Contrast-Enhanced Ultrasound-Guided Microwave Ablation for Iatrogenic Hepatic Hemorrhage: A Feasibility Study on Precision Hemostasis

<b>Objectives</b>: The aim of this study was to investigate the feasibility of contrast-enhanced ultrasound (CEUS)-guided microwave ablation for managing iatrogenic hepatic hemorrhage following percutaneous liver puncture. <b>Materials and methods</b>: This retrospective study analyzed six patients (5 males, 1 female; mean age 56.8 ± 12.3 years) with CEUS-confirmed active hepatic hemorrhage refractory to 10 min compression and Agkistrodon halflorum hemagglutinase administration after percutaneous liver puncture (2023-2024). Etiologies included portal vein cavernous transformation (n = 4) and therapeutic intervention complications (n = 2). All patients underwent CEUS-guided microwave ablation comprising three phases: bleeding site localization, real-time ultrasound-guided ablation, and immediate postprocedural verification (CEUS: n = 6; DSA: n = 2). The protocol was approved by the institutional ethics committee with written informed consent. <b>Results</b>: All six patients achieved immediate hemostasis (mean 2.8 min) through CEUS-guided microwave ablation with 100% technical/clinical success. Preprocedural localization combined color Doppler and CEUS, while intraoperative real-time guidance ensured precise microwave needle placement. Post-ablation verification relied on CEUS (n = 6) with DSA confirmation in two cases. No major complications occurred; one patient reported transient abdominal pain resolving spontaneously. All patients remained stable during 7-day follow-up with no delayed complications. <b>Conclusions</b>: This study suggests that CEUS-guided microwave ablation is a rapid, minimally invasive, and effective option for iatrogenic hepatic hemorrhage, warranting further validation in larger cohorts.