC. Number of hydrodissection needles, volume of hydrodissection, separation of tumour/liver parenchyma from IVC/HV post-hydrodissection; technical success of ablation; and complications were tabulated.

Results

Two to three 22G spinal needles were required per case for adequate dissection. Mean volume to obtain sufficient hydrodissection was 410 ml on average. Physical separation of the IVC and tumour/hepatic parenchyma was successful in all cases, by 9 mm on average (range 5–12 mm). It also leaded to physical separation of the ostia of the right and middle HV in all cases. There was no early or delayed complication, notably no venous thrombosis in the post-operative period. All lesions but one were completely ablated after one session at 3-month follow-up. The patient with residual tumour was successfully retreated.

Conclusion

Retrohepatic hydrodissection is a feasible technique to separate a tumour from the IVC and/or ostia of the HV. This could potentially limit the heat-sink effect/reduce the risk of thrombosis. Larger follow-up studies are required to assess efficacy on a long-term basis.

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Title: Hydrodissection of the Retrohepatic Space: A Technique to Physically Separate a Liver Tumour from the Inferior Vena Cava and the Ostia of the Hepatic Veins
Authors: Julien Garnon
Guillaume Koch
Jean Caudrelier
Emanuele Boatta
Pramod Rao
Maud Nouri-Neuville
Nitin Ramamurthy
Roberto Luigi Cazzato
Afshin Gangi
Publication date: 01-01-2019
Publisher: Springer US
Published in: CardioVascular and Interventional Radiology / Issue 1/2019
Print ISSN: 0174-1551
Electronic ISSN: 1432-086X
DOI: https://doi.org/10.1007/s00270-018-2105-y

At a glance: The STEP trials

Springer Medicine

Hydrodissection of the Retrohepatic Space: A Technique to Physically Separate a Liver Tumour from the Inferior Vena Cava and the Ostia of the Hepatic Veins

Abstract

Objective

Materials and Methods

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Objective

Materials and Methods

Results

Conclusion

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