title: Ablation zones and weight-bearing bones: points of caution for the palliative interventionalist.
abstract: OBJECTIVE
  To evaluate and classify underlying mechanisms of adverse outcomes after percutaneous computed tomography (CT)-guided cryoablation for palliation of painful musculoskeletal metastatic disease.
  
  
  METHODS
  Data were collected for patients who underwent CT-guided percutaneous palliative cryoablation for painful musculoskeletal metastatic disease between January 2010 and December 2012. Cases with adverse outcomes or suboptimal response were identified and classified according to the Society of Interventional Radiology (SIR) classification system for complications by outcome and according to underlying mechanism of the outcome as delineated on follow-up examination.
  
  
  RESULTS
  There were 61 patients who received ablation for painful musculoskeletal metastatic disease. Six patients with adverse outcomes were identified. Two were minor complications (A, n = 1; B, n = 1), and four were major complications (C, n = 1; D, n = 3). Four patients incurred sequelae related to damage of ancillary structures included in the ablation zone, and two patients developed complete fractures after ablation of lesions in weight-bearing bones.
  
  
  CONCLUSIONS
  Complete cryoablation of a painful musculoskeletal metastatic lesion may lead to ancillary damage of adjacent structures or fracture in weight-bearing bones.
authors.affiliation: Division of Vascular and Interventional Radiology, University Hospitals Case Medical Center, 11100 Euclid Avenue, Cleveland, OH 44106. Electronic address: jdprologo@hotmail.com.
authors.forename: J David
authors.initials: JD
authors.lastname: Prologo
authors.affiliation: Division of Vascular and Interventional Radiology, University Hospitals Case Medical Center, 11100 Euclid Avenue, Cleveland, OH 44106.
authors.forename: Indravadan
authors.initials: I
authors.lastname: Patel
authors.affiliation: Division of Vascular and Interventional Radiology, University Hospitals Case Medical Center, 11100 Euclid Avenue, Cleveland, OH 44106.
authors.forename: Ji
authors.initials: J
authors.lastname: Buethe
authors.affiliation: Division of Vascular and Interventional Radiology, University Hospitals Case Medical Center, 11100 Euclid Avenue, Cleveland, OH 44106.
authors.forename: Nathan
authors.initials: N
authors.lastname: Bohnert
mesh_terms: D000328:Adult; D000368:Aged; D018771:Arthralgia / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control*; D001859:Bone Neoplasms / Q000000981:diagnostic imaging / Q000556:secondary* / Q000601:surgery*; D003452:Cryosurgery / Q000009:adverse effects*; D005260:Female; D050723:Fractures, Bone / Q000175:diagnosis / Q000209:etiology* / Q000517:prevention & control; D006801:Humans; D008297:Male; D059146:Metastasectomy / Q000009:adverse effects; D008875:Middle Aged; D010166:Palliative Care / Q000379:methods*; D011859:Radiography; D012189:Retrospective Studies; D017695:Soft Tissue Injuries / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control; D025321:Surgery, Computer-Assisted / Q000009:adverse effects*; D016896:Treatment Outcome; D016474:Weight-Bearing