Contrast-Enhanced Ultrasound-Guided Microwave Ablation for Iatrogenic Hepatic Hemorrhage: A Feasibility Study on Precision Hemostasis

TL;DR

This study shows that using contrast-enhanced ultrasound to guide microwave ablation can quickly stop liver bleeding after medical procedures.

Contribution

The study introduces a new method for precise hemostasis using CEUS-guided microwave ablation for iatrogenic hepatic hemorrhage.

Findings

All six patients achieved immediate hemostasis within 2.8 minutes using the technique.

No major complications occurred, with only one case of transient abdominal pain.

Technical and clinical success rates were 100% with stable outcomes during 7-day follow-up.

Abstract

Objectives: The aim of this study was to investigate the feasibility of contrast-enhanced ultrasound (CEUS)-guided microwave ablation for managing iatrogenic hepatic hemorrhage following percutaneous liver puncture. Materials and methods: This retrospective study analyzed six patients (5 males, 1 female; mean age 56.8 ± 12.3 years) with CEUS-confirmed active hepatic hemorrhage refractory to 10 min compression and Agkistrodon halflorum hemagglutinase administration after percutaneous liver puncture (2023–2024). Etiologies included portal vein cavernous transformation (n = 4) and therapeutic intervention complications (n = 2). All patients underwent CEUS-guided microwave ablation comprising three phases: bleeding site localization, real-time ultrasound-guided ablation, and immediate postprocedural verification (CEUS: n = 6; DSA: n = 2). The protocol was approved by the institutional ethics committee with written informed consent. Results: All six patients achieved immediate hemostasis (mean 2.8 min) through CEUS-guided microwave ablation with 100% technical/clinical success. Preprocedural localization combined color Doppler and CEUS, while intraoperative real-time guidance ensured precise microwave needle placement. Post-ablation verification relied on CEUS (n = 6) with DSA confirmation in two cases. No major complications occurred; one patient reported transient abdominal pain resolving spontaneously. All patients remained stable during 7-day follow-up with no delayed complications. Conclusions: This study suggests that CEUS-guided microwave ablation is a rapid, minimally invasive, and effective option for iatrogenic hepatic hemorrhage, warranting further validation in larger cohorts.

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