Thoracic Radiofrequency Ablation in a Patient With Von Willebrand's Disease: A Case Report

Congenital bleeding disorders involve specific deficiencies in factors that can alter hemostasis, increasing the risk of bleeding. This case report describes a patient with Von Willebrand's disease who was diagnosed with severe thoracic facet arthritis with pain scores of 9/10. An antihemophilic factor (vWF, Humate-P) injection was administered by a hematologist just before thoracic medial branch blocks. Rather than receiving traditional second thoracic medial branch blocks on another day, the patient, after documenting complete relief of his symptoms with 1% lidocaine, received bilateral T6-8 thoracic radiofrequency ablations, which resulted in complete resolution of his symptoms. A second dose of Humate-P was delivered 24 hours post-procedure. Careful planning with hematologists can enable safe and effective interventional pain procedures in patients with congenital hematologic disorders. This appears to be the first case report in world literature of a patient with Von Willebrand's disease successfully receiving thoracic radiofrequency ablations.