Percutaneous MR-Guided Cryoablation of Low-Flow Vascular Malformation: Technical Feasibility, Safety and Clinical Efficacy

Purpose To retrospectively assess the technical feasibility, safety and clinical efficacy of percutaneous MR-guided cryoablation of low-flow vascular malformations (LFVM). Materials and Methods Between July 2013 and May 2019, 9 consecutive patients (5 male; 4 female; mean age 39.4 +/- 15.3 years, range 15-68) underwent MR-guided cryoablation of LFVM. Patients were treated due to pain in all cases. Procedural data, complications and clinical results were analyzed. Results Technical success defined as complete coverage of the LFVM by the iceball without involvement of nearby non-target thermal-sensitive structures was achieved in 9/9 (100%) cases. Mean procedure time was 122 +/- 20 min (range 90-150); 2-6 cryoprobes (mean 3.7 +/- 1.2) and 2-4 freezing cycles (mean freezing time 19.8 +/- 11.8 min; range 4-40) were applied. No complications were noted. Mean time from the first treatment to the last follow-up was 548 days (range 30-1776). Persistent/recurring pain was noted in 3/9 cases (33%) 30, 133 and 639 days after cryoablation, respectively, and was related in all cases to MR-confirmed local residual/recurring disease. A second cryoablation treatment was performed in these 3 cases with complete pain control at the last available follow-up (153, 25, 91 days, respectively). In the whole population, at mean 161 days (range 25-413) after the last treatment, on the numerical pain rate scale, pain significantly dropped from mean 6.4 +/- 2.1 (range 3-9/10) before CA to mean 0.3 +/- 0.9 (range 0-3/10) after (p = 0.009). Conclusions Percutaneous MR-guided cryoablation is technically feasible, safe and effective for the treatment of symptomatic LFVM.