Arteriography- and portography-guided vascular mapping for clustered electrode placement in pancreatic irreversible electroporation

PURPOSE: To assess the feasibility, safety, and early imaging outcomes of an intraprocedural vascular mapping workflow integrating selective arteriography and/or portography to guide clustered electrode irreversible electroporation (IRE) for locally advanced pancreatic cancer (LAPC). METHODS: In this single-center retrospective study, 48 patients with LAPC underwent percutaneous IRE (August 2024-December 2025). Selective arteriography (97.9%) and portography (75.0%) delineated the peripancreatic vascular anatomy. Clustered electrodes were supplemented as required. Technical success was defined as completion of the angiographic mapping workflow with planned electrode placement. The ablation zone-to-tumor size ratio was measured using intraprocedural computed tomography (CT) and early imaging response on the first follow-up CT. RESULTS: The technical success rate was 100%. Selective arteriography was performed in 47/48 patients (97.9%) and portography in 36/48 (75.0%). Supplemented clustered electrode configurations were used in 44/48 patients (91.7%), and electrode repositioning was required in 3/48 (6.3%). Intraprocedural complications, both bleeding events, occurred in 2/48 patients (4.2%). Portal vein (PV) stent placement was performed in 11/48 patients (22.9%), with stent-related complications in 2/11 (18.2%)-one with systemic sepsis and one with PV thrombosis with intrahepatic extension. The ablation zone-to-tumor size ratio was ≥ 1.0 in all 48 patients (median, 1.29; range, 1.12-1.69). Imaging response was evaluable in 40/48 patients (83.3%) at a median of 85 days, with stable disease in 38/40 (95.0%) and progressive disease in 2/40 (5.0%). CONCLUSION: Standardized vascular mapping supports consistent clustered electrode placement during pancreatic IRE in patients with LAPC, achieving complete ablation zone coverage in all patients. CLINICAL SIGNIFICANCE: A standardized intraprocedural vascular mapping workflow using selective arteriography and portography supports reproducible clustered electrode placement during pancreatic IRE, achieving complete ablation zone coverage on intraprocedural CT in all cases and providing real-time anatomic guidance for safer electrode trajectory planning. This technical success provides a procedural framework for further evaluation of oncologic outcomes in prospective studies.