It is a
treatment to decrease the blood supply to a liver tumor.
In some cases, it is used to treat the tumor with
chemotherapy. The goal of this treatment is to shrink
the tumor and lessen the symptoms that you may be
having. A tube (catheter) is placed into a large blood
vessel in the groin. It is then threaded up into the
hepatic artery in the liver. A special mixture is put
into the artery that supplies blood to the tumor. This
mixture blocks the blood supply to the tumor and causes
it to shrink. The blocking of the blood supply is
are two types of embolizations:
The mixture for a bland embolization is made up of
spongy particles and contrast (dye) material. The
mixture for the chemo embolization is made up of spongy
particles, contrast material, and chemotherapy. Your
doctor will discuss with you which type is best for your
kind of liver tumor.
You will need to have blood drawn to make sure your
liver and kidneys are working well. You may need to
have more CT scans to check on the tumor and the liver.
You may have these tests before you come to the hospital
or when you are admitted.
come to the hospital the morning of the procedure.
You must not eat or drink anything after midnight.
You can expect to spend 1 night in the hospital.
come to the hospital the morning the procedure.
Your evening meal will be clear liquids. You may not
have anything to eat or drink after midnight.
You will drink a liquid laxative to clean out your colon
(large bowel) until your bowel movements become clear.
You can expect to spend 2 nights in the hospital.
When you are settled in your room, the oncology nurse
practitioner (NP) will review your health history, do a
brief physical exam, and talk with you about what to
expect. The IVR doctor and NP will visit you to review
what to expect and answer your questions. Before you
are taken to Interventional Radiology, two IVs
(intravenous lines) will be put into your arms. Through
the IV, you will be given fluids and antibiotics. You
will have a tube (catheter) placed in your bladder to
During the Procedure
You will be brought to a special room. You will lie on
a narrow bed. At this time, you will be given medicine
to help prevent nausea and pain and to help you relax.
Your upper leg and groin area will be washed with iodine
soap. Next, you will get a numbing medicine at the site
on the groin where the tube is to be placed. The doctor
will place the tube into the large blood vessel in the
groin and thread it up into the artery. When the tube
is in the right place, the doctor will slowly inject,
through the tube, the bland or chemo mixture until the
blood flow to the tumor is almost stopped. Then, the
tube will be removed. The doctor will put pressure on
your groin for 15 minutes to prevent bleeding. The
whole procedure may take up to 2 hours. You will be
taken back to your room. A CT scan may be done at this
time or before you go home. The scan will show how much
of the mixture was placed into the tumor.
in Your Room
You will need to lie flat for a few hours. This will
help prevent bleeding from the site where the tube was
placed. You will be given only clear liquids to drink.
This will help you avoid nausea and bloating. If you
can drink the clear liquids without any problems, you
will be allowed to eat some food.
After the embolization, some people have fever, chills,
pain, nausea, vomiting, and fatigue. This is called “post-embolization
and may last 1 to 4 days. If you have any of these
symptoms, you will be given medicine to help. In most
cases, you will be able to go home within 2 – 3 days.
At home, you will take antibiotics for about one week
and pain medicine, as you need it.
(8-oz) glasses of fluid daily.
If you have a fever over 101° F for 2 readings taken 4
hours apart, call your doctor.
Call the oncology staff if you are having pain or nausea
that has not improved by taking the medicine, or if
these symptoms quickly get worse.
In about 4 – 6 weeks after the procedure, you will
return to see your oncologist. Blood will be taken, and
a CT scan will be done. This will help to show how well
the embolization worked for you. Your doctors will
review the CT scan and talk to you about whether or not
you need to have another embolization done.
Percutaneous radio frequency ablation (RFA) is an
exciting approach to destroying inoperable primary or
metastasis tumors in the liver. In the treatment of
hepatocellular carcinoma (HCC), less than 40% of
patients are candidates for surgery, and the rate of
recurrence after curative surgery is high. Percutaneous
techniques like RFA are, therefore, very important. RFA
is widely used for metastatic and small primary tumors
RFA serves as a bridge for transplant candidates,
especially in relation to small primary lesions.
Percutaneous RFA is a minimally invasive, repeatable
procedure with few complications. It is performed under
radiological guidance. Randomized controlled trials have
shown that RFA is superior to ethanol injection in the
treatment of small HCC. RFA results in a higher rate
of complete necrosis and requires fewer treatment
sessions than percutaneous ethanol injection (PEI).
Long-term survival rates are also better with RFA. A
randomized clinical trial has shown that RFA results in
significantly better 1-year complete response than does
PEI. RFA in combination with transcatheter arterial
chemoembolization (TACE) is also an effective treatment
for inoperable hepatic tumors.
Recent studies that have compared percutaneous RFA and
percutaneous microwave coagulation therapy (PMCT) have
shown better results with RFA in treatment of small
tumors. RFA results in better survival rates, fewer
complications, and significantly lower local recurrence
In RFA, a needle is inserted into the liver, usually
under the guidance of ultrasonography or CT. Once placed
within the tumor, a generator is used to deliver a
rapidly alternating current (radiofrequency energy).
This needle may be bipolar or unipolar; the latter
requires grounding pads placed on the patient's thighs.
Heat is generated at the site of the lesion through
frictional heat produced by rapid agitation of adjacent
cells and produces destruction (liquefactive necrosis)
of the tumor.
This technology is used widely in Europe and the United
States. As noted by Shiina et al, 1500 institutes in
Japan have introduced RFA in the treatment of liver
Percutaneous radiofrequency ablation (RFA) can be
performed with local anesthesia and mild sedation. Deep
sedation or general anesthesia can also be used.
Modality of anesthesia depends upon the patient choice
and operator preferences. For more information, see
Local Anesthetic Agents, Infiltrative Administration and
In a day case setting, the local anesthetic is injected
into the site where the skin incision is planned, and
the patient is sedated by an intravenous injection. The
patient is often able to go home the same day. If
general anesthesia is not used, discomfort or pain may
be felt while the area is being ablated. Day case
treatments for RFA are becoming more common.
imaging equipment needed for radiofrequency ablation
(RFA) depends on the modality used. It can include the
equipment necessary for ultrasonography, CT, or MRI.
RFA equipment itself has 3 main components.
An electrical generator
The needle electrodes are available in 2 forms.
Simple straight needles, as in the image below
Electrodes for radiofrequency ablation.
Straight needles that contain multiple curved,
retractable electrodes that are kept inside the needle
until its tip is positioned within a tumor (When the
needle is properly positioned, a plunger on the hub of
the needle is advanced so that the electrodes extend
from the needle tip. When fully extended, these
electrodes resemble an open umbrella, as shown in the
image below.) Umbrella-type electrodes for
radiofrequency generator is connected by insulated wires
to the needle electrodes and to grounding pads that are
placed on the patient's thighs. The generator produces
alternating electrical current in the range of