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

Abstract

Introduction: Hemorrhage is a serious complication following percutaneous biopsy requiring detecting and immediate treatment of active bleeding. This study aimed to explore the potential benefits of ultrasound (US)-guided microwave ablation (MWA) to treat acute hemorrhage in risky locations.

Materials and methods: We present seven patients (four males and three females) aged 19-69 years with solid-organ arterial hemorrhage treated by US-guided MWA and followed up with contrast-enhanced US (CEUS).

Results: All seven cases successfully underwent MWA for hemostasis, and their vital signs subsequently stabilized. During the follow-up from 13 to 36 days, the ablation area decreased slowly in five patients and was still stable in two cases. There were no complications observed in this study after MWA treatment. We also reviewed a total of 12 publications in the past 10 years.

Conclusion: This study suggested that US-guided MWA may be an effective and safe strategy for acute hemorrhage in the emergency setting. To confirm this method and benefit more patients, more prospective studies with larger samples and longer follow-ups are recommended.

Keywords: ablation; biopsy; contrast-enhanced US; hemorrhage; hemostasis; microwave; sonography.

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.