Vascular complications following histotripsy of hepatocellular carcinoma

Objective: Histotripsy, an ultrasound-based technology for noninvasive tissue destruction, is FDA-approved for treating liver tumors. However, its safety profile — particularrly regarding major vascular complications — has not been well established.Method: We present two cases of arterial pseudoaneurysms following histotripsy for hepatocellular carcinoma. Clinical course, imaging findings, and associated clinical factors were reviewed.Results Of those two pseudoaneurysms patients, one developed a likely bilio-vascular fistula and one with portal vein thrombosis.Conclusions Major vascular complications may represent a rare but significant risk of histotripys in the treatment of liver tumors. Further studies are required to estimated the incidence; to clarify patient factors and treatment factors that may predispose to these complications.