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Masada T, Tanaka T, Nishiofuku H, Fukuoka Y, Taiji R, Sato T, Tatsumoto S, Minamiguchi K, Marugami N, Kichikawa K. Use of a Glass Membrane Pumping Emulsification Device Improves Systemic and Tumor Pharmacokinetics in Rabbit VX2 Liver Tumor in Transarterial Chemoembolization. J Vasc Interv Radiol 2019; 31:347-351. [PMID: 31542274 DOI: 10.1016/j.jvir.2019.06.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 06/17/2019] [Accepted: 06/18/2019] [Indexed: 11/19/2022] Open
Abstract
PURPOSE To evaluate the phamacokinetics of epirubicin in conventional transarterial chemoembolization using a developed pumping emulsification device with a microporous glass membrane in VX2 rabbits. MATERIALS AND METHODS Epirubicin solution (10 mg/mL) was mixed with ethiodized oil (1:2 ratio) using the device or 3-way stopcock. Forty-eight rabbits with VX2 liver tumor implanted 2 weeks prior to transarterial chemoembolization were divided into 2 groups: a device group (n = 24) and a 3-way-stopcock group (n = 24). Next, 0.5 mL of emulsion was injected into the hepatic artery, followed by embolization using 100-300-μm microspheres. The serum epirubicin concentrations (immediately after, 5 minutes after, and 10 minutes after) and the tumor epirubicin concentrations (20 minutes after and 48 hours after) were measured after transarterial chemoembolization. Histopathologic evaluation was performed with a fluorescence microscope. RESULTS The area under the curve and maximum concentrations of epirubicin in plasma were 0.45 ± 0.18 μg min/mL and 0.13 ± 0.06 μg/mL, respectively, in the device group and 0.71 ± 0.45 μg min/mL and 0.22 ± 0.17 μg/mL, respectively, in the 3-way-stopcock group (P = .013 and P = .021, respectively). The mean epirubicin concentrations in VX2 tumors at 48 hours in the device group and the 3-way-stopcock group were 13.7 ± 6.71 and 7.72 ± 3.26 μg/g tissue, respectively (P = .013). The tumor necrosis ratios at 48 hours were 62 ± 11% in the device group and 51 ± 13% in the 3-way-stopcock group (P = .039). CONCLUSIONS Conventional transarterial chemoembolization using the pumping emulsification device significantly improved the pharmacokinetics of epirubicin compared to the current standard technique using a 3-way stopcock.
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Affiliation(s)
- Tetsuya Masada
- Department of Radiology, Nara Medical University, 840 Shijo-ch, Kashihara, 634-8522, Japan
| | - Toshihiro Tanaka
- Department of Radiology, Nara Medical University, 840 Shijo-ch, Kashihara, 634-8522, Japan.
| | - Hideyuki Nishiofuku
- Department of Radiology, Nara Medical University, 840 Shijo-ch, Kashihara, 634-8522, Japan
| | - Yasushi Fukuoka
- Department of Radiology, Nara Medical University, 840 Shijo-ch, Kashihara, 634-8522, Japan
| | - Ryosuke Taiji
- Department of Radiology, Nara Medical University, 840 Shijo-ch, Kashihara, 634-8522, Japan
| | - Takeshi Sato
- Department of Radiology, Nara Medical University, 840 Shijo-ch, Kashihara, 634-8522, Japan
| | - Shota Tatsumoto
- Department of Radiology, Nara Medical University, 840 Shijo-ch, Kashihara, 634-8522, Japan
| | - Kiyoyuki Minamiguchi
- Department of Radiology, Nara Medical University, 840 Shijo-ch, Kashihara, 634-8522, Japan
| | - Nagaaki Marugami
- Department of Radiology, Nara Medical University, 840 Shijo-ch, Kashihara, 634-8522, Japan
| | - Kimihiko Kichikawa
- Department of Radiology, Nara Medical University, 840 Shijo-ch, Kashihara, 634-8522, Japan
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Meng XX, Liao HQ, Liu HC, Jiang HL, Gu YF, Li X, Dong WH. Application of side-hole catheter technique for transradial arterial chemoembolization in patients with hepatocellular carcinoma. Abdom Radiol (NY) 2019; 44:3195-3199. [PMID: 31144089 DOI: 10.1007/s00261-019-02072-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
PURPOSE The purpose of this study was to retrospectively evaluate the efficacy and safety of side-hole catheter technique for transarterial chemoembolization (TACE) via transradial artery access (TRA) in patients with hepatocellular carcinoma. MATERIALS AND METHODS From November 2015 to August 2017, a total of 1040 TACE procedures were performed via TRA for hepatocellular carcinoma. In 10 (1%) of these 1040 TACE procedures via TRA, conventional microcatheter technique (CMT) failed and side-hole catheter technique was attempted. RESULTS Ten procedures of selective catheterizations by CMT failed due to the poor stability of the angiographic catheters or the target artery arising from the very proximal portion of the parent artery. These arteries included the right inferior phrenic artery in eight patients, one left gastric artery, and one right renal capsular artery. Cobra or MPA catheter with the microcatheter through the side-hole yielded a technical success rate of 100%. No procedure-related complications were observed. The mean time required to catheterize the target artery with the side-hole catheter was 9.5 min (5-15 min). CONCLUSION Side-hole catheter technique may enable the completion of chemoembolization in cases that a potential tumor-feeding vessel cannot be catheterized by means of CMT for TACE via TRA.
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Affiliation(s)
- Xiao-Xi Meng
- Department of Interventional Radiology, Changzheng Hospital, The Second Military Medical University, Shanghai, 200003, China
| | - Hua-Qiang Liao
- Department of Interventional Radiology, Changzheng Hospital, The Second Military Medical University, Shanghai, 200003, China
| | - Hong-Chao Liu
- Department of Interventional Radiology, Changzheng Hospital, The Second Military Medical University, Shanghai, 200003, China
| | - Hai-Lin Jiang
- Department of Interventional Radiology, Changzheng Hospital, The Second Military Medical University, Shanghai, 200003, China
| | - Ya-Feng Gu
- Department of Interventional Radiology, Changzheng Hospital, The Second Military Medical University, Shanghai, 200003, China
| | - Xi Li
- Department of Interventional Radiology, Changzheng Hospital, The Second Military Medical University, Shanghai, 200003, China
| | - Wei-Hua Dong
- Department of Interventional Radiology, Changzheng Hospital, The Second Military Medical University, Shanghai, 200003, China.
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Li H, Wu F, Duan M, Zhang G. Drug-eluting bead transarterial chemoembolization (TACE) vs conventional TACE in treating hepatocellular carcinoma patients with multiple conventional TACE treatments history: A comparison of efficacy and safety. Medicine (Baltimore) 2019; 98:e15314. [PMID: 31124925 PMCID: PMC6571239 DOI: 10.1097/md.0000000000015314] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
This study aimed to compare the efficacy and safety of drug-eluting bead transarterial chemoembolization (DEB-TACE) vs conventional TACE (cTACE) in hepatocellular carcinoma (HCC) patients with multiple cTACE treatments history.Eighty-one HCC patients with multiple cTACE treatments history who underwent DEB-TACE (N = 42) and cTACE treatment (N = 39) were included in this retrospective cohort study and allocated to DEB-TACE and cTACE groups accordingly. Multiple cTACE treatments history was defined as history of three or more cycles cTACE treatments. Then treatment responses were assessed according to the criteria of modified Response Evaluation Criteria in Solid Tumors (mRECIST), and progression free survival (PFS), as well as overall survival (OS), was calculated. In addition, adverse events and liver function related indexes were recorded.Complete response (P = .167) was of no difference while objective response rate (ORR) (P = .003) was increased in DEB-TACE group compared with cTACE group. Patients in DEB-TACE group presented with more favorable PFS (P = .028) and OS (P = .037) compared with cTACE group. Further analysis revealed that DEB-TACE (vs cTACE) was an independent predictive factor for better ORR (P = .001), PFS (P = .006) and OS (P = .001). The albumin (ALB) level at first month after treatment was elevated (P = .015) while the other liver function indexes levels did not vary (all P > .05) in DEB-TACE group compared with cTACE group. The incidences of pain (P = .327), fever (P = .171) and nausea/vomiting (P = .400) during hospitalization were similar between the 2 groups.DEB-TACE is more efficient and equally tolerant compared with cTACE in HCC patients with multiple cTACE treatments history.
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Affiliation(s)
- Hui Li
- Department of Intervention, Jining No.1 People's Hospital
| | - Fucang Wu
- Department of Intervention, Jining Infectious Disease Hospital
| | - Min Duan
- Regular Physical Examination Center, Rencheng District People's Hospital of Jining City, Jining
| | - Guodong Zhang
- Department of Intervention, Shandong Medical Imaging Research Institute, Jinan, China
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Boitet A, Grassin-Delyle S, Louedec L, Dupont S, Lamy E, Coggia M, Michel JB, Coscas R. An Experimental Study of Paclitaxel Embolisation During Drug Coated Balloon Angioplasty. Eur J Vasc Endovasc Surg 2019; 57:578-586. [PMID: 30871939 DOI: 10.1016/j.ejvs.2018.11.019] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Accepted: 11/27/2018] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Drug coated balloons (DCB) improve the patency of femoropopliteal angioplasty but their use in infrapopliteal lesions is debateable as paclitaxel (PTX) particle embolisation has been suspected in some trials. The aim of this study was to compare experimentally five DCBs in terms of distal embolism of PTX. METHODS Twenty-five New Zealand rabbits were divided into five groups according to the DCB used: Lutonix (Bard), In.Pact (Medtronic), Passeo-18 Lux (Biotronik), Ranger (Boston Scientific), and Stellarex (Spectranetics) (n = 5 in each group). After ligation of the right common iliac artery, a 4 × 40 mm DCB was inflated in the infrarenal aorta for 180 seconds. Rabbits were euthanised two hours after inflation of the DCB. The infrarenal aorta, a blood sample and three left hind leg muscles (tensor fasciae latae [TFL], vastus lateralis [VL], and tibialis anterior [TA] muscles) were harvested for blind measurement of PTX concentrations and histological analysis (PTX emboli count). RESULTS In the TA muscle (the most distal), concentrations of PTX were significantly lower for the Ranger (0.067 ng/mg) than for the Lutonix (0.342 ng/mg; p = .008), In.Pact (0.370 ng/mg; p = .012), and Passeo-18-Lux (0.160 ng/mg; p = .021) DCBs. Similarly, concentrations of PTX were significantly lower for the Passeo-18-Lux than for the In.Pact (p = .028). Concentrations of PTX were not significantly different between DCBs in the TFL and VL muscles. Concentrations of PTX were found to be significantly higher in the plasma and lower in the aorta and on the DCBs after use of Lutonix compared with the four other DCBs. Histological analysis revealed evidence of embolised PTX crystals in small arterioles of all muscle tissue samples without any significant difference between the DCBs. CONCLUSIONS This study suggests some differences regarding distal embolisation profiles between the five assessed DCBs. Although clinical implications remain to be demonstrated, the present results may have implications when choosing a DCB, especially in a critical limb ischaemia setting.
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Affiliation(s)
- Auréline Boitet
- UMR 1148, Inserm-Paris7 - Denis Diderot University, Xavier Bichat Hospital, Paris, France; Department of Vascular Surgery, Ambroise Paré University Hospital, AP-HP, Boulogne-Billancourt, France
| | - Stanislas Grassin-Delyle
- UMR 1173, Inserm-Paris11 - Faculty of Health Sciences Simone Veil, Versailles Saint-Quentin-en-Yvelines University, Paris-Saclay University, Paris, France
| | - Liliane Louedec
- UMR 1148, Inserm-Paris7 - Denis Diderot University, Xavier Bichat Hospital, Paris, France
| | - Sebastien Dupont
- UMR 1148, Inserm-Paris7 - Denis Diderot University, Xavier Bichat Hospital, Paris, France
| | - Elodie Lamy
- UMR 1173, Inserm-Paris11 - Faculty of Health Sciences Simone Veil, Versailles Saint-Quentin-en-Yvelines University, Paris-Saclay University, Paris, France
| | - Marc Coggia
- UMR 1173, Inserm-Paris11 - Faculty of Health Sciences Simone Veil, Versailles Saint-Quentin-en-Yvelines University, Paris-Saclay University, Paris, France
| | - Jean-Baptiste Michel
- UMR 1148, Inserm-Paris7 - Denis Diderot University, Xavier Bichat Hospital, Paris, France
| | - Raphaël Coscas
- UMR 1148, Inserm-Paris7 - Denis Diderot University, Xavier Bichat Hospital, Paris, France; Department of Vascular Surgery, Ambroise Paré University Hospital, AP-HP, Boulogne-Billancourt, France; UMR 1173, Inserm-Paris11 - Faculty of Health Sciences Simone Veil, Versailles Saint-Quentin-en-Yvelines University, Paris-Saclay University, Paris, France; UMR 1018, Inserm-Paris11 - CESP, Versailles Saint-Quentin en-Yvelines University, Paris-Saclay University, Paris, France.
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Zhu LZ, Xu S, Qian HL. Transarterial embolization and low-dose continuous hepatic arterial infusion chemotherapy with oxaliplatin and raltitrexed for hepatocellular carcinoma with major portal vein tumor thrombus. World J Gastroenterol 2018; 24:2501-2507. [PMID: 29930471 PMCID: PMC6010942 DOI: 10.3748/wjg.v24.i23.2501] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Revised: 03/09/2018] [Accepted: 03/29/2018] [Indexed: 02/06/2023] Open
Abstract
AIM To determine the efficacy and safety of transarterial embolization and low-dose continuous hepatic arterial infusion chemotherapy with oxaliplatin and raltitrexed in hepatocellular carcinoma (HCC) with major portal vein tumor thrombus (MPVTT).
METHODS Eighty-six patients with MPVTT accepted routine embolization. The catheter was kept in the hepatic artery and oxaliplatin (50 mg in 250 mL of glucose) was infused by pump for 4 h, followed by raltitrexed (2 mg in 100 mL of 0.9% saline) infusion by pump for the next 1 h. The efficacy and safety were evaluated after the transarterial chemoembolization (TACE).
RESULTS Full or partial embolization was achieved in 86 cases, where all the cases received low dose continuous hepatic arterial infusion chemotherapy. Complete responses (CRs), partial responses (PRs), stable disease (SD), and disease progression (PD) for intrahepatic disease were observed in 0, 45, 20, and 21 patients, respectively. The 1-, 2-and 3-year overall survival rates of the 86 patients were 40.7%, 22.1%, and 8.1% respectively, and the median survival time was 8.7 mo. Complication was limited.
CONCLUSION TACE with low dose continuous hepatic arterial infusion of oxaliplatin and raltitrexed could be an option in MPVTT patient; it was shown to be effective in patients with advanced HCC with MPVTT with less toxicity.
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Affiliation(s)
- Lin-Zhong Zhu
- Department of Interventional Therapy, Beijing Cancer Hospital, Beijing 100142, China
| | - Song Xu
- Department of Radiology, Yunnan Second People’s Hospital, Kunming 650021, Yunnan Province, China
| | - Hai-Long Qian
- Interventional Therapy, Baotou Cancer Hospital, Baotou 014030, Inner Mongolia, China
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Sun J, Zhou G, Zhang Y, Zhou T, Nie C, Zhu T, Chen S, Wang B, Yu Z, Wang H, Chen X, Hong L, Chen L, Wang W, Zheng S. Comprehensive analysis of common safety profiles and their predictive factors in 520 records of liver cancer patients treated by drug-eluting beads transarterial chemoembolization. Medicine (Baltimore) 2018; 97:e11131. [PMID: 29952956 PMCID: PMC6039676 DOI: 10.1097/md.0000000000011131] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
This study aimed to investigate the difference of common adverse events (AEs) between patients experienced first drug-eluting beads transarterial chemoembolization (DEB-TACE; FD) and second or higher DEB-TACE (SHD), and the factors influencing AEs.Five hundred twenty DEB-TACE records were retrospectively reviewed in this cohort study, among which 284 and 236 records were in FD and SHD groups, respectively. The incidence and/or severity of pain, fever, vomiting, and increased blood pressure (BP) were collected.Pain numerical rating scale (NRS) score, pain severity, body temperature, fever severity, and fever lasting days were higher in FD group than in SHD group, while no difference of vomiting and increased BP between 2 groups were disclosed. Age ≥65 years was associated with decreased high fever and less possibility of vomiting in FD group, and lower pain and fever severity in SHD group; Male decreased the possibility of vomiting in both the groups, and reduced increased BP incidence in SHD group; diabetes history correlated with decreased pain degree and less fever in FD group.In conclusion, SHD was better tolerated compared with FD in liver cancer patients, and older age as well as male were correlated with less occurrence or severity of common AEs in DEB-TACE operation.
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Affiliation(s)
- Junhui Sun
- Hepatobiliary and Pancreatic Interventional Treatment Center, Division of Hepatobiliary and Pancreatic Surgery, Hepatobiliary and Pancreatic Clinical Medical Center, The First Affiliated Hospital, School of Medicine, Zhejiang University
- Key Laboratory of Combined Multi-organ Transplantation, Ministry of Public Health
- Key Laboratory of Precision Diagnosis and Treatment for Hepatobiliary and Pancreatic Tumor of Zhejiang Province
- Medical Engineering and Information Innovation Center, Zhejiang University
- Collaborative Innovation Center for Diagnosis Treatment of Infectious Diseases, Zhejiang University, Hangzhou, China
| | - Guanhui Zhou
- Hepatobiliary and Pancreatic Interventional Treatment Center, Division of Hepatobiliary and Pancreatic Surgery, Hepatobiliary and Pancreatic Clinical Medical Center, The First Affiliated Hospital, School of Medicine, Zhejiang University
- Key Laboratory of Combined Multi-organ Transplantation, Ministry of Public Health
- Key Laboratory of Precision Diagnosis and Treatment for Hepatobiliary and Pancreatic Tumor of Zhejiang Province
- Medical Engineering and Information Innovation Center, Zhejiang University
| | - Yuelin Zhang
- Hepatobiliary and Pancreatic Interventional Treatment Center, Division of Hepatobiliary and Pancreatic Surgery, Hepatobiliary and Pancreatic Clinical Medical Center, The First Affiliated Hospital, School of Medicine, Zhejiang University
- Key Laboratory of Combined Multi-organ Transplantation, Ministry of Public Health
- Key Laboratory of Precision Diagnosis and Treatment for Hepatobiliary and Pancreatic Tumor of Zhejiang Province
- Medical Engineering and Information Innovation Center, Zhejiang University
| | - Tanyang Zhou
- Hepatobiliary and Pancreatic Interventional Treatment Center, Division of Hepatobiliary and Pancreatic Surgery, Hepatobiliary and Pancreatic Clinical Medical Center, The First Affiliated Hospital, School of Medicine, Zhejiang University
- Key Laboratory of Combined Multi-organ Transplantation, Ministry of Public Health
- Key Laboratory of Precision Diagnosis and Treatment for Hepatobiliary and Pancreatic Tumor of Zhejiang Province
- Medical Engineering and Information Innovation Center, Zhejiang University
| | - Chunhui Nie
- Hepatobiliary and Pancreatic Interventional Treatment Center, Division of Hepatobiliary and Pancreatic Surgery, Hepatobiliary and Pancreatic Clinical Medical Center, The First Affiliated Hospital, School of Medicine, Zhejiang University
- Key Laboratory of Combined Multi-organ Transplantation, Ministry of Public Health
- Key Laboratory of Precision Diagnosis and Treatment for Hepatobiliary and Pancreatic Tumor of Zhejiang Province
- Medical Engineering and Information Innovation Center, Zhejiang University
| | - Tongyin Zhu
- Hepatobiliary and Pancreatic Interventional Treatment Center, Division of Hepatobiliary and Pancreatic Surgery, Hepatobiliary and Pancreatic Clinical Medical Center, The First Affiliated Hospital, School of Medicine, Zhejiang University
- Key Laboratory of Combined Multi-organ Transplantation, Ministry of Public Health
- Key Laboratory of Precision Diagnosis and Treatment for Hepatobiliary and Pancreatic Tumor of Zhejiang Province
- Medical Engineering and Information Innovation Center, Zhejiang University
| | - Shengqun Chen
- Hepatobiliary and Pancreatic Interventional Treatment Center, Division of Hepatobiliary and Pancreatic Surgery, Hepatobiliary and Pancreatic Clinical Medical Center, The First Affiliated Hospital, School of Medicine, Zhejiang University
- Key Laboratory of Combined Multi-organ Transplantation, Ministry of Public Health
- Key Laboratory of Precision Diagnosis and Treatment for Hepatobiliary and Pancreatic Tumor of Zhejiang Province
- Medical Engineering and Information Innovation Center, Zhejiang University
| | - Baoquan Wang
- Hepatobiliary and Pancreatic Interventional Treatment Center, Division of Hepatobiliary and Pancreatic Surgery, Hepatobiliary and Pancreatic Clinical Medical Center, The First Affiliated Hospital, School of Medicine, Zhejiang University
- Key Laboratory of Combined Multi-organ Transplantation, Ministry of Public Health
- Key Laboratory of Precision Diagnosis and Treatment for Hepatobiliary and Pancreatic Tumor of Zhejiang Province
- Medical Engineering and Information Innovation Center, Zhejiang University
| | - Ziniu Yu
- Hepatobiliary and Pancreatic Interventional Treatment Center, Division of Hepatobiliary and Pancreatic Surgery, Hepatobiliary and Pancreatic Clinical Medical Center, The First Affiliated Hospital, School of Medicine, Zhejiang University
- Key Laboratory of Combined Multi-organ Transplantation, Ministry of Public Health
- Key Laboratory of Precision Diagnosis and Treatment for Hepatobiliary and Pancreatic Tumor of Zhejiang Province
- Medical Engineering and Information Innovation Center, Zhejiang University
| | - Hongliang Wang
- Hepatobiliary and Pancreatic Interventional Treatment Center, Division of Hepatobiliary and Pancreatic Surgery, Hepatobiliary and Pancreatic Clinical Medical Center, The First Affiliated Hospital, School of Medicine, Zhejiang University
- Key Laboratory of Combined Multi-organ Transplantation, Ministry of Public Health
- Key Laboratory of Precision Diagnosis and Treatment for Hepatobiliary and Pancreatic Tumor of Zhejiang Province
- Medical Engineering and Information Innovation Center, Zhejiang University
| | - Xinhua Chen
- Hepatobiliary and Pancreatic Interventional Treatment Center, Division of Hepatobiliary and Pancreatic Surgery, Hepatobiliary and Pancreatic Clinical Medical Center, The First Affiliated Hospital, School of Medicine, Zhejiang University
- Key Laboratory of Combined Multi-organ Transplantation, Ministry of Public Health
- Key Laboratory of Precision Diagnosis and Treatment for Hepatobiliary and Pancreatic Tumor of Zhejiang Province
- Medical Engineering and Information Innovation Center, Zhejiang University
- Collaborative Innovation Center for Diagnosis Treatment of Infectious Diseases, Zhejiang University, Hangzhou, China
| | - Liangjie Hong
- Key Laboratory of Combined Multi-organ Transplantation, Ministry of Public Health
- Key Laboratory of Precision Diagnosis and Treatment for Hepatobiliary and Pancreatic Tumor of Zhejiang Province
- Medical Engineering and Information Innovation Center, Zhejiang University
- Collaborative Innovation Center for Diagnosis Treatment of Infectious Diseases, Zhejiang University, Hangzhou, China
| | - Liming Chen
- Hepatobiliary and Pancreatic Interventional Treatment Center, Division of Hepatobiliary and Pancreatic Surgery, Hepatobiliary and Pancreatic Clinical Medical Center, The First Affiliated Hospital, School of Medicine, Zhejiang University
- Key Laboratory of Combined Multi-organ Transplantation, Ministry of Public Health
- Key Laboratory of Precision Diagnosis and Treatment for Hepatobiliary and Pancreatic Tumor of Zhejiang Province
- Medical Engineering and Information Innovation Center, Zhejiang University
| | - Weilin Wang
- Hepatobiliary and Pancreatic Interventional Treatment Center, Division of Hepatobiliary and Pancreatic Surgery, Hepatobiliary and Pancreatic Clinical Medical Center, The First Affiliated Hospital, School of Medicine, Zhejiang University
- Key Laboratory of Combined Multi-organ Transplantation, Ministry of Public Health
- Key Laboratory of Precision Diagnosis and Treatment for Hepatobiliary and Pancreatic Tumor of Zhejiang Province
- Medical Engineering and Information Innovation Center, Zhejiang University
- Collaborative Innovation Center for Diagnosis Treatment of Infectious Diseases, Zhejiang University, Hangzhou, China
| | - Shusen Zheng
- Hepatobiliary and Pancreatic Interventional Treatment Center, Division of Hepatobiliary and Pancreatic Surgery, Hepatobiliary and Pancreatic Clinical Medical Center, The First Affiliated Hospital, School of Medicine, Zhejiang University
- Key Laboratory of Combined Multi-organ Transplantation, Ministry of Public Health
- Key Laboratory of Precision Diagnosis and Treatment for Hepatobiliary and Pancreatic Tumor of Zhejiang Province
- Medical Engineering and Information Innovation Center, Zhejiang University
- Collaborative Innovation Center for Diagnosis Treatment of Infectious Diseases, Zhejiang University, Hangzhou, China
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Miki I, Murata S, Uchiyama F, Yasui D, Ueda T, Sugihara F, Saito H, Yamaguchi H, Murakami R, Kawamoto C, Uchida E, Kumita SI. Evaluation of the relationship between hepatocellular carcinoma location and transarterial chemoembolization efficacy. World J Gastroenterol 2017; 23:6437-6447. [PMID: 29085193 PMCID: PMC5643269 DOI: 10.3748/wjg.v23.i35.6437] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Revised: 07/25/2017] [Accepted: 08/15/2017] [Indexed: 02/06/2023] Open
Abstract
AIM To evaluate the relationship between the location of hepatocellular carcinoma (HCC) and the efficacy of transarterial chemoembolization (TACE).
METHODS We evaluated 115 patients (127 nodules), excluding recurrent nodules, treated with TACE between January 2011 and June 2014. TACE efficacy was evaluated according to mRECIST. The HCC location coefficient was calculated as the distance from the central portal portion to the HCC center (mm)/liver diameter (mm) on multiplanar reconstruction images rendered (MPR) to visualize bifurcation of the right and left branches of the portal vein and HCC center. The HCC location coefficient was compared between complete response (CR) and non-CR groups in Child-Pugh grade A and B patients.
RESULTS The median location coefficient of HCC among all nodules, the right lobe, and the medial segment was significantly higher in the CR group than in the non-CR group in the Child-Pugh grade A patients (0.82 vs 0.62, P < 0.001; 0.71 vs 0.59, P < 0.01; 0.81 vs 0.49, P < 0.05, respectively). However, there was no significant difference in the median location coefficient of the HCC in the lateral segment between in the CR and in the non-CR groups (0.67 vs 0.65, P > 0.05). On the other hand, in the Child-Pugh grade B patients, the HCC median location coefficient in each lobe and segment was not significantly different between in the CR and in the non-CR groups.
CONCLUSION Improved TACE efficacy may be obtained for HCC in the peripheral zone of the right lobe and the medial segment in Child-Pugh grade A patients.
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Affiliation(s)
- Izumi Miki
- Department of Radiology, Center of Advanced Medicine, Nippon Medical School, Bunkyo-ku, Tokyo 113-8603, Japan
| | - Satoru Murata
- Department of Radiology, Center of Advanced Medicine, Nippon Medical School, Bunkyo-ku, Tokyo 113-8603, Japan
| | - Fumio Uchiyama
- Department of Radiology, Ebina-Sogo Hospital, Ebina-shi 243-0433, Japan
| | - Daisuke Yasui
- Department of Radiology, Center of Advanced Medicine, Nippon Medical School, Bunkyo-ku, Tokyo 113-8603, Japan
| | - Tatsuo Ueda
- Department of Radiology, Center of Advanced Medicine, Nippon Medical School, Bunkyo-ku, Tokyo 113-8603, Japan
| | - Fumie Sugihara
- Department of Radiology, Center of Advanced Medicine, Nippon Medical School, Bunkyo-ku, Tokyo 113-8603, Japan
| | - Hidemasa Saito
- Department of Radiology, Center of Advanced Medicine, Nippon Medical School, Bunkyo-ku, Tokyo 113-8603, Japan
| | - Hidenori Yamaguchi
- Department of Radiology, Tamanagayama Hospital, Nippon Medical School, Tama-shi, Tokyo 206-8523, Japan
| | - Ryusuke Murakami
- Department of Radiology, Center of Advanced Medicine, Nippon Medical School, Bunkyo-ku, Tokyo 113-8603, Japan
| | - Chiaki Kawamoto
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Nippon Medical School, Bunkyo-ku, Tokyo 113-8603, Japan
| | - Eiji Uchida
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School, Bunkyo-ku, Tokyo 113-8603, Japan
| | - Shin-ichiro Kumita
- Department of Radiology, Center of Advanced Medicine, Nippon Medical School, Bunkyo-ku, Tokyo 113-8603, Japan
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Chen G, Zhang D, Ying Y, Wang Z, Tao W, Zhu H, Zhang J, Peng Z. [Clinical investigation on transarterial chemoembolization with indigenous drug-eluting beads in treatment of unresectable hepatocellular carcinoma]. Zhejiang Da Xue Xue Bao Yi Xue Ban 2017; 46:44-51. [PMID: 28436630 PMCID: PMC10400833 DOI: 10.3785/j.issn.1008-9292.2017.02.07] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Objective: To evaluate the efficacy and safety of drug-eluding beads transarterial chemoembolization (DEB-TACE) in treatment of unrecectable hepatocellular carcinoma (HCC). Methods: The clinical data of 42 consecutive HCC patients undergoing TACE were retrospectively analyzed, including 20 cases received conventional TACE (cTACE group) and 22 cases received TACE with epirubicine-loaded microspheres (CalliSpheres ®) (DEB-TACE group). MRI scans were performed 1 week before and 1, 3 and 6 months after initial therapy. The response to treatment, disease recurrence, complications and adverse effects were documented and compared between two groups. Results: There were no significant differences in 1-month, 3-month and 6-month objective response rate (CR+PR) and disease control rate (CR+PR+SD), disease recurrence, complications and adverse effects of interventional therapy between cTACE group and DEB-TACE group. Additionally, there were no significant differences about locoregional biliary injuries, intrahepatic biloma, and newly detected intra- or extrahepatic HCC on MRI between cTACE group and DEB-TACE group. Conclusion: There were no statistically significant differences between cTACE group and DEB-TACE group with regard to the short-term response, disease recurrence, complications and side effects. Hepatic-locoregional complications may be more frequent in DEB-TACE group than those in cTACE group.
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Affiliation(s)
- Gang Chen
- Department of Radiology, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China; Department of Radiology, Traditional Chinese Medicine Hospital of Ningbo, Ningbo 315010, China
| | - Ding Zhang
- Department of Radiology, Traditional Chinese Medicine Hospital of Ningbo, Ningbo 315010, China
| | - Yacao Ying
- Department of Radiology, Traditional Chinese Medicine Hospital of Ningbo, Ningbo 315010, China
| | - Zhifeng Wang
- Department of Radiology, Traditional Chinese Medicine Hospital of Ningbo, Ningbo 315010, China
| | - Wei Tao
- Department of Radiology, Traditional Chinese Medicine Hospital of Ningbo, Ningbo 315010, China
| | - Hao Zhu
- Department of Radiology, Traditional Chinese Medicine Hospital of Ningbo, Ningbo 315010, China
| | - Jingfeng Zhang
- Department of Radiology, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China.
| | - Zhiyi Peng
- Department of Radiology, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China.
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9
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Maleux G, Cornelissen S, Bonne L. New materials in embolizations. J Cardiovasc Surg (Torino) 2016; 57:750-757. [PMID: 27647339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Percutaneous, catheter-directed embolotherapy is an established interventional technique for the management of many vascular disorders. For more than three decades, typical embolization devices included macro and microcoils, polyvinyl alcohol microparticles, glue and certain liquids such as absolute alcohol. In the past decade, however, several new embolic devices and refinements of existing embolic devices have arrived on the market and a number of clinical studies have demonstrated their added value. In this review article, these new embolic devices and their typical indications will be discussed, as well as the results of studies involving the embolic devices.
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Affiliation(s)
- Geert Maleux
- Department of Radiology, University Hospitals Leuven, Leuven, Belgium -
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Rognoni C, Ciani O, Sommariva S, Facciorusso A, Tarricone R, Bhoori S, Mazzaferro V. Trans-arterial radioembolization in intermediate-advanced hepatocellular carcinoma: systematic review and meta-analyses. Oncotarget 2016; 7:72343-72355. [PMID: 27579537 PMCID: PMC5342166 DOI: 10.18632/oncotarget.11644] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2016] [Accepted: 07/10/2016] [Indexed: 02/01/2023] Open
Abstract
Trans-arterial radioembolization (TARE) is a recognized, although not explicitly recommended, experimental therapy for unresectable hepatocellular carcinoma (HCC).A systematic literature review was performed to identify published studies on the use of TARE in intermediate and advanced stages HCC exploring the efficacy and safety of this innovative treatment.Twenty-one studies reporting data on overall survival (OS) and time to progression (TTP), were included in a meta-analysis. The pooled post-TARE OS was 63% (95% CI: 56-70%) and 27% (95% CI: 21-33%) at 1- and 3-years respectively in intermediate stage HCC, whereas OS was 37% (95% CI: 26-50%) and 13% (95% CI: 9-18%) at the same time intervals in patients with sufficient liver function (Child-Pugh A-B7) but with an advanced HCC because of the presence of portal vein thrombosis. When an intermediate and advanced case-mix was considered, OS was 58% (95% CI: 48-67%) and 17% (95% CI: 12-23%) at 1- and 3-years respectively. As for TTP, only four studies reported data: the observed progression probability was 56% (95% CI: 41-70%) and 73% (95% CI: 56-87%) at 1 and 2 years respectively. The safety analysis, focused on the risk of liver decompensation after TARE, revealed a great variability, from 0-1% to more than 36% events, influenced by the number of procedures, patient Child-Pugh stage and treatment duration.Evidence supporting the use of radioembolization in HCC is mainly based on retrospective and prospective cohort studies. Based on this evidence, until the results of the ongoing randomized trials become available, radioembolization appears to be a viable treatment option for intermediate-advanced stage HCC.
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Affiliation(s)
- Carla Rognoni
- Centre for Research on Health and Social Care Management (CERGAS), Bocconi University, Milan, Italy
| | - Oriana Ciani
- Centre for Research on Health and Social Care Management (CERGAS), Bocconi University, Milan, Italy
- Evidence Synthesis and Modelling for Health Improvement (ESMI), University of Exeter Medical School, South Cloisters, St Luke's Campus, Exeter, UK
| | - Silvia Sommariva
- Centre for Research on Health and Social Care Management (CERGAS), Bocconi University, Milan, Italy
| | - Antonio Facciorusso
- Department of Surgery, Liver Surgery, Transplantation and Gastroenterology, Istituto Nazionale Tumori Fondazione IRCCS, National Cancer Institute of Milan, and University of Milan, Milan, Italy
| | - Rosanna Tarricone
- Centre for Research on Health and Social Care Management (CERGAS), Bocconi University, Milan, Italy
- Department of Policy Analysis and Public Management, Bocconi University, Milan, Italy
| | - Sherrie Bhoori
- Department of Surgery, Liver Surgery, Transplantation and Gastroenterology, Istituto Nazionale Tumori Fondazione IRCCS, National Cancer Institute of Milan, and University of Milan, Milan, Italy
| | - Vincenzo Mazzaferro
- Department of Surgery, Liver Surgery, Transplantation and Gastroenterology, Istituto Nazionale Tumori Fondazione IRCCS, National Cancer Institute of Milan, and University of Milan, Milan, Italy
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Ambrosini P, Ruijters D, Niessen WJ, Moelker A, van Walsum T. Continuous roadmapping in liver TACE procedures using 2D-3D catheter-based registration. Int J Comput Assist Radiol Surg 2015; 10:1357-70. [PMID: 25985880 PMCID: PMC4563001 DOI: 10.1007/s11548-015-1218-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Accepted: 04/30/2015] [Indexed: 02/07/2023]
Abstract
Purpose Fusion of pre/perioperative images and intra-operative images may add relevant information during image-guided procedures. In abdominal procedures, respiratory motion changes the position of organs, and thus accurate image guidance requires a continuous update of the spatial alignment of the (pre/perioperative) information with the organ position during the intervention. Methods In this paper, we propose a method to register in real time perioperative 3D rotational angiography images (3DRA) to intra-operative single-plane 2D fluoroscopic images for improved guidance in TACE interventions. The method uses the shape of 3D vessels extracted from the 3DRA and the 2D catheter shape extracted from fluoroscopy. First, the appropriate 3D vessel is selected from the complete vascular tree using a shape similarity metric. Subsequently, the catheter is registered to this vessel, and the 3DRA is visualized based on the registration results. The method is evaluated on simulated data and clinical data. Results The first selected vessel, ranked with the shape similarity metric, is used more than 39 % in the final registration and the second more than 21 %. The median of the closest corresponding points distance between 2D angiography vessels and projected 3D vessels is 4.7–5.4 mm when using the brute force optimizer and 5.2–6.6 mm when using the Powell optimizer. Conclusion We present a catheter-based registration method to continuously fuse a 3DRA roadmap arterial tree onto 2D fluoroscopic images with an efficient shape similarity.
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Affiliation(s)
- Pierre Ambrosini
- Biomedical Imaging Group Rotterdam, Erasmus MC, Rotterdam, The Netherlands,
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Yagyu Y, Tsurusaki M, Kamiyama K, Kitagaki H, Murakami T. Feasible and technical aspects of transcatheter arterial chemoembolization for non-resectable hepatocellular carcinoma using a 3.5-French catheter system. Abdom Imaging 2014; 39:1304-1308. [PMID: 24770608 DOI: 10.1007/s00261-014-0148-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
PURPOSE To evaluate the feasibility and technical aspects of transcatheter arterial chemoembolization (TACE) for non-resectable hepatocellular carcinoma (HCC) using a 3.5-French (Fr) catheter system. METHODS This study included 328 consecutive cases of HCC among 232 patients who underwent TACE procedures using both a 3.5-Fr catheter system and a microcatheter fitted to a 3.5-Fr system between April 2009 and November 2011. We assessed the ability to reach the catheter into the proper hepatic artery (PHA), main hepatic branch, segmental artery, and subsegmental or sub-subsegmental artery. The feasibility was rated according to the following factors: (1) the number of arteries that could be used to reach the target artery/total number of procedures using the 3.5-Fr system, (2) the rate of successful completion of the procedures without changing over to the 4-Fr system and (3) the reasons for changing over the 4-Fr system. RESULTS TACE of the PHA (27 sessions), RHA/LHA (103 sessions), segmental (31 sessions), or subsegmental/sub-subsegmental arteries (162 sessions) was performed. The rate of successfully reaching the target artery using the 3.5-Fr system was 93% (306/328 sessions). We were unable to reach the target artery in 22 sessions, including 11/8/3 procedures targeting the sub-subsegmental artery, subsegmental artery, and RHA/LHA, respectively. We changed over to the 4-Fr system in six sessions; therefore, the rate of successful completion of the procedures without changing over to the 4-Fr system was 98% (322/328 sessions). CONCLUSIONS TACE of the target artery can be successfully performed using the 3.5-Fr system in most patients with HCC.
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Affiliation(s)
- Yukinobu Yagyu
- Department of Radiology, Faculty of Medicine, Kinki University, 377-2 Ohnohigashi, Osakasayama, Osaka, 589-8511, Japan
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13
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Wang Y, Xiong B, Liang B, Zhao H, Li H, Qian J, Liang HM, Feng GS, Zheng CS. Hepatic parenchymal changes following transcatheter embolization and chemoembolization in a rabbit tumor model. PLoS One 2013; 8:e70757. [PMID: 23967098 PMCID: PMC3743795 DOI: 10.1371/journal.pone.0070757] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2013] [Accepted: 06/22/2013] [Indexed: 02/08/2023] Open
Abstract
OBJECTIVE To compare the effects of transcatheter arterial chemoembolization (TACE) with transcatheter arterial embolization (TAE) on liver function, hepatic damage, and hepatic fibrogenesis in a rabbit tumor model. MATERIALS AND METHODS Thirty-nine New Zealand white rabbits implanted with VX2 tumors in the left liver lobes were randomly divided into three groups: TAE, TACE, and control group. In the TAE group (n = 15), polyvinyl alcohol particles (PVAs) were used for left hepatic artery embolization. In the TACE group (n = 15), the tumors were treated with left hepatic arterial infusions of a suspension of 10-hydroxycamptothecin and lipiodol, followed by embolization with PVAs. In the control group (n = 9), the animals received sham treatment with distilled water. Serum and liver samples were collected at 6 hours, 3 days and 7 days after treatment. Liver damage was measured using a liver function test and histological analyses. Liver fibrogenesis and hepatic stellate cell (HSC) activation were evaluated using Sirius Red and anti-alpha-smooth muscle actin (α-SMA) immunohistochemical stains. RESULTS TACE caused liver injury with greater increases in serum alanine aminotransferase and aspartate aminotransferase levels on day 3 (P<0.05). Histological analyses revealed increased hepatic necrosis in adjacent non-tumorous liver tissue from day 3 compared to the TAE group (Suzuki score of 2.33±1.29 versus 1.13±1.18, P = 0.001). HSC activation and proliferation were significantly increased in the TACE group compared to the control group at 3 and 7 days after treatment (0.074±0.014 vs. 0.010±0.006, and 0.088±0.023 vs. 0.017±0.009, P<0.05). Sirius Red staining demonstrated a statistically significant increase in collagen deposition in the livers in the TACE group 7 days after embolization compared to the control group (0.118±0.012 vs. 0.060±0.017, P = 0.05). CONCLUSION The results of this animal study revealed that TACE induced prominent hepatocellular damage and hepatic fibrogenesis, which compromised liver function and may be responsible for chronic liver decompensation.
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Affiliation(s)
- Yong Wang
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, P. R. China
| | - Bin Xiong
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, P. R. China
| | - Bin Liang
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, P. R. China
| | - Hui Zhao
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, P. R. China
| | - Hui Li
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, P. R. China
| | - Jun Qian
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, P. R. China
| | - Hui-Min Liang
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, P. R. China
| | - Gan-Sheng Feng
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, P. R. China
| | - Chuan-Sheng Zheng
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, P. R. China
- * E-mail:
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Kritzinger J, Klass D, Ho S, Lim H, Buczkowski A, Yoshida E, Liu D. Hepatic embolotherapy in interventional oncology: technology, techniques, and applications. Clin Radiol 2012; 68:1-15. [PMID: 22917735 DOI: 10.1016/j.crad.2012.06.112] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2012] [Revised: 05/27/2012] [Accepted: 06/01/2012] [Indexed: 01/17/2023]
Abstract
Embolotherapy continues to play a growing role in the management of primary and secondary hepatic malignancies. In this review article, we examine the basis of therapy with a focus on neovascularization, which makes treatments via the hepatic artery possible. An overview of the three generations of embolic and therapeutic agents follows. The techniques, technologies, and complications of bland embolization, transarterial chemoembolization, drug-eluting beads, and selective internal radiotherapy are covered to give the reader an overview of this exciting field in interventional radiology.
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Affiliation(s)
- J Kritzinger
- Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada.
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Ohuchi Y, Kaminou T, Hashimoto M, Sugiura K, Adachi A, Kawai T, Endou M, Ogawa T. Transfemoral approach using a 3.5-French catheter system for use in transcatheter arterial chemoembolization in patients with hepatocellular carcinoma: technical assessment. Hepatogastroenterology 2011; 58:916-921. [PMID: 21830416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
BACKGROUND/AIMS To evaluate the technical feasibility of the transfemoral approach using a 3.5-Fr catheter system for transcatheter arterial chemoembolization (TACE) in patients with hepatocellular carcinoma (HCC). METHODOLOGY This study included 81 patients with unresectable HCC who underwent transfemoral TACE using a 3.5-Fr catheter system without a sheath between August 2008 and June 2010. A 2.0-Fr microcatheter was used within a 3.5-Fr catheter in all cases. After completion of TACE, manual compression was applied to the puncture site for 5min, and patients were kept supine for 1h. The success rate and periprocedural complications of TACE were evaluated. RESULTS Transfemoral TACE with a 3.5-Fr catheter system was carried out in 103 transfemoral TACE sessions. TACE was performed for 103 subsegmental arteries, 19 segmental arteries, 13 lobar arteries, 8 right inferior phrenic arteries, 1 left inferior phrenic artery, and 1 inferior pancreatico-duodenal artery. Image quality in all hepatic angiograms using 3.5-Fr catheters was satisfactory. Technical success was achieved in 97 (94%) out of 103 procedures. In only 1 patient, it took 10min to achieve hemostasis. There were no periprocedural complications. CONCLUSIONS Transfemoral TACE using a 3.5-Fr catheter system is technically feasible and enables early ambulation safely in patients with HCC.
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Affiliation(s)
- Yasufumi Ohuchi
- Division of Radiology, Department of Pathophysiological and Therapeutic Science, Faculty of Medicine, Tottori University, Yonago, Japan.
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Mikami K, Osuga K, Nakamura H. [Transcatheter arterial chemoembolization for hepatocellular carcinoma using 3 French catheter system]. Gan To Kagaku Ryoho 2009; 36:959-962. [PMID: 19542715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
PURPOSE To describe the initial experience of transcatheter arterial chemoembolization(TACE)for hepatocellular carcinoma(HCC)using the 3 French(F)catheter system designed for visceral angiography. MATERIAL AND METHODS Twenty patients with HCC underwent TACE via the right femoral artery using the combination of a 3 F sheath introducer, a 3.3 F catheter, and a 2-2.4 F microcatheter compatible with the 3.3 F catheter. Completion of homeostasis at the puncture site was assessed after five minutes of manual compression. We assessed whether the resumption of ambulating two hours after TACE was safe and feasible. RESULTS In 18/20 patients(90%), selective TACE was achieved with the 3 F catheter system. In three of these patients, it was necessary to use a 4 F dilator before insertion of the 3 F sheath introducer. In two patients, the 3.3 F catheter could not enter the celiac artery, and needed to be changed to the 4 F catheter system. In one patient, it took eight minutes until homeostasis was completed. In sixteen patients, the scheduled resumption of ambulation was obtained. In contrast, two patients experienced rehemorrhage, and required further compression. CONCLUSION TACE can be performed using the 3 F catheter system with early resumption of ambulating in most cases.
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Affiliation(s)
- Koji Mikami
- Dept. of Radiology, Suita Municipal Hospital, Japan
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17
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Golowa YS, Kalva SP, D'Othee BJ. Use of a Yashiro catheter to facilitate complex visceral catheterization. J Vasc Interv Radiol 2009; 20:557-9. [PMID: 19243973 DOI: 10.1016/j.jvir.2009.01.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2008] [Revised: 12/08/2008] [Accepted: 01/05/2009] [Indexed: 11/27/2022] Open
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Huang JH, Fan WJ, Li CJ, Gu YK, Zhang L, Gao F, Lu LW, Li WQ. Application of multislice spiral CT angiography on transcatheter arterial chemoembolization for hepatocellular carcinoma. Ai Zheng 2009; 28:159-163. [PMID: 19550129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
BACKGROUND AND OBJECTIVE Multislice spiral CT angiography (MSCTA) is very important in the diagnosis and treatment of liver diseases. Currently, most studies on three-dimensional MSCTA of the liver vascular system focus on the liver tumors, preoperative assessment of liver transplantation and the systematic anatomy of the liver vascular system. This study was to investigate the clinical application of MSCTA on transcatheter arterial chemoembolization (TACE) for hepatocellular carcinoma (HCC) by comparing images of MSCTA and digital subtraction angiography (DSA). METHODS MSCT dual-phase enhanced scanning was performed in 50 patients with advanced HCC. Both hepatic artery angiography and portal vein angiography were conducted using maximal intensity projection (MIP) and volume rendering technique (VRT). DSA of the celiac artery, superior mesenteric artery, renal artery and diaphragm artery, as well as TACE were performed in all patients. MSCTA and DSA images of the 50 patients were compared. RESULTS MSCTA and DSA showed equal detectability in revealing classification of the hepatic artery anatomy and tumor blood vessels, with a coincidence of 100% (p = 1.00). However, MSCTA was superior to DSA in displaying arterioportal shunt and portal vein tumor thrombus. CONCLUSIONS As a noninvasive and easy to conduct technique, MSCTA can accurately provide information of the hepatic artery, portal vein and tumor supply vessels. Therefore MSCTA has a favorable value to guide TACE for HCC.
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Affiliation(s)
- Jin-Hua Huang
- State Key Laboratory of Oncology in South China, Department of Imaging and Interventional Radiology, Sun Yat-sen University, Guangzhou, Guangdong, PR China.
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Gonzalez MV, Tang Y, Phillips GJ, Lloyd AW, Hall B, Stratford PW, Lewis AL. Doxorubicin eluting beads-2: methods for evaluating drug elution and in-vitro:in-vivo correlation. J Mater Sci Mater Med 2008; 19:767-75. [PMID: 17653626 DOI: 10.1007/s10856-006-0040-y] [Citation(s) in RCA: 80] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/20/2006] [Accepted: 11/01/2006] [Indexed: 05/16/2023]
Abstract
DC Bead is a sulfonate-modified, PVA-based microspherical embolisation agent approved for the treatment of hypervascular tumours and arterio-venous malformations. The beads have previously been shown to actively sequester oppositely charged drugs, such as doxorubicin hydrochloride (dox) by an ion-exchange mechanism. In order to characterise the release kinetics and predict the in vivo behaviour of drug eluting beads (DEB), two elution methods were utilised. The first, an application of the USP dissolution method Type II - Apparatus, enables study of the complete elution of loaded DC Bead in less than 4 h, allowing relatively rapid comparison to be made between different products and formulations. Release data obtained using this method were fitted to first order kinetics (R (2) > 0.998) and the elution constants shown to increase with the total surface area of the beads exposed to the elution medium. Diffusion coefficients were calculated adopting the Fickian diffusion model, which predicted slow elution rates under physiological conditions. The second method involved the use of a T-Apparatus where the drug experiences an element of diffusion through a static environment. This method was developed to resemble the in vivo situation in embolisation procedures more closely. Slow release of dox from DC Bead with half-lives over 1,500 h were predicted for all size ranges using a slow release model. A strong linear relationship was found between the release data from T-Apparatus and pharmacokinetic data obtained from patients treated with DC Bead loaded with dox in transarterial chemoembolisation (TACE) procedures. These data indicated a Level A in vitro-in vivo correlation (IVIVC) for the first 24 h post embolisation. Both systems developed were automated and good reproducibility was obtained for all samples, demonstrating the usefulness of these elution techniques for product development and comparative testing.
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Affiliation(s)
- M Victoria Gonzalez
- Drug Delivery Division, Biocompatibles UK Ltd, Farnham Business Park, Weydon Lane, Farnham, Surrey, UK
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20
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Ohmoto K, Yoshioka N, Tomiyama Y, Shibata N, Kawase T, Yoshida K, Kuboki M, Yamamoto S. Use of intra-arterial carbon-dioxide-enhanced ultrasonography for guidance of radiofrequency ablation and transcatheter arterial chemoembolization in hepatocellular carcinoma. Cardiovasc Intervent Radiol 2007; 29:1111-3. [PMID: 16933161 DOI: 10.1007/s00270-005-0285-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
A 73-year-old man with hepatitis-C-related cirrhosis and an elevated alpha-fetoprotein level and tumor in segment 3 of his liver was referred for interventional radiologic treatment. He was not a candidate for surgical resection due to impaired liver function and his personal preferences. On conventional ultrasonography no lesion could be detected, but the tumor was clearly depicted by intra-arterial carbon-dioxide-enhanced ultrasonography. Radiofrequency ablation was performed safely and accurately under the guidance of carbon-dioxide-enhanced ultrasonography. By concomitant performance of transcatheter arterial chemoembolization with radiofrequency ablation, extensive necrosis was obtained and adequate tumor volume reduction achieved with only one treatment session.
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MESH Headings
- Aged
- Antibiotics, Antineoplastic/administration & dosage
- Biomarkers, Tumor/blood
- Carbon Dioxide
- Carcinoma, Hepatocellular/diagnostic imaging
- Carcinoma, Hepatocellular/etiology
- Carcinoma, Hepatocellular/therapy
- Catheter Ablation
- Catheters, Indwelling
- Chemoembolization, Therapeutic/instrumentation
- Combined Modality Therapy
- Doxorubicin/administration & dosage
- Ethiodized Oil/administration & dosage
- Gelatin Sponge, Absorbable/administration & dosage
- Hemostatics/administration & dosage
- Hepatitis C/complications
- Hepatitis C/therapy
- Humans
- Image Enhancement
- Injections, Intra-Arterial
- Liver Cirrhosis/etiology
- Liver Cirrhosis/therapy
- Liver Neoplasms/diagnostic imaging
- Liver Neoplasms/etiology
- Liver Neoplasms/therapy
- Male
- Tomography, X-Ray Computed
- Ultrasonography, Interventional
- alpha-Fetoproteins/metabolism
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Affiliation(s)
- Kenji Ohmoto
- Division of Hepatology, Department of Medicine, Kawasaki Medical School, 577 Matsushima, Kurashiki, Okayama, 701-0192, Japan.
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Kim SH, Lee WJ, Lim HK, Lim JH. Prediction of viable tumor in hepatocellular carcinoma treated with transcatheter arterial chemoembolization: usefulness of attenuation value measurement at quadruple-phase helical computed tomography. J Comput Assist Tomogr 2007; 31:198-203. [PMID: 17414753 DOI: 10.1097/01.rct.0000236424.20514.2e] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
OBJECTIVE To assess the usefulness of attenuation value measurement at quadruple-phase helical computed tomography (CT) for predicting viable tumor in hepatocellular carcinoma (HCC) treated with transcatheter arterial chemoembolization (TACE). METHODS Thirty-two patients who had an iodized-oil defect area (IODA) in HCCs treated with TACE were included in our study; these patients were divided into group 1 (n = 21) with viable tumor and group 2 (n = 11) without viable tumor in the IODA. All the patients underwent quadruple-phase helical CT (unenhanced and contrast-enhanced hepatic arterial, portal venous and equilibrium phases) before and after TACE. The attenuation difference of the IODA between unenhanced and each contrast-enhanced phase was measured, and the attenuation degree of the IODA relative to the hepatic parenchyma were subjectively assessed and then compared between the 2 groups. RESULTS The mean attenuation differences of the IODAs were 28.8, 35.9, and 25.6 Hounsfield unit (HU) in group 1 and 0.4, 1.9, and 2.0 HU in group 2 at the hepatic arterial, portal venous, and equilibrium phases, respectively, with statistically significant difference for each phase (P < 0.05). The IODAs had attenuation difference of more than 20 HU on at least 1 contrast-enhanced phase in group 1 and less than 5 HU at all contrast-enhanced phases in group 2. For the attenuation degree of IODAs relative to the hepatic parenchyma, 12 patients (57%) showed hyperattenuation at the hepatic arterial phase, and remaining nine (43%) at the hepatic arterial phase and all patients at the portal venous and equilibrium phases showed isoattenuation or hypoattenuation in group 1. In group 2, all the patients showed hypoattenuation at all the 3 phases. CONCLUSIONS The presence of viable tumor of the IODA in HCC treated with TACE can be precisely assessed by measuring attenuation values, strongly suggesting viable tumor when the attenuation difference is more than 20 HU on at least 1 contrast-enhanced phase at quadruple-phase helical CT.
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Affiliation(s)
- Seong Hyun Kim
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
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Miyayama S, Matsui O, Yamashiro M, Ryu Y, Kaito K, Ozaki K, Takeda T, Yoneda N, Notsumata K, Toya D, Tanaka N, Mitsui T. Ultraselective Transcatheter Arterial Chemoembolization with a 2-F Tip Microcatheter for Small Hepatocellular Carcinomas: Relationship Between Local Tumor Recurrence and Visualization of the Portal Vein with Iodized Oil. J Vasc Interv Radiol 2007; 18:365-76. [PMID: 17377182 DOI: 10.1016/j.jvir.2006.12.004] [Citation(s) in RCA: 198] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
PURPOSE To retrospectively evaluate the relationship between local tumor recurrence and iodized oil deposition in the portal vein by using ultraselective transcatheter arterial chemoembolization (TACE) for small hepatocellular carcinoma. MATERIALS AND METHODS One-hundred twenty-three tumors smaller than 5 cm in diameter (mean diameter, 1.9 cm; median diameter, 1.6 cm) were treated with TACE by using a 2-F tip microcatheter at a distal portion of the subsegmental artery of the liver. Portal vein visualization at spot radiography during TACE was divided into three grades, as follows: 0 = not visualized, 1 = limited near the tumor, and 2 = whole or extended to the embolized area. Local recurrence rates of each grade group were compared. The recurrent pattern was divided into intratumoral and peritumoral recurrence. Complications were also analyzed. RESULTS Of the 123 tumors, 53 (43.1%) were classified as grade 2, 52 (42.3%) were classified as grade 1, and 18 (14.6%) tumors were classified as grade 0. Overall local recurrence rates at 12, 24, and 36 months were 25.6%, 34.7%, and 34.7%, respectively. The local recurrence rates for the grades 2, 1, and 0 groups were 7.9%, 24.8%, and 85.7%, respectively, at 12 months and 17.7%, 38.9%, and 85.7% at 24 months. Recurrence rates in the grade 2 group were significantly lower than those in the grades 1 and 0 groups (P = .0485 and P < .0001, respectively). Intratumoral recurrence was observed in 21 tumors, most of which were in the grade 0 group. Peritumoral recurrence was noted in 16 tumors, most of which were in the grade 2 group. There were no major complications. CONCLUSION Ultraselective TACE was safe and effective in a significant number of tumors. In particular, local recurrence was significantly lower when a greater degree of portal vein visualization was demonstrated during TACE.
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Affiliation(s)
- Shiro Miyayama
- Department of Diagnostic Radiology, Fukuiken Saiseikai Hospital, 7-1 Funabashi, Wadanaka-cho, Fukui 918-8503, Japan.
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Malloy P. Nondissolvable plastic stopcock and other technical tips for chemoembolization. J Vasc Interv Radiol 2007; 18:321. [PMID: 17327571 DOI: 10.1016/j.jvir.2006.12.717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Kroencke TJ, Kluner C, Hamm B, Gauruder-Burmester A. Use of the 4F Rösch Inferior Mesenteric Catheter in Embolization Procedures in the Pelvis: A Review of 300 Cases. Cardiovasc Intervent Radiol 2007; 30:268-72. [PMID: 17200899 DOI: 10.1007/s00270-006-0192-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The aim of this study is to evaluate the use of a 4F Rösch inferior mesenteric (RIM) catheter for pelvic embolization procedures. Between October 2000 and January 2006, 364 patients (357 female, 7 male; age: 23-67 years) underwent embolization of various pathologies [uterine fibroids (n = 324), pure adenomyosis of the uterus (n = 19), postpartum hemorrhage (n =1), traumatic or postoperative hemorrhage (n = 9), bleeding related to cervical cancer (n =7), AV malformation of the uterus (n = 2) and high-flow priapism (n = 2)] at a single institution. In all cases, bilateral catheterization was primarily attempted with the use of a 4F hook-shaped braided endhole catheter (Rösch-Inferior-Mesenteric, RIM-Catheter, Cordis, Miami, FL). Frequency of initial failure to catheterize the vascular territory of interest and carry out the embolization were recorded and the types of difficulty encountered were noted. Catheterization of the main stem of the vessel territory of interest with the use of a unilateral femoral approach and the 4F RIM catheter was successful in 334/364 (91.8%) the embolization cases. Bilateral catheterization of the internal iliac arteries using a single common femoral artery access and the 4F RIM catheter was achieved in 322/364 (88.5%) patients. In 12/364 (3.3%) patients, a contralateral puncture was performed and the same 4F catheter was used. In 28/364 (7.7%) cases the 4F RIM catheter was exchanged for a catheter with a cobra-shaped or sidewinder configuration. The 4F RIM catheter is a simple and valuable alternative to catheters and techniques commonly employed for pelvic artery embolization.
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Affiliation(s)
- Thomas J Kroencke
- Department of Radiology, Charité Universitätsmedizin Berlin, 10098 Berlin, Germany.
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Okazaki H, Higuchi K, Shiba M, Nakamura S, Wada T, Yamamori K, Machida A, Kadouchi K, Tamori A, Tominaga K, Watanabe T, Fujiwara Y, Nakamura K, Arakawa T. Successful treatment of giant rectal varices by modified percutaneous transhepatic obliteration with sclerosant: Report of a case. World J Gastroenterol 2006; 12:5408-11. [PMID: 16981280 PMCID: PMC4088217 DOI: 10.3748/wjg.v12.i33.5408] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2006] [Revised: 04/28/2006] [Accepted: 05/22/2006] [Indexed: 02/06/2023] Open
Abstract
We present a female patient with continuous melena, diagnosed with rectal variceal bleeding. She had a history of esophageal varices, which were treated with endoscopic therapy. Five years after the treatment of esophageal varices, continuous melena occurred. Since colonoscopy showed that the melena was caused by giant rectal varices, we thought that they were not suitable to receive endoscopic treatment. We chose the modified percutaneous transhepatic obliteration with sclerosant, which is one of the interventional radiology techniques but a new clinical procedure for rectal varices. After the patient received this therapy, her condition of rectal varices was markedly improved.
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Affiliation(s)
- Hirotoshi Okazaki
- Department of Gastroenterology, Osaka City University Graduate School of Medicine, 1-4-3, Asahimachi, Abeno-ku, Osaka, Japan
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Miyayama S, Matsui O, Taki K, Minami T, Ito C, Shinmura R, Takamatsu S, Kobayashi M, Notsumata K, Toya D, Tanaka N, Kozaka K. Transcatheter arterial chemoembolization for hepatocellular carcinoma fed by the reconstructed inferior phrenic artery: anatomical and technical analysis. J Vasc Interv Radiol 2006; 15:815-23. [PMID: 15297585 DOI: 10.1097/01.rvi.0000136986.34890.d7] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
PURPOSE To evaluate reconstructed patterns of occluded inferior phrenic artery (IPA) and determine the technical success rate and complications of transcatheter arterial chemoembolization (TACE) for hepatocellular carcinoma (HCC) fed by the occluded IPA through the anastomosing branch. MATERIALS AND METHODS In 19 patients, 24 IPAs, including two that had been previously embolized, were demonstrated through collateral pathways. The incidence of each collateral circulation was evaluated. Thirteen IPAs in 12 patients fed the tumor and TACE was attempted. TACE was performed only if the catheter could be advanced into the anastomosing branch so that the nontarget branches were avoided. RESULTS A reconstructed unilateral IPA was observed in 14 patients (11 right IPAs and three left IPAs) and two reconstructed IPAs were observed in five. The IPA was demonstrated through the dorsal pancreatic artery (n = 13), inferior or middle adrenal artery (n = 7), left gastric artery (n = 2), contralateral IPA (n = 2), lumbar artery (n = 1), and small branch derived from the celiac trunk (n = 1). Five IPAs (21%) were demonstrated through more than two separate arteries, including two demonstrated through both dorsal pancreatic arteries arising from the celiac and superior mesenteric artery. The IPA opacified through the lumbar artery had been previously embolized. TACE of the reconstructed IPA was possible in 10 of 13 IPAs (77%). Complications related to the procedure were a small amount of pleural effusion (n = 4) and basal atelectasis (n = 2). CONCLUSION The IPA is reconstructed mainly through the retroperitoneal anastomosing branch in the upper abdomen. TACE of the reconstructed IPA can be performed with a high success rate without major complications.
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Affiliation(s)
- Shiro Miyayama
- Department of Diagnostic Radiology, Kanazawa University, School of Medicine, Takara-machi, Kanazawa 920-8640, Japan.
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Lewis AL, Gonzalez MV, Lloyd AW, Hall B, Tang Y, Willis SL, Leppard SW, Wolfenden LC, Palmer RR, Stratford PW. DC bead: in vitro characterization of a drug-delivery device for transarterial chemoembolization. J Vasc Interv Radiol 2006; 17:335-42. [PMID: 16517780 DOI: 10.1097/01.rvi.0000195323.46152.b3] [Citation(s) in RCA: 304] [Impact Index Per Article: 16.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
PURPOSE The purpose of this investigation is to present the in vitro characterization and detailed drug-loading procedure for DC Bead, a microsphere product that can be loaded with chemotherapeutic agents for embolization. MATERIALS AND METHODS DC Bead is an embolic microsphere product that is capable of being loaded with anthracycline drugs such as doxorubicin just before administration in a transarterial chemoembolization (TACE) procedure. Beads can be loaded from solutions prepared from doxorubicin powder or the doxorubicin HCl formulation. In this evaluation, bead sizes were measured by optical microscopy with video imaging. Gravimetric analysis demonstrated the effect of drug loading on bead water content, and its consequent impact on bead compressibility was determined. The subsequent deliverability of the beads was assessed by mixing the beads with contrast medium and saline solution and passing the beads through an appropriately sized microcatheter. A T-cell apparatus was used to monitor the in vitro elution of the drug from the beads over a period of 24 hours in various elution media. RESULTS DC Bead spheres could be easily loaded with doxorubicin to a recommended level of 25 mg/mL of hydrated beads by immersion of the beads in the drug solution for 10-120 minutes depending on microsphere size. Other commercial embolic microspheres were shown not to load doxorubicin to the same extent or release it in the same fashion and were considered unsuitable for local drug delivery. Maximum theoretic capacity for DC Bead was approximately 45 mg/mL. Increase in doxorubicin loading resulted in a concomitant decrease in water content and consequential increase in bead resistance to compression force. Drug loading also resulted in a decrease in the average size of the beads, which was dependent on bead size and drug dose. This did not impact bead delivery at any drug loading level to a maximum of 37.5 mg/mL. Beads 100-700 microm in size could be delivered through 2.7-F microcatheters, whereas the 700-900-microm range required 3-F catheters. Modeling of the kinetics of drug elution from the beads in vitro at a loading dose of 25 mg/mL yielded calculated half-lives of 150 hours for the 100-300-microm range to a maximum of 1,730 hours for the 700-900-microm size range, which was dependent on the ionic strength of the elution medium. For comparison, there was a rapid loss of drug from an unstable Lipiodol emulsion with a half-life of approximately 1 hour. CONCLUSIONS DC Bead can be loaded with doxorubicin to provide an accurate dosage of drug per unit volume of beads. Drug elution is dependent on ion exchange with the surrounding environment and is controlled and sustained, unlike the rapid separation of the drug from Lipiodol. Drug loading has no impact on the handling and deliverability of the beads, making them suitable for superselective TACE.
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Affiliation(s)
- Andrew L Lewis
- Drug Delivery Division, School of Pharmacy and Biomolecular Sciences, University of Brighton, East Sussex, United Kingdom.
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Hong K, Liapi E, Georgiades CS, Geschwind JFH. Case-controlled comparison of a percutaneous collagen arteriotomy closure device versus manual compression after liver chemoembolization. J Vasc Interv Radiol 2005; 16:339-45. [PMID: 15758129 DOI: 10.1097/01.rvi.0000147068.25548.57] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
PURPOSE To compare complications and outcomes between the use of the Duett collagen closure device after one or multiple deployments and manual compression in patients treated with transcatheter arterial chemoembolization (TACE) for primary or metastatic liver cancer. MATERIALS AND METHODS A database of 214 patients who underwent a total of 426 TACE procedures between July 2001 and July 2003 was retrospectively analyzed with regard to the use of the Duett closure device to obtain hemostasis. The Duett device was used in 211 cases (121 patients), whereas manual compression was performed in 215 cases (93 patients). Primary endpoints included complications related to hemostasis, time to hemostasis (TTH), time to ambulation (TTA), and time to discharge (TTD). Risk factors were tested for correlation with complications (P < .05). Other endpoints included descriptive data regarding the Duett treatment group. RESULTS Only minor complications were observed in both groups, without a statistically significant difference (P = .16). The mean TTH and TTA were significantly shorter (P < .0001) in the Duett group, whereas there was no difference in TTD between groups (P = .59). Reaccessing the same arterial site for separate procedures was not a significant risk factor for complications in the Duett group (P < .0001). CONCLUSION The Duett closure device achieves similar safety and efficacy as manual compression in this distinct group of patients. In addition, this device can be safely and repetitively deployed at the arteriotomy site after each TACE procedure.
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Affiliation(s)
- Kelvin Hong
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Hospital, 600 North Wolfe Street, Blalock 545, Baltimore, Maryland 21287, USA.
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Chrisman HB, Liu DM, Bui JT, Resnick SA, Sato K, Chen R, Vogelzang RL, Omary RA. The Safety and Efficacy of a Percutaneous Closure Device in Patients Undergoing Uterine Artery Embolization. J Vasc Interv Radiol 2005; 16:347-50; quiz 351. [PMID: 15758130 DOI: 10.1097/01.rvi.0000149903.84071.99] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
PURPOSE The use of suture-mediated closure devices (SMCDs) in patients undergoing uterine artery embolization (UAE) for symptomatic leiomyomata is controversial. With recent literature suggesting a higher complication rate with the use of SMCDs, their use in this specific population has been questioned. The purpose of this study is to assess the safety and efficacy of SMCDs specifically for those patients undergoing UAE for symptomatic uterine leiomyomata. MATERIALS AND METHODS A prospective database was established in a single high-volume medical center for patients undergoing UAE for symptomatic leiomyomata. Data were tracked prospectively, with technical outcome and complication rates serving as endpoints. RESULTS UAE was performed in 342 consecutive patients from January 2001 to September 2003. The SMCD was used in 328 of these patients (96%). Successful primary hemostasis was achieved in 320 of 328 patients (97%), with additional manual compression required in the remaining eight patients (3%). No major complications were observed. Minor complications consisted of minor hematomas in four women (1%) and anteriomedial thigh pain in 68 women (21%) within 1 month of follow-up, resulting in an overall complication rate of 22%. All symptoms related to anteromedial thigh pain ipsilateral to the arterial puncture site were managed conservatively with 1 week of oral nonsteroidal antiinflammatory medication. CONCLUSION The SMCD provided safe and effective hemostasis in patients undergoing UAE. Transient thigh discomfort, which may result from irritation of the anterior femoral cutaneous nerves (femoral neuralgia syndrome), was uniformly relieved with nonsteroidal antiinflammatory therapy.
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Affiliation(s)
- Howard B Chrisman
- Department of Radiology, Interventional Radiology Section, Northwestern University, Northwestern Memorial Hospital, Illnois, Chicago, USA
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Miyayama S, Matsui O, Taki K, Minami T, Ito C, Shinmura R, Takamatsu S, Kobayashi M, Notsumata K. Combined Use of an Occlusion Balloon Catheter and a Microcatheter for Embolization of the Unselectable Right Inferior Phrenic Artery Supplying Hepatocellular Carcinoma. Cardiovasc Intervent Radiol 2004; 27:677-81. [PMID: 15578146 DOI: 10.1007/s00270-004-0216-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
We report the combined use of an occlusion balloon catheter and a microcatheter for transcatheter arterial embolization (TAE) of hepatocellular carcinoma (HCC) fed by the unselectable right inferior phrenic artery (IPA). In one case, HCC was fed by the reconstructed right IPA via a small branch arising from the proximate portion of the celiac artery. In another, the tumor was fed by the right IPA that had been previously embolized with coils. TAE was successfully performed through a microcatheter placed in the celiac artery immediately proximal to the occluding balloon catheter of the celiac trunk and coil embolization of the left gastric artery.
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Faber L, Seggewiss H, Welge D, Fassbender D, Schmidt HK, Gleichmann U, Horstkotte D. Echo-guided percutaneous septal ablation for symptomatic hypertrophic obstructive cardiomyopathy: 7 years of experience. Eur J Echocardiogr 2004; 5:347-55. [PMID: 15341870 DOI: 10.1016/j.euje.2004.01.001] [Citation(s) in RCA: 100] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2003] [Revised: 12/22/2003] [Accepted: 01/05/2004] [Indexed: 10/26/2022]
Abstract
AIMS To analyze the impact of intra-procedural echocardiographic imaging on the interventional strategy in ethanol-induced septal ablation (PTSMA) for symptomatic hypertrophic obstructive cardiomyopathy (HOCM), based on a single-center experience of 7 years. METHODS AND RESULTS PTSMA was intended for refractory symptoms in 337 patients (pts.) with HOCM (mean age: 54 +/- 15 years), with 312 procedures completed by injection of 2.8 +/- 1.2 ml ethanol. In 25 pts. (8%) the intervention was aborted without ethanol injection, mostly because of echocardiographic findings (n = 18/6%). An echocardiography-driven target vessel change was necessary in 33 pts. (11%). In the 312 pts. who received ethanol, permanent pacing was necessary in 22 cases (7%). In-hospital mortality was 1.3% (4 pts.). After 3 months, mean NYHA functional class was reduced from 2.9 +/- 0.5 to 1.5 +/- 0.6 (p < 0.0001) along with a gradient reduction from 60 +/- 33 to 13 +/- 18 mmHg at rest, and from 120 +/- 43 to 38 +/- 35 mmHg with provocation (p < 0.0001 each). Exercise capacity improved from 94 +/- 51 to 115 +/- 43 W, peak oxygen consumption from 18 +/- 4 to 21 +/- 6 ml/kg/min (p < 0.01 each). There was no significant difference regarding residual gradients in pts. with different levels of immediate gradient reduction during probatory balloon occlusion. CONCLUSIONS Catheter-based septal ablation is an effective non-surgical technique for reducing symptoms and outflow gradients in HOCM. Intra-procedural echocardiographic guidance has a cumulative impact on the interventional strategy in about 15-20%, and clearly identifies pts. who should not receive ethanol but undergo a surgical myectomy.
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Affiliation(s)
- Lothar Faber
- Department of Cardiology, Heart and Diabetes Center North Rhine-Westphalia, Ruhr-University Bochum, Georgstr. 11, D-32545 Bad Oeynhausen, Germany.
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Hidajat N, Griesshaber V, Hildebrandt B, Hosten N, Schröder RJ, Felix R. Repetitive transarterial chemoembolization (rTACE) of hepatocellular carcinoma: comparisons between an arterial port system and conventional angiographic technique. Eur J Radiol 2004; 51:6-11. [PMID: 15186878 DOI: 10.1016/j.ejrad.2003.09.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2003] [Revised: 08/30/2003] [Accepted: 09/02/2003] [Indexed: 11/25/2022]
Abstract
PURPOSE To compare the cost and radiation exposure of repetitive transarterial chemoembolization (rTACE) using percutaneously implantable port system with rTACE using conventional catheterization technique. MATERIALS AND METHODS In five patients with unresectable hepatocellular carcinoma, three cycles of TACE were performed using conventional technique and six cycles using port. The cumulative cost of material and contrast agent and dose area product (DAP) were compared with the cost and DAP that would be expected if the rTACE was performed conventionally. RESULTS The cost of material and contrast agent was 1002.6 Euro after three cycles of TACE using conventional technique and six cycles using port, but would be 1111.8 Euro if the nine cycles were performed using conventional technique alone. The rTACE with three cycles using conventional technique and six cycles using port led to approximately 63% of the cumulative DAP that would be expected in rTACE using conventional technique alone. CONCLUSION In rTACE, the use of percutaneously implantable port system might enable a reduction of cost and radiation exposure.
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Affiliation(s)
- Nico Hidajat
- Department of Radiology, Charité, Virchow-Clinic of the Humboldt-University Berlin, Augustenburger Platz 1, 13353 Berlin, Germany.
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Shiozawa S, Tsuchiya A, Endo S, Kato H, Katsube T, Kumazawa K, Naritaka Y, Ogawa K. Transradial approach for transcatheter arterial chemoembolization in patients with hepatocellular carcinoma: comparison with conventional transfemoral approach. J Clin Gastroenterol 2003; 37:412-7. [PMID: 14564191 DOI: 10.1097/00004836-200311000-00013] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
We evaluated the clinical usefulness and safety of transradial approach for transcatheter arterial chemoembolization (TACE) in patients with hepatocellular carcinoma (HCC) compared with that of conventional transfemoral approach. The two groups (radial group, n = 177; femoral group, n = 150) of cases were retrospectively compared with regard to the successful rate of angiography or TACE, time required for catheterizaiton and complications. Hepatic angiography and TACE were completed in 174 (98.3%) of 177 cases in the radial group. There was no intergroup difference of time required for catheterization. Minor complications (dull pain, numbness) occurred in 8 (4.6%) patients in the radial group, and there were lower complications in the radial group compared to the femoral group. TACE by our new transradial approach was found to have therapeutic efficacy with lower complications comparable to that of the conventional transfemoral approach.
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Affiliation(s)
- Shunichi Shiozawa
- Department of Surgery, Tokyo Women's Medical University, Daini Hospital, Japan.
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Nelson PK, Russell SM, Woo HH, Alastra AJG, Vidovich DV. Use of a wedged microcatheter for curative transarterial embolization of complex intracranial dural arteriovenous fistulas: indications, endovascular technique, and outcome in 21 patients. J Neurosurg 2003; 98:498-506. [PMID: 12650420 DOI: 10.3171/jns.2003.98.3.0498] [Citation(s) in RCA: 105] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT The aim of this study was to describe the application of a novel transarterial approach to curative embolization of complex intracranial dural arteriovenous fistulas (DAVFs). This technique is particularly useful in patients harboring high-grade DAVFs with direct cortical venous drainage or for whom transvenous coil embolization is not possible because of limited sinus venous access to the fistula site due to thrombosis or stenotic changes. METHODS Twenty-three DAVFs in 21 patients were treated using a transarterial N-butyl cyanoacrylate (NBCA) embolization technique with the aid of a wedged catheter. In all patients, definitive treatment involved two critical steps: 1) a microcatheter was wedged within a feeding artery, establishing flow-arrest conditions within the catheterized vessel distal to the microcatheter tip; and 2) NBCA was injected under these resultant flow-arrest conditions across the pathological arteriovenous connection and into the immediate draining venous apparatus, definitively occluding the fistula. Patient data were collected in a retrospective manner by reviewing office and inpatient charts and embolization reports, and by directly analyzing all procedural and diagnostic angiograms. Eight patients presented with the principal complaint of tinnitus/bruit, five with intracranial hemorrhage, four with cavrnous sinus syndrome, and one each with seizures, ataxia, visual field loss, and hiccups. The parent (recipient) venous structure of the DAVFs in this study included 11 leptomeningeal veins, eight transverse/sigmoid sinuses, three cavernous sinuses, and one sphenoparietal sinus. The NBCA permeated the arteriovenous shunt, perifistulous network, and proximal draining vein in all DAVFs. Occlusion was confirmed on postembolization angiography studies. No complication occurred in any patient in this series. There has been no recurrence during a mean follow up of 18.7 months (range 2-46 months). CONCLUSIONS Transarterial NBCA embolization with the aid of a wedged catheter in flow-arrest conditions is a safe and an effective treatment for intracranial DAVFs.
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Affiliation(s)
- Peter Kim Nelson
- Neurointerventional Service, Department of Radiology, New York University School of Medicine, New York, New York, USA.
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Geschwind JFH, Ramsey DE, Cleffken B, van der Wal BCH, Kobeiter H, Juluru K, Hartnell GG, Choti MA. Transcatheter arterial chemoembolization of liver tumors: effects of embolization protocol on injectable volume of chemotherapy and subsequent arterial patency. Cardiovasc Intervent Radiol 2003; 26:111-7. [PMID: 12616414 DOI: 10.1007/s00270-002-2524-6] [Citation(s) in RCA: 83] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The purpose of this study was to determine whether transcatheter arterial chemoembolization (TACE) protocol affects the total volume of chemotherapy injected into the liver as well as subsequent arterial patency. A total of 160 patients with primary or secondary liver cancer were treated with 3 different chemoembolization protocols at a single institution. Data were analyzed retrospectively. Group 1 (n = 36) consisted of slurry of chemotherapy, oil and polyvinyl alcohol particles (PVA), group 2 (n = 91), chemotherapy and oil followed by PVA, and group 3 (n = 33), chemotherapy and oil followed by Gelfoam pledgets. The total volume of chemotherapy injected into the liver was recorded. Arterial patency was determined during subsequent chemoembolizations. The mean percentage of total intended chemotherapy dose administered was 54.6% for group 1, 75.3% for group 2, and 80.6% for group 3. Arterial patency at follow-up angiography was 56% for group 1, 74% for group 2, and 81% for group 3. The slurry protocol (group 1) significantly reduced arterial patency and injectable volume of chemotherapy during TACE.
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Affiliation(s)
- Jean-Francois H Geschwind
- The Russell H. Morgan Department of Radiology, The Johns Hopkins University School of Medicine, 600 North Wolfe Street, Baltimore, Maryland 21287, USA
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36
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Transcatheter arterial chemoembolization of hepatic tumors. Tecnologica MAP Suppl 2000;:13-8. [PMID: 11503768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
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37
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Caturelli E, Siena DA, Fusilli S, Villani MR, Schiavone G, Nardella M, Balzano S, Florio F. Transcatheter arterial chemoembolization for hepatocellular carcinoma in patients with cirrhosis: evaluation of damage to nontumorous liver tissue-long-term prospective study. Radiology 2000; 215:123-8. [PMID: 10751477 DOI: 10.1148/radiology.215.1.r00ap21123] [Citation(s) in RCA: 79] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
PURPOSE To evaluate damage to cirrhotic liver tissue after transcatheter arterial chemoembolization (TACE) in patients with hepatocellular carcinoma (HCC). MATERIALS AND METHODS TACE was performed in 111 patients with HCC that involved less than 30% of the liver. Baseline liver function was evaluated with Child-Pugh scores and other indicators. Eighty-two patients had Child-Pugh class A disease, 27 had class B disease, and two had class C disease. All patients underwent chemotherapy followed by gelatin sponge particle embolization in the proper ("complete" embolization; n = 69) or right or left main ("partial" embolization; n = 42) hepatic artery. Liver function was assessed 4 months later, and 95 patients underwent a second TACE (complete embolization in 57, partial in 38). Liver function was again assessed 4 months later in 60 patients. RESULTS No patient died. Child-Pugh scores increased in all patients from a mean 5.96 to 6.28 (not significant) and 6.51 (P =. 05) after first and second TACEs, respectively. In patients with class A disease, scores increased from a mean 5.37 to 5.73 (P =.01) and 5.89 (P =.001) after first and second TACEs, respectively; in patients with class B disease, scores changed from a mean of 7.48 to 7.67 and 7.30 after first and second TACEs, respectively (not significant). CONCLUSION TACE does not induce significant long-term worsening of liver function in patients with class A or B cirrhosis.
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Affiliation(s)
- E Caturelli
- Division of Gastroenterology, Ospedale "Casa Sollievo della Sofferenza" IRCC, Foggia, Italy
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38
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Steiner P, Brunken C, Begemann P, Bücheler E. [Palliative therapy of hepatocellular carcinoma. Transarterial chemoembolization (TACE) and thermoablation]. Internist (Berl) 2000; 41:198-204. [PMID: 10756435 DOI: 10.1007/s001080050025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- P Steiner
- Abteilung für Radiologische Diagnostik, Universitäts-Krankenhaus Hamburg-Eppendorf.
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Schlottmann K, Strotzer M, Messmann H, Feuerbach S, Schölmerich J, Lock G. Color Doppler detected spontaneous recanalization after transarterial catheter embolization-induced dissection of the hepatic artery--therapeutic implications. Am J Gastroenterol 1999; 94:3385-6. [PMID: 10566764 DOI: 10.1111/j.1572-0241.1999.03385.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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40
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Ishijima H, Koyama Y, Aoki J, Kawano T, Nakajima T, Ishizaka H, Endo K. Use of a combined CT-angiography system for demonstration of correlative anatomy during embolotherapy for hepatocellular carcinoma. J Vasc Interv Radiol 1999; 10:811-5. [PMID: 10392953 DOI: 10.1016/s1051-0443(99)70120-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Affiliation(s)
- H Ishijima
- Department of Diagnostic Radiology, Gunma University Hospital, Maebashi, Japan
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41
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Kim DE, Yoon HK, Ko GY, Kwon JS, Song HY, Sung KB. Hepatic falciform artery: is prophylactic embolization needed before short-term hepatic arterial chemoinfusion? AJR Am J Roentgenol 1999; 172:1597-9. [PMID: 10350296 DOI: 10.2214/ajr.172.6.10350296] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
OBJECTIVE The purpose of this study was to assess the need for prophylactic embolization of the hepatic falciform artery (HFA) to prevent supraumbilical skin rash before short-term hepatic arterial chemoinfusion with or without subsequent embolization. MATERIALS AND METHODS Transcatheter arterial chemoinfusions or chemoembolizations were performed on 127 consecutive patients with hepatocellular carcinoma between August 1997 and September 1997. Hepatic angiography findings regarding the anatomic variations of the hepatic artery and the presence and origin of the HFA were analyzed. The patients were followed up for 35-143 days (mean, 78 days). The incidence of supraumbilical skin rash was assessed for two groups of patients, those with an HFA and those without. We also evaluated other factors that seemed closely related to the presence of an HFA. RESULTS An HFA was identified in 16 (13%) of 127 patients. Each HFA originated either in the left hepatic artery (n = 14) or the middle hepatic artery (n = 2). In the 16 patients with an HFA, serum bilirubin levels were significantly higher than in patients without one (p < .05), whereas serum albumin levels and prothrombin times were significantly lower (p < .05) and more prolonged (p = .02) than in patients without one. Portal venous collateral vessels were more frequently seen in patients with an HFA (50%) than in those without one (31%), but the frequency was not significant (p = .157). However, supraumbilical skin rash was not seen in any patient. CONCLUSION We found no need for prophylactic embolization of the HFA to prevent supraumbilical skin rash before short-term hepatic arterial chemoinfusion with or without subsequent embolization.
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Affiliation(s)
- D E Kim
- Department of Diagnostic Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Affiliation(s)
- M Mehta
- Department of Medical Imaging, Mount Sinai Hospital, University of Toronto, ON, Canada
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Tomura N, Kato K, Hirano H, Hirano Y, Watarai J. Chemoembolization of maxillary tumors via the superficial temporal artery using a coaxial catheter system. Radiat Med 1998; 16:157-60. [PMID: 9650908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
A preliminary experience of embolization of maxillary tumors via the superficial temporal artery using a coaxial catheter system is presented. Five patients with maxillary carcinoma were slated to undergo embolization before radical surgery. Embolization with carboplatine microcapsules was performed via the superficial temporal artery using a coaxial catheter system. Carboplatine microcapsules consisted of 60% (W/W) carboplatine core and 40% (W/W) ethylcellulose shell. Embolization was performed twice in three patients, three times in one patient, and once in one patient. The interval between embolizations was from one to three weeks. The total dose of carboplatine microcapsules given ranged from 100 to 230 mg. Responses to the treatment were determined by measurements of tumor reduction and increase in low attenuation areas of the tumor on postcontrast CT. Tumor reduction over 48% was achieved in four of five tumors. All the tumors showed an increased area of low attenuation in the tumor on the postcontrast CT after embolization. No significant complications occurred. This method makes it easy to superselectively repeat embolization.
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Affiliation(s)
- N Tomura
- Department of Radiology, Akita University School of Medicine, Hondo, Japan
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Kimura T, Haruta I, Isobe Y, Ueno E, Toda J, Nemoto Y, Ishikawa K, Miyazono Y, Shimizu K, Yamauchi K, Hayashi N. A novel therapeutic approach for rectal varices: a case report of rectal varices treated with double balloon-occluded embolotherapy. Am J Gastroenterol 1997; 92:883-6. [PMID: 9149207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
We present a patient with continuous melena, diagnosed as rectal varices bleeding. She had a history of esophageal varices, which was treated by endoscopic ligation therapy. Eight years after the treatment of esophageal varices, the continuous melena began. Colonoscopic examination showed that the melena was caused by rectal varices, which were so severe that they could not be treated by either endoscopic sclerotherapy or surgical devascularization. Taking into considering the overall risk of treating rectal varices, we chose the approach of double balloon-occluded embolotherapy (DBOE) with 5% ethanolamine oleate with iopamodol as a liquid embolic material. DBOE is one of the interventional radiology techniques (Morita et al., Acta Hepatol Jpn 1994;35:109-120), but in this case was a completely new and novel clinical procedure for rectal varices. After the DBOE therapy, the condition of rectal varices was markedly improved. Thus, DBOE might be a new tool for treating inoperable rectal varices.
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Affiliation(s)
- T Kimura
- Department of Radiology, Tokyo Women's Medical College, Shinjuku-ku, Japan
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Abstract
UNLABELLED PURPOSE AND MATERIAL: A new family of catheters was developed to overcome the shortcomings of conventional catheters and to avoid the use of coaxial catheters in superselective angiography and embolization. The new catheter is nylon, 1.67 mm (JF) long, and has a rigid proximal part (to ensure torque control and pushability) and a long 2-step flexible tip (to follow arterial tortuosities). It has a hydrophilic coating, and a long-lasting shape memory. This new catheter type was compared experimentally with conventional catheters. RESULTS Clear advantages were found with the new catheters in pushability and trackability as they, more often than conventional catheters, permitted us to reach the periphery of an artery. Departmental experience with the new catheters currently amounts to over 500 arterial procedures. CONCLUSION The new catheters could frequently replace coaxial catheters, which would contribute towards reducing the costs of intravascular procedures.
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Affiliation(s)
- H M Hoogewoud
- Department of Radiology, Hôpital Cantonal, Fribourg, Switzerland
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Paúl L, Villar R, Sanchez A, García-Hidalgo E. Rupture of radiopaque tip of a Torcon MR catheter. J Vasc Interv Radiol 1997; 8:300-1. [PMID: 9084002 DOI: 10.1016/s1051-0443(97)70561-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
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Tomura N, Kobayashi M, Hirano J, Watarai J, Okamoto Y, Togawa K, Kowada M, Murota H. Chemoembolization of head and neck cancer with carboplatine microcapsules. Acta Radiol 1996; 37:52-6. [PMID: 8611325 DOI: 10.1177/02841851960371p111] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Fourteen patients with malignant tumor in the head and neck region were treated with infusion of carboplatine microcapsules (CBDCA-mc) via percutaneous super-selective catheterization. A microcatheter was advanced into a feeding artery using a coaxial catheter system. Eleven patients had over 30% reduction of the tumor size on CT within 1 month after embolization. Twelve patients had an increased amount of low attenuation tissue in the tumor on CT after embolization, suggesting increased necrosis in the tumor. No definite hematologic toxicity was found. A majority of patients complained of moderate pain in the embolized region immediately after embolization, easily relieved by i.v. analgesics. Chemoembolization using CBDCA-mc may be an effective therapeutic modality in advanced cases of head and neck cancer.
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Affiliation(s)
- N Tomura
- Department of Radiology, Akita University School of Medicine, Japan
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Abstract
A newly available Tracker-325 catheter (Target Therapeutics, Fremont, CA, USA), modified from the Tracker-18 catheter, has the same outer diameter but a larger lumen. This catheter was used in 15 patients during a 7-month period for superselective arterial catheterization when conventional catheters could not be placed successfully. Arterial embolization (n = 7), chemoembolization (n = 5), and chemoinfusion (n = 3), were performed. The increased luminal diameter of the Tracker-325 allowed an increased flow rate for diagnostic arteriography, accommodated larger embolic particles, and improved the ability to achieve a super-selective position.
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Affiliation(s)
- V P Chuang
- Department of Diagnostic Radiology, University of Texas M.D. Anderson Cancer Center, Houston 77030, USA
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49
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Kim JH, Chung JW, Han JK, Park JH, Choi BI, Han MC. Transcatheter arterial embolization of the internal mammary artery in hepatocellular carcinoma. J Vasc Interv Radiol 1995; 6:71-4; discussion 75-7. [PMID: 7703585 DOI: 10.1016/s1051-0443(95)71059-4] [Citation(s) in RCA: 44] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Affiliation(s)
- J H Kim
- Department of Radiology, Seoul National University, College of Medicine, Korea
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50
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Tomura N, Kato K, Sato K, Hirano H, Kobayashi M, Watarai J. [Chemoembolization of maxillary carcinoma via the superficial temporal artery using a coaxial catheter system]. Nihon Igaku Hoshasen Gakkai Zasshi 1995; 55:79-80. [PMID: 7899071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
To perform chemoembolization of maxillary carcinoma, an approach through the superficial temporal artery was applied. A 5-French guiding catheter was advanced into the maxillary artery. The microcatheter was advanced into the terminal portion of the maxillary artery through the guiding catheter, and then carboplatine microcapsules were infused into the feeding artery. Chemoembolization was performed twice in one patient and three times in another. This new method will make it feasible to repeat chemoembolization in patients with head and neck tumors.
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Affiliation(s)
- N Tomura
- Department of Radiology, Akita University, School of Medicine
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