title: Radiofrequency Ablation for the Treatment of Hepatocellular Carcinoma in Patients with Transjugular Intrahepatic Portosystemic Shunts.
abstract: OBJECTIVE
  To assess radiofrequency (RF) ablation efficacy, as well as the patency of transjugular intrahepatic portosystemic shunts (TIPSs), in patients with hepatocellular carcinoma (HCC).
  
  
  METHODS
  Retrospective database review of patients with pre-existing TIPS undergoing RF ablation of HCC was conducted over a 159-month period ending in November 2013. TIPS patency pre- and post-RF ablation was assessed by ultrasound, angiography, and/or contrast-enhanced CT or MRI. Patient demographics and immediate post-RF ablation outcomes and complications were also reviewed.
  
  
  RESULTS
  19 patients with 21 lesions undergoing 25 RF ablation sessions were included. Child-Pugh class A, B, and C scores were seen in 1, 13, and 5 patients, respectively. Eleven patients (58 %) ultimately underwent liver transplantation. Immediate technical success was seen in all ablation sessions without residual tumor enhancement (100 %). No patients (0 %) suffered liver failure within 1 month of ablation. Pre-ablation TIPS patency was demonstrated in 22/25 sessions (88 %). Of 22 cases with patent TIPS prior to ablation, post-ablation patency was demonstrated in 22/22 (100 %) at immediate post-ablation imaging and in 21/22 (95 %) at last follow-up (1 patient was incidentally noted to have occlusion 31 months later). No immediate complications were observed.
  
  
  CONCLUSIONS
  Ablation efficacy was similar to the cited literature values for patients without TIPS. Furthermore, TIPS patency was preserved in the majority of cases. Patients with both portal hypertension and HCC are not uncommonly encountered, and a pre-existing TIPS does not appear to be a definite contraindication for RF ablation.
authors: Department of Radiology, David Geffen School of Medicine at UCLA, 757 Westwood Plaza, Los Angeles, 90024, CA, USA. jonathan.park09@gmail.com.
authors: Jonathan K
authors: JK
authors: Park
authors: Department of Radiology, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, 94305, CA, USA. qat200@gmail.com.
authors: Quazi Z
authors: QZ
authors: Al-Tariq
authors: Department of Radiology, David Geffen School of Medicine at UCLA, 757 Westwood Plaza, Los Angeles, 90024, CA, USA. taryar.zaw@gmail.com.
authors: Taryar M
authors: TM
authors: Zaw
authors: Department of Radiology, David Geffen School of Medicine at UCLA, 757 Westwood Plaza, Los Angeles, 90024, CA, USA. sraman@mednet.ucla.edu.
authors: Steven S
authors: SS
authors: Raman
authors: Department of Radiology, David Geffen School of Medicine at UCLA, 757 Westwood Plaza, Los Angeles, 90024, CA, USA. dlu@mednet.ucla.edu.
authors: David S K
authors: DS
authors: Lu
mesh_terms: D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000175:diagnosis / Q000601:surgery*; D017115:Catheter Ablation; D003952:Diagnostic Imaging; D005260:Female; D006801:Humans; D008099:Liver / Q000601:surgery; D008113:Liver Neoplasms / Q000175:diagnosis / Q000601:surgery*; D016031:Liver Transplantation / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D019168:Portasystemic Shunt, Transjugular Intrahepatic; D011183:Postoperative Complications / Q000175:diagnosis; D015642:Radiology, Interventional; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: Hepatocellular carcinoma (HCC); Interventional oncology; Liver/hepatic; Portal vein hypertension; Radiofrequency ablation; Transjugular intrahepatic portosystemic shunt (TIPS/TIPSS)