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Sample records for transcatheter hepatic artery

  1. Influence of transcatheter hepatic artery embolization using iodized oil on radiofrequency ablation of hepatic neoplasms

    International Nuclear Information System (INIS)

    Du Xilin; Ma Qingjiu; Wang Yiqing; Wang Zhimin; Zhang Hongxin

    2004-01-01

    Objective: To observe the effect of iodized oil on radiofrequency thermal ablation (RFA) of hepatic neoplasms by using a cluster array of ten separate electrodes. Methods: The patients were divided into 2 groups, group A with transcatheter hepatic artery embolization, group B without transcatheter hepatic artery embolization. All patients were undergone radiofrequency ablation of hepatic neoplasms. Results: The time of RFA for group A was (9 ± 2.1) minutes, showing the diameter of necrosis of (5.3 ± 1.4) cm. The time of RFA for group B was (16 ± 4. 6) minutes demonstrating the diameter of necrosis of (3.5 ± 1.8) cm (P<0.01). Conclusions: These findings suggest that radiofrequency thermal ablation of hepatic neoplasms with transcatheter hepatic artery embolization using iodized oil might improve the safety and synergic effect

  2. Evaluation of hepatic atrophy after transcatheter arterial embolization

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    Chung, Hwan Hoon; Lee, Mee Ran; Oh, Min Cheol; Park, Chul Min; Seol, Hae Young; Cha, In Ho

    1995-01-01

    Hepatic atrophy has been recognized as a complication of hepatic and biliary disease but we have often found it in follow up CT after transcatheter arterial embolization (TACE). The purpose of this study is to evaluate the characteristics of hepatic atrophy after TACE. Of 53 patients who had TACE. We evaluated the relationship between the incidence of hepatic atrophy and the number of TACE, and also evaluated the average number of TACE in patients with hepatic atrophy. Of 20 patients who had received more than average number of TACE for development of hepatic atrophy (2 times with portal vein obstruction, 2.7 times without portal vein obstruction in this study), we evaluated the relationship between the lipiodol uptake pattern of tumor and the incidence of hepatic atrophy. There were 8 cases of hepatic atrophy (3 with portal vein obstruction, 5 without portal vein obstruction), average number for development of hepatic atrophy were 2.5 times. As the number of TACE were increased, the incidence of hepatic atrophy were also increased. Of 20 patients who received more than average number of TACE for development of hepatic atrophy, we noted 6 cases of hepatic atrophy in 11 patients with dense homogenous lipiodol uptake pattern of tumor and noted only 1 case of hepatic atrophy in 9 patient with inhomogenous lipiodol uptake pattern. Hepatic atrophy was one of the CT findings after TACE even without portal vein obstruction. Average number of TACE was 2.5 times and risk factors for development of hepatic atrophy were portal vein obstruction, increased number of TACE, and dense homogenous lipiodol uptake pattern of tumor

  3. Transcatheter hepatic arterial thermo-chemotherapy and thermo-lipiodol embolization for the treatment of hepatic metastases from colorectal carcinoma

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    Wang Xuan; Chen Xiaofei

    2009-01-01

    Objective: To evaluate the clinical efficacy of transcatheter hepatic arterial thermo-chemotherapy and thermo-lipiodol embolization in the treatment of hepatic metastases from colorectal carcinoma. Methods: Sixty-eight cases with hepatic metastases from colorectal carcinoma were equally and randomly divided into two groups. The patients in study group were treated with transcatheter hepatic arterial thermo-chemotherapy and thermo-lipiodol embolization, while the patients in control group were treated with conventional (normal temperature) transcatheter hepatic arterial chemotherapy lipiodol embolization. Results: The effective rate of study group and control group was 65%(22/34) and 32%(11/34) respectively, the difference between two groups was statistically significant (P<0.05). No significant difference in the postoperative changes of hepatic function tests was found between the two groups. The survival rate at 6,12,18 and 24 months after the treatment was 100%, 82%, 44% and 18% respectively in study group, while it was 91%, 47%, 15% and 6% respectively in control group. Conclusion: Transcatheter hepatic arterial thermo-chemotherapy and thermo-lipiodol embolization is an effective and safe treatment for the hepatic metastases from colorectal carcinoma and has no obvious damage to the hepatic function. (authors)

  4. An experimental study on combined transcatheter hepatic arterial embolization and retrograde hepatic venous embolization

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    Wang Maoqiang; Zhang Jinshan; Xing Zhanhai

    1997-01-01

    The experimental study is aimed at achieving the effect of hepatic tumor and tumor-bearing lobar or segmental resection by using combined transcatheter hepatic arterial embolization and retrograde hepatic venous embolization (THAE-RHVE) in experimental study. THAE-RHVE was carried out in 8 mongrel dogs. Hepatic arterial embolization was performed by injecting lipiodol followed by gelatin sponge particles, following complete occlusion of the hepatic vein with balloon catheter. Retrograde hepatic venous embolization (RHVE) was then performed by injecting a mixture of absolute ethanol and meglumini diatrizoatis (MD) via the inflated balloon catheter. Ethanol and MD were combined with a ratio of 1:1. RHVE alone was performed in 4 dogs as control. The animals were followed up for 1∼8 weeks with liver function test, CT, gross and microscopic examinations. There was no technical failure or procedural complications. Transient elevation of AST and ALT levels was seen immediately in both groups after the procedure. Follow-up CT after 3 weeks showed dense lipiodol accumulation in the embolized lobe or segment and the corresponding portal branches in the THAE-RHVE animals. At 1 week after THAE-RHVE, complete coagulation necrosis was seen at histologic examination in the embolized lobe. The hepatic vein and portal branches of the embolized area had thickened walls and were filled with thrombus. At 2 weeks, granulomatous tissue and inflammatory cell infiltration surrounding the necrotic area could be seen. At 4∼8 weeks, marked atrophy of the embolized lobe was found, and the necrotic area was progressively reducing in size and being replaced by fibrosis. In the control group, incomplete segmental coagulated necrosis was seen and the necrosis area wa smaller than that of THAE-REVE. Hepatic lobectomy or segmentectomy can be achieved with THAE-RHVE. This new method is safe and easy, and may be useful in the treatment of HCC

  5. Transcatheter Arterial Chemoembolization Based on Hepatic Hemodynamics for Hepatocellular Carcinoma

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    Satoru Murata

    2013-01-01

    Full Text Available Hepatocellular carcinoma (HCC is the sixth most common cancer and the third leading cause of cancer-related deaths in the world. The Barcelona Clinic Liver Cancer (BCLC classification has recently emerged as the standard classification system for clinical management of patients with HCC. According to the BCLC staging system, curative therapies (resection, transplantation, and percutaneous ablation can improve survival in HCC patients diagnosed at an early stage and offer potential long-term curative effects. Patients with intermediate-stage HCC benefit from transcatheter arterial chemoembolization (TACE, and those diagnosed at an advanced stage receive sorafenib, a multikinase inhibitor, or conservative therapy. Most patients receive palliative or conservative therapy only, and approximately 50% of patients with HCC are candidates for systemic therapy. TACE is often recommended for advanced-stage HCC patients all over the world because these patients desire therapy that is more effective than systemic chemotherapy or conservative treatment. This paper aims to summarize both the published data and important ongoing studies for TACE and to discuss technical improvements in TACE for advanced-stage HCC.

  6. Study of the additional filter in transcatheter hepatic arterial embolization

    International Nuclear Information System (INIS)

    Hitomi, Go; Arao, Shinichi; Tomomitsu, Tatsushi

    2010-01-01

    It is well known that Interventional Radiology (IVR) is useful. However, the patient dose in IVR is increasing because of the prolongation of fluoroscopic time and the increase in the number of radiographies in recent years. We studied the adequacy of the additional filter for the decrease of the skin surface dose in patients with hepatocellular carcinoma of transcatheter arterial embolization (TAE). In 20 patients (15 men and 5 women, average age: 66.9 and 72.0 years old) who had undergone TAE, we estimated the skin surface dose from the records of their exposure condition (tube voltage, tube current, time, and field size of image intensifier) and the results of the phantom experiment with 2 kinds of additional filter. The estimated skin surface dose of the patient was 1.75±0.84 with the additional filter of 1.5 mm thickness of aluminum (1.5 mmAl), 1.46±0.67 Gy with 0.03 mm thickness tantalum (0.03 mmTa) and 1.17±0.55 Gy with 0.06 mm thickness of tantalum (0.06 mmTa). Against a skin surface dose of 1.5 mmAl, the dose reduction of 16.7% was shown in 0.03 mmTa and 33.2% in 0.06 mmTa. With a digital subtraction angiography (DSA) phantom of iodine density 0.5 and 1.0 and 2.0 mgI/ml, DSA images were acquisitioned at tube voltage 70, 80 and 90 kV to compare the detectability of contrast media in 0.06 mmTa with 1.5 mmAl. To evaluate the detectability of contrast media in 0.06 mmTa in 1.5 mmAl, receiver operating characteristic (ROC) analysis was performed with the pixel value of the phantom image. The area under the ROC curve in a 1.5 mmAl filter and the 0.06 mmTa filter provided with each contrast media density and each tube voltage was approximately a constant value. It was suggested that there was no differences in the detectability of contrast media in both additional filters. In conclusion, the skin surface dose of the patient was able to be reduced 33.2% without decreasing contrast media detectability by changing the additional filter from 1.5 mmAl to 0.06 mm

  7. Changes in Hepatic Blood Flow During Transcatheter Arterial Infusion with Heated Saline in Hepatic VX2 Tumor

    International Nuclear Information System (INIS)

    Cao Wei; Li Jing; Wu Zhiqun; Zhou Changxi; Liu Xi; Wan Yi; Duan Yunyou

    2013-01-01

    Purpose. This study evaluates the influence of transcatheter arterial infusion with heated saline on hepatic arterial and portal venous blood flows to tumor and normal hepatic tissues in a rabbit VX2 tumor model. Methods. All animal experiments were approved by the institutional animal care and use committee. Twenty rabbits with VX2 liver tumors were divided into the following two groups: (a) the treated group (n = 10), which received a 60 mL transarterial injection of 60 °C saline via the hepatic artery; (b) the control group (n = 10), which received a 60 mL injection of 37 °C saline via the hepatic artery. Using ultrasonography, the blood flows in both the portal vein and hepatic artery were measured, and the changes in the hemodynamic indices were recorded before and immediately after the injection. The changes in the tumor and normal liver tissues of the two groups were histopathologically examined by hematoxylin and eosin staining after the injection. Results. After the transcatheter arterial heated infusion, there was a decrease in the hepatic arterial blood flow to the tumor tissue, a significant decrease in the hepatic artery mean velocity (P < 0.05), and a significant increase in the resistance index (P < 0.05). On hematoxylin and eosin staining, there were no obvious signs of tissue destruction in the normal liver tissue or the tumor tissue after heated perfusion, and coagulated blood plasma was observed in the cavities of intratumoral blood vessels in the treated group. Conclusions. The changes in tumor blood flow in the rabbit VX2 tumor model were presumably caused by microthrombi in the tumor vessels, and the portal vein likely mediated the heat loss in normal liver tissue during the transarterial heated infusion.

  8. Changes in Hepatic Blood Flow During Transcatheter Arterial Infusion with Heated Saline in Hepatic VX2 Tumor

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    Cao Wei, E-mail: cawe-001@163.com [Tangdu Hospital, The Fourth Military Medical University, Department of Interventional Radiology (China); Li Jing, E-mail: lijing02@fmmu.edu.cn [Tangdu Hospital, The Fourth Military Medical University, Department of Burn and Plastic Surgery (China); Wu Zhiqun, E-mail: zhiqunwu@fmmu.edu.cn [Tangdu Hospital, The Fourth Military Medical University, Department of Interventional Radiology (China); Zhou Changxi, E-mail: changxizhou@163.com [Chinese PLA General Hospital, Department of Respiratory Disease (China); Liu Xi, E-mail: xiliu@fmmu.edu.cn [Tangdu Hospital, The Fourth Military Medical University, Department of Ultrasound Diagnostics (China); Wan Yi, E-mail: yiwan@163.com [The Fourth Military Medical University, Department of Health Statistics, Institute for Health Informatics (China); Duan Yunyou, E-mail: yunyouduan@fmmu.edu.cn [Tangdu Hospital, The Fourth Military Medical University, Department of Ultrasound Diagnostics (China)

    2013-06-15

    Purpose. This study evaluates the influence of transcatheter arterial infusion with heated saline on hepatic arterial and portal venous blood flows to tumor and normal hepatic tissues in a rabbit VX2 tumor model. Methods. All animal experiments were approved by the institutional animal care and use committee. Twenty rabbits with VX2 liver tumors were divided into the following two groups: (a) the treated group (n = 10), which received a 60 mL transarterial injection of 60 Degree-Sign C saline via the hepatic artery; (b) the control group (n = 10), which received a 60 mL injection of 37 Degree-Sign C saline via the hepatic artery. Using ultrasonography, the blood flows in both the portal vein and hepatic artery were measured, and the changes in the hemodynamic indices were recorded before and immediately after the injection. The changes in the tumor and normal liver tissues of the two groups were histopathologically examined by hematoxylin and eosin staining after the injection. Results. After the transcatheter arterial heated infusion, there was a decrease in the hepatic arterial blood flow to the tumor tissue, a significant decrease in the hepatic artery mean velocity (P < 0.05), and a significant increase in the resistance index (P < 0.05). On hematoxylin and eosin staining, there were no obvious signs of tissue destruction in the normal liver tissue or the tumor tissue after heated perfusion, and coagulated blood plasma was observed in the cavities of intratumoral blood vessels in the treated group. Conclusions. The changes in tumor blood flow in the rabbit VX2 tumor model were presumably caused by microthrombi in the tumor vessels, and the portal vein likely mediated the heat loss in normal liver tissue during the transarterial heated infusion.

  9. Hepatocellular carcinoma with extensive hepatic artery injury: transcatheter arterial chemoembolization through collaterals after coil embolizatoin of gastric arteries

    International Nuclear Information System (INIS)

    Kim, Gab Choul; Yoon, Hyun Ki; Hwang, Jae Cheol; Lee, Duck Hee; Song, Ho Young; Suh, Dong Jin; Lee, Yung Sang; Chung, Young Hwa; Sung, Gyu Bo; Ko, Ki Young

    1999-01-01

    To evaluate the efficacy and safety of transcatheter arterial chemoembolization(TACE) after coil embolization of the gastroduodenal artery in hepatocellular carcinoma cases with multiple collateral arteries caused by proper hepatic artery injury. Between March 1997 and November 1998, a prospective trial of transcatheter arterial chemoembolization (TACE) was performed through collaterals from the gastroduodenal artery of 31 hepatocellular carcinoma patients with extensive proper hepatic artery injury due to repeated TACE. Among this number, 16 (group A) underwent TACE after coil embolization of the right gastric and gastroduodenal artery. The other 15 patients (group B) underwent TACE without coil embolization. The two groups had the same TNM stage and Clild-Pugh status. During the follow-up period, group A underwent additional TACE 3.3 times, and group B 2.8 times. The therapeutic effect of TACE was evaluated with computed tomography and by measuring alpha-fetoprotein levels. Complications were evaluated by means of gastrofibroscopy, laboratory data, and evaluation of the patients' clinical symptoms. The results obtained after six months and one year were compared within and between each group. At six months follow-up, CT findings had improved or were unchanged in 11 patients(69 %) in group A, and four patients(27 %) in group B(p = 0.032). In ten patients in each group, the level of alpha-fetoprotein was above 200 ng/ml. Its level was decreased in five patients(50 %) and three patients(30 %), respectively. The six-month survival rate was 81 % (13/16) in group A and 67% (10/15) in group B (p 0.43), while the one-year survival figures for these two groups were 50 % (8/16) and 20 % (3/15), respectively(p = 0.135). In group A, the CT findings were steady in five out of eight patients(63 %), while in groupB, CT findings showed that tumors with increased alpha-fetoprotein levels had increased in size and/or number. In group A, it was found that in two (33 %) of six

  10. Hepatocellular carcinoma with extensive hepatic artery injury: transcatheter arterial chemoembolization through collaterals after coil embolizatoin of gastric arteries

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    Kim, Gab Choul; Yoon, Hyun Ki; Hwang, Jae Cheol; Lee, Duck Hee; Song, Ho Young; Suh, Dong Jin; Lee, Yung Sang; Chung, Young Hwa; Sung, Gyu Bo [Ulsan Univ. College of Medicine, Seoul (Korea, Republic of); Ko, Ki Young [Catholic Univ. College of Medicine, Seoul (Korea, Republic of)

    1999-09-01

    To evaluate the efficacy and safety of transcatheter arterial chemoembolization(TACE) after coil embolization of the gastroduodenal artery in hepatocellular carcinoma cases with multiple collateral arteries caused by proper hepatic artery injury. Between March 1997 and November 1998, a prospective trial of transcatheter arterial chemoembolization (TACE) was performed through collaterals from the gastroduodenal artery of 31 hepatocellular carcinoma patients with extensive proper hepatic artery injury due to repeated TACE. Among this number, 16 (group A) underwent TACE after coil embolization of the right gastric and gastroduodenal artery. The other 15 patients (group B) underwent TACE without coil embolization. The two groups had the same TNM stage and Clild-Pugh status. During the follow-up period, group A underwent additional TACE 3.3 times, and group B 2.8 times. The therapeutic effect of TACE was evaluated with computed tomography and by measuring alpha-fetoprotein levels. Complications were evaluated by means of gastrofibroscopy, laboratory data, and evaluation of the patients' clinical symptoms. The results obtained after six months and one year were compared within and between each group. At six months follow-up, CT findings had improved or were unchanged in 11 patients(69 %) in group A, and four patients(27 %) in group B(p = 0.032). In ten patients in each group, the level of alpha-fetoprotein was above 200 ng/ml. Its level was decreased in five patients(50 %) and three patients(30 %), respectively. The six-month survival rate was 81 % (13/16) in group A and 67% (10/15) in group B (p 0.43), while the one-year survival figures for these two groups were 50 % (8/16) and 20 % (3/15), respectively(p = 0.135). In group A, the CT findings were steady in five out of eight patients(63 %), while in groupB, CT findings showed that tumors with increased alpha-fetoprotein levels had increased in size and/or number. In group A, it was found that in two (33 %) of six

  11. Clinical Analysis of Pulmonary Lipiodol Embolism in Patients with Hepatic Carcinoma after Transcatheter Arterial Chemoembolization

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    Wen-jin JIANG

    2015-03-01

    Full Text Available Objective:To explore the clinical manifestations, therapeutic methods and preventive measures of pulmonary lipiodol embolism (PLE induced by transcatheter arterial chemoembolization (TACE so as to improve the cognition and management of PLE. Methods:A total of 2 613 patients with hepatic cancer without history of pulmonary disease who were treated with TACE in our hospital from Sept., 2004 to Mar., 2013 were selected. The clinical manifestations, therapeutic methods and preventing measures of the 9 patients who were accompanied with PLE were observed to analyze the pre-operative hepatic computed tomography (CT and chest X-ray, intra-operative contrast examination, dosage of lipiodol and chemotherapeutic drugs, clinical manifestation and therapeutic progression as well as the postoperative follow-up.Results: Nine patients accompanied by PLE had different-severity cough, hemoptysis and progressive dyspnea, and chest X-ray and/or CT showed flaky high-density radiography. After treated with oxygen inhalation, bronchus expansion and inflammation alleviation, 8 patients were improved but 1 died. Of the 8 patients, 2 were given ventilator to assist breath, and the clinical symptoms of 8 patients disappeared within 3-15 d. The re-examined chest X-ray showed normal after 20-60 d follow-up observation. Additionally, 6 patients were with nidus diameter ≥10 cm, 6 with hepatic artery-vein fistula and 7 with lipiodol dosage ≥20 mL.Conclusion: PLE often occurs in patients with giant hepatic carcinoma accompanied by hepatic artery-vein fistula, whose lipiodol dosage is ≥20 mL. Accurate and correct management during operation can effectively reduce the development of PLE.

  12. Incidentally Detected Inoperable Malignant Pheochromocytoma with Hepatic Metastasis Treated by Transcatheter Arterial Chemoembolization

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    Joong Keun Kim

    2014-12-01

    Full Text Available Malignant pheochromocytoma (PCC is a rare condition. Although the liver is the second most frequent site of metastasis in malignant PCC, no definite treatments have been established. Herein, we report a case of liver metastasis of PCC that was successfully treated by transcatheter arterial chemoembolization (TACE. A 69-year-old man was admitted to the Department of Gastroenterology for evaluation of an incidental hepatic mass in August 2013. He had undergone right adrenalectomy in May 2005 and PCC had been confirmed on the basis of histopathological findings. Liver biopsy was performed, and metastatic PCC was diagnosed. The lesion appeared inoperable because of invasion of the portal vein and metastases in the lymph nodes along the hepatoduodenal ligament. Thus, TACE was performed instead. After TACE, symptoms including dizziness and cold sweating improved, and the patient's serum catecholamine levels decreased. On the basis of this case, we believe that TACE may be a useful treatment for liver metastasis in malignant PCC.

  13. Treatment of primany hepatic carcinoma with three-dimensional conformal radiation therapy combined with transcatheter arterial chemoembolization

    International Nuclear Information System (INIS)

    Wu Li; Wen Xiaoping; Huang Wei

    2006-01-01

    Objective: To evaluate the effects of three-dimensional conformal radiation therapy (3DCRT) combined with transcatheter arterial chemoembolization (TACE) on stage m/IV primary hepatic carcinoma. Methods: Eighty cases of stage III/IV primary hepatic carcinoma were randomly divided into two groups: 40 cases treated with three-dimensional conformal radiation therapy combined with transcatheter arterial chemoembolization (3DCRT + TACE group) and 40 cases treated with three-dimensional conformal radiation therapy associated with hepatic arterial infusion chemotherapy (3DCRT +HAI group). Results: The response rates were 75% and 45% in 3DCRT + TACE group and 3DCRT + HAI group, respectively; and the difference between the two groups was statistically significant (P 0.05), The 0.5-, 1- and 2-year survival rates were 73% , 45% and 28% in 3DCRT + TACE group, and 45%, 25% and 13% in 3DCRT + HAI group, respectively; and the difference between the two groups was statistically significant (P 0.05). Conclusion: Three-dimensional conformal radiation therapy combined with transcatheter arterial chemoembolization improved prognosis of stage III/IV primary hepatic carcinoma. (authors)

  14. Ischemic Cholangitis Caused by Transcatheter Hepatic Arterial Chemoembolization 10 Months After Resection of the Extrahepatic Bile Duct

    International Nuclear Information System (INIS)

    Hasegawa, Kiyoshi; Kubota, Keiichi; Aoki, Taku; Hirai, Ichiro; Miyazawa, Masashi; Ohtomo, Kuni; Makuuchi, Masatoshi

    2000-01-01

    We report a case of ischemic cholangitis that occurred after transcatheter hepatic arterial chemoembolization (TAE). Ten months prior to TAE the patient had undergone central bisegmentectomy for hepatocellular carcinoma with resection of the extrahepatic bile duct. Eleven days after TAE, he developed suppurative cholangitis and multiple organ failure. Prior surgical ligation of the peribiliary arteries around the extrahepatic bile duct followed by TAE was considered to have played a crucial role in the development of ischemic cholangitis. This case demonstrates the importance of blood flow from the peribiliary arteries for the survival of the biliary epithelium

  15. Comparison of survival rates among different treatment methods of transcatheter hepatic arterial chemoembolization for hepatocellular carcinoma

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    Shim, Yong Woon; Lee, Jong Tae; Yoo, Hyung Sik; Lee, Do Yun; Jun, Pyoung Jun; Chang, So Yong [Yonsei Univ. College of Medicine, Seoul (Korea, Republic of)

    1996-06-01

    To compare the survival rates of patients with hepatoma using different methods of transcatheter arterial chemoemblization(THAE). Four hundred and eighty three patients with hepatoma diagnosed by biopsy, serum alpha-fetoprotein, abdominal CT scan, abdominal ultrasonography or hepatic angiography were included, but not all had received surgical treatment. They were divided onto two groups according to Child's classification and into subgroups according to different methods of THAE. Five-tear survival rates among these groups were retrospectively compared. The patients were aged between 24 and 85(mean, 58) ; male to female ratio was 324 : 61 for those who received THAE (369 : 87 when only hepatic angiography was considered.). In the group with more than a single episode of chemoembolization, regardless of Child's classification, a better survival rate compared to the other groups with or without concommitant radiotherapy or without chemoembolization was noted. There was no difference in the survival rate of patients with multiple chemoembolization. moreover, no difference in this rate was observed no matter what chemotherapeutic agents, including Adriamycin, Cis-Diaminedichloroplatinum of I-131-Lipiodol, were used. Amortization by gelfoam in conjuction with Adriamycin resulted in no difference in survival rate regardless of frequency of chemoembolization. An improved survival rate was seen when multiple episodes of chemoembolization were applied, but no difference was seen when there was concomitant application of either gelfoam or radiotherapy. Two different chemotherapeutic agents, Adriamycin and Cis-Diaminedichloroplatinum, were used, but there was no difference between them in their effect on survival rates.

  16. Transcatheter arterial embolization with trisacryl gelatin microspheres (Embosphere®) leads to life-threatening tumor lysis syndrome in a rectal carcinoid patient with hepatic metastases

    International Nuclear Information System (INIS)

    Lo, Yuan-Hao; Tsai, Ming-Tsun; Kuo, Chen-Yu; Liu, Wen-Sheng; Lee, Rheun-Chuan; Yeh, Yi-Chen; Li, Chung-Pin; Chen, Jinn-Yang; Chao, Yee

    2012-01-01

    The incidence of gastrointestinal carcinoids appears to be increasing, and the rectum is the third most common location. Transcatheter arterial embolization (TAE) with trisacryl gelatin microspheres (Embosphere ® ) has been reported as an effective method for hepatic metastases of rectal carcinoids. Complications are uncommon and usually of minor consequence. We report an unusual case of a 34-year-old man with tumor lysis syndrome following TAE with Embosphere ® in a patient with multiple hepatic metastases of a rectal carcinoid. Early detection and effective treatment are essential for this rare but potentially catastrophic complication

  17. Transcatheter arterial embolization for traumatic bleeding control

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    Ryu, Choon Wook; Lee, Sang Kwon; Suh, Kyung Jin; Kim, Tae Heon; Kim, Yong Joo; Kang, Duck Sik

    1989-01-01

    Angiography is essential for the detection of bleeding vessels in traumatic vascular injury. Immediately after the diagnosis, transcatheter embolization can be performed for the control of bleeding effectively and easily with proper use of embolic materials. Transcatheter embolization is believed to be the treatment of choice when emergency control is needed, where surgical approach is difficult and in those who are poor candidate for surgery. We have tried bleeding control in 18 cases of trauma over recent 4 years. The results were as follows; 1. Causes of bleeding(cases): Blunt or penetrating trauma (10), latrogenic trauma (8), (Postoperative (5), Needle biopsy (2), Percutaneous hepatic procedure (1)) 2. Embolized vessels: Renal artery branches (8), Hepatic artery branches (2), Arteries supplying chest wall (2), External carotid artery branches (3), Internal carotid artery (1), Circumflex humeral artery (1), Internal iliac artery branches (1). 3. Embolic agents: Gelfoam cubes (16), Stainless steel coils (3), Detachable latex balloon (1). 4. Successful bleeding control was achieved in 17 cases and reduction of the amount of bleeding in one case without significant complications

  18. Quantitative Real-Time Fluoroscopy Analysis on Measurement of the Hepatic Arterial Flow During Transcatheter Arterial Chemoembolization of Hepatocellular Carcinoma: Comparison with Quantitative Digital Subtraction Angiography Analysis

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    Lin, Yi-Yang; Lee, Rheun-Chuan, E-mail: rclee@vghtpe.gov.tw; Guo, Wan-Yuo, E-mail: wyguo@vghtpe.gov.tw; Chu, Wei-Fa [Taipei Veterans General Hospital, Department of Radiology (China); Wu, Frank Chun-Hsien [Siemens Healthcare Ltd. (China); Gehrisch, Sonja [Siemens Healthcare GmbH (Germany)

    2016-11-15

    PurposeTo quantify the arterial flow change during transcatheter arterial chemoembolization (TACE) for hepatocellular carcinoma (HCC) using digital subtraction angiography, quantitative color-coding analysis (d-QCA), and real-time subtraction fluoroscopy QCA (f-QCA).Materials and MethodsThis prospective study enrolled 20 consecutive patients with HCC who had undergone TACE via a subsegmental approach between February 2014 and April 2015. The TACE endpoint was a sluggish antegrade tumor-feeding arterial flow. d-QCA and f-QCA were used for determining the relative maximal density time (rT{sub max}) of the selected arteries. The rT{sub max} of the selected arteries was analyzed in d-QCA and f-QCA before and after TACE, and its correlation in both analyses was evaluated.ResultsThe pre- and post-TACE rT{sub max} of the embolized segmental artery in d-QCA and f-QCA were 1.59 ± 0.81 and 2.97 ± 1.80 s (P < 0.001) and 1.44 ± 0.52 and 2.28 ± 1.02 s (P < 0.01), respectively. The rT{sub max} of the proximal hepatic artery did not significantly change during TACE in d-QCA and f-QCA. The Spearman correlation coefficients of the pre- and post-TACE rT{sub max} of the embolized segmental artery between d-QCA and f-QCA were 0.46 (P < 0.05) and 0.80 (P < 0.001). Radiation doses in one series of d-QCA and f-QCA were 140.7 ± 51.5 milligray (mGy) and 2.5 ± 0.7 mGy, respectively.Conclusionsf-QCA can quantify arterial flow changes with a higher temporal resolution and lower radiation dose. Flow quantification of the embolized segmental artery using f-QCA and d-QCA is highly correlated.

  19. Quantitative Real-Time Fluoroscopy Analysis on Measurement of the Hepatic Arterial Flow During Transcatheter Arterial Chemoembolization of Hepatocellular Carcinoma: Comparison with Quantitative Digital Subtraction Angiography Analysis

    International Nuclear Information System (INIS)

    Lin, Yi-Yang; Lee, Rheun-Chuan; Guo, Wan-Yuo; Chu, Wei-Fa; Wu, Frank Chun-Hsien; Gehrisch, Sonja

    2016-01-01

    PurposeTo quantify the arterial flow change during transcatheter arterial chemoembolization (TACE) for hepatocellular carcinoma (HCC) using digital subtraction angiography, quantitative color-coding analysis (d-QCA), and real-time subtraction fluoroscopy QCA (f-QCA).Materials and MethodsThis prospective study enrolled 20 consecutive patients with HCC who had undergone TACE via a subsegmental approach between February 2014 and April 2015. The TACE endpoint was a sluggish antegrade tumor-feeding arterial flow. d-QCA and f-QCA were used for determining the relative maximal density time (rT_m_a_x) of the selected arteries. The rT_m_a_x of the selected arteries was analyzed in d-QCA and f-QCA before and after TACE, and its correlation in both analyses was evaluated.ResultsThe pre- and post-TACE rT_m_a_x of the embolized segmental artery in d-QCA and f-QCA were 1.59 ± 0.81 and 2.97 ± 1.80 s (P < 0.001) and 1.44 ± 0.52 and 2.28 ± 1.02 s (P < 0.01), respectively. The rT_m_a_x of the proximal hepatic artery did not significantly change during TACE in d-QCA and f-QCA. The Spearman correlation coefficients of the pre- and post-TACE rT_m_a_x of the embolized segmental artery between d-QCA and f-QCA were 0.46 (P < 0.05) and 0.80 (P < 0.001). Radiation doses in one series of d-QCA and f-QCA were 140.7 ± 51.5 milligray (mGy) and 2.5 ± 0.7 mGy, respectively.Conclusionsf-QCA can quantify arterial flow changes with a higher temporal resolution and lower radiation dose. Flow quantification of the embolized segmental artery using f-QCA and d-QCA is highly correlated.

  20. Clinical effects of transcatheter hepatic arterial embolization with holmium-166 poly(l-lactic acid) microspheres in healthy pigs

    Energy Technology Data Exchange (ETDEWEB)

    Vente, M.A.D.; Nijsen, J.F.W.; Wit, T.C. de; Schip, A.D. van het [University Medical Center Utrecht, Department of Nuclear Medicine, P.O. Box 85500, Utrecht (Netherlands); Seppenwoolde, J.H.; Seevinck, P.R. [University Medical Center Utrecht, Image Sciences Institute, Utrecht (Netherlands); Krijger, G.C. [Delft University of Technology, Department of Radiation, Radionuclides and Reactors, Faculty of Applied Sciences, Delft (Netherlands); Huisman, A. [University Medical Center Utrecht, Department of Clinical Chemistry and Haematology, Utrecht (Netherlands); Zonnenberg, B.A. [University Medical Center Utrecht, Department of Internal Medicine, Utrecht (Netherlands); Ingh, T.S.G.A.M. van den [TCCI Consultancy B.V., P.O. Box 85032, Utrecht (Netherlands)

    2008-07-15

    The aim of this study is to evaluate the toxicity of holmium-166 poly(l-lactic acid) microspheres administered into the hepatic artery in pigs. Healthy pigs (20-30 kg) were injected into the hepatic artery with holmium-165-loaded microspheres ({sup 165}HoMS; n = 5) or with holmium-166-loaded microspheres ({sup 166}HoMS; n = 13). The microspheres' biodistribution was assessed by single-photon emission computed tomography and/or MRI. The animals were monitored clinically, biochemically, and ({sup 166}HoMS group only) hematologically over a period of 1 month ({sup 165}HoMS group) or over 1 or 2 months ({sup 166}HoMS group). Finally, a pathological examination was undertaken. After microsphere administration, some animals exhibited a slightly diminished level of consciousness and a dip in appetite, both of which were transient. Four lethal adverse events occurred in the {sup 166}HoMS group due either to incorrect administration or comorbidity: inadvertent delivery of microspheres into the gastric wall (n = 2), preexisting gastric ulceration (n = 1), and endocarditis (n = 1). AST levels were transitorily elevated post-{sup 166}HoMS administration. In the other blood parameters, no abnormalities were observed. Nuclear scans were acquired from all animals from the {sup 166}HoMS group, and MRI scans were performed if available. In pigs from the {sup 166}HoMS group, atrophy of one or more liver lobes was frequently observed. The actual radioactivity distribution was assessed through ex vivo {sup 166m}Ho measurements. It can be concluded that the toxicity profile of HoMS is low. In pigs, hepatic arterial embolization with {sup 166}HoMS in amounts corresponding with liver-absorbed doses of over 100 Gy, if correctly administered, is not associated with clinically relevant side effects. This result offers a good perspective for upcoming patient trials. (orig.)

  1. Inferior phrenic artery embolization in the treatment of hepatic neoplasms

    International Nuclear Information System (INIS)

    Duprat, G.; Charnsangavej, C.; Wallace, S.; Carrasco, C.H.

    1988-01-01

    Twenty-nine inferior phrenic artery embolizations were performed in 20 patients with primary or metastatic hepatic neoplasms. All patients had interruption of their hepatic arteries by previous infusion of chemotherapy, hepatic arterial embolization or surgical ligation. In one patient, bilateral pleural effusions developed following embolization of the inferior phrenic artery. No other severe complications occurred. Inferior phrenic artery embolization is a safe procedure and permits the continuation of transcatheter treatment of hepatic neoplasms. (orig.)

  2. Inferior phrenic artery embolization in the treatment of hepatic neoplasms

    Energy Technology Data Exchange (ETDEWEB)

    Duprat, G.; Charnsangavej, C.; Wallace, S.; Carrasco, C.H.

    Twenty-nine inferior phrenic artery embolizations were performed in 20 patients with primary or metastatic hepatic neoplasms. All patients had interruption of their hepatic arteries by previous infusion of chemotherapy, hepatic arterial embolization or surgical ligation. In one patient, bilateral pleural effusions developed following embolization of the inferior phrenic artery. No other severe complications occurred. Inferior phrenic artery embolization is a safe procedure and permits the continuation of transcatheter treatment of hepatic neoplasms.

  3. Transcatheter Coil Embolization of Splenic Artery Aneurysm

    International Nuclear Information System (INIS)

    Yamamoto, Satoshi; Hirota, Shozo; Maeda, Hiroaki; Achiwa, Sachiko; Arai, Keisuke; Kobayashi, Kaoru; Nakao, Norio

    2008-01-01

    The purpose of this study was to evaluate clinical results and technical problems of transcatheter coil embolization for splenic artery aneurysm. Subjects were 16 patients (8 men, 8 women; age range, 40-80 years) who underwent transcatheter embolization for splenic artery aneurysm (14 true aneurysms, 2 false aneurysms) at one of our hospitals during the period January 1997 through July 2005. Two aneurysms (12.5%) were diagnosed at the time of rupture. Multiple splenic aneurysms were found in seven patients. Aneurysms were classified by site as proximal (or strictly ostial) (n = 3), middle (n = 3), or hilar (n = 10). The indication for transcatheter arterial embolization was a false or true aneurysm 20 mm in diameter. Embolic materials were fibered coils and interlocking detachable coils. Embolization was performed by the isolation technique, the packing technique, or both. Technically, all aneurysms were devascularized without severe complications. Embolized aneurysms were 6-40 mm in diameter (mean, 25 mm). Overall, the primary technical success rate was 88% (14 of 16 patients). In the remaining 2 patients (12.5%), partial recanalization occurred, and re-embolization was performed. The secondary technical success rate was 100%. Seven (44%) of the 16 study patients suffered partial splenic infarction. Intrasplenic branching originating from the aneurysm was observed in five patients. We conclude that transcatheter coil embolization should be the initial treatment of choice for splenic artery aneurysm

  4. Hepatic falciform artery

    International Nuclear Information System (INIS)

    Jaques, Paul F.; Mauro, Matthew A.; Sandhu, Jeet

    1997-01-01

    The hepatic falciform artery is an occasional terminal branch of the left or middle hepatic artery, and may provide an uncommon but important collateral route when the principal visceral arteries are occluded

  5. Hepatocellular carcinoma: treatment with transcatheter arterial chemoembolization

    International Nuclear Information System (INIS)

    Acunas, Buelent; Rozanes, Izzet

    1999-01-01

    This article presents a review of the literature regarding the use of transcatheter arterial chemoembolization (TACE) in the treatment of hepatocellular carcinoma (HCC). There have been two different approaches to the treatment: (a) percutaneous tumor ablation methods which can be divided into injectable and thermal methods; percutaneous ethanol injection (PEI) is the most widely used method, and (b) TACE. PEI is the treatment of choice for single HCCs smaller or equal to 3 cm in size. For patients with large HCCs combined TACE and PEI is probably the most effective nonsurgical treatment. In the presence of multiple HCC nodules, TACE remains the treatment of choice

  6. A Meta-Analysis of Arsenic Trioxide Combined with Transcatheter Arterial Chemoembolization for Treatment of Primary Hepatic Carcinoma

    Directory of Open Access Journals (Sweden)

    Ling He

    2016-01-01

    Full Text Available Primary hepatic carcinoma (PHC is one of the most common malignant tumours in the world. More and more research has shown that As2O3 combined with TACE has a good curative effect in treating PHC. The objectives of this study were to evaluate the therapeutic efficacy and safety of As2O3 combined with TACE in treating PHC. The CNKI, VIP, Wanfang, PubMed, and Cochrane databases were searched from their inception until December 2015. Randomized controlled trials (RCTs comparing As2O3 combined with TACE versus TACE alone in treating PHC were identified. Stata SE 12.0 was used for data analysis. 17 RCTs with 1055 patients were included. Meta-analysis showed that, compared with TACE alone, As2O3 combined with TACE showed significant effects in improving the clinical efficacy rate (P<0.01, decreasing the value of alpha-fetoprotein (P<0.01, increasing the one-year survival rate (P<0.01, and improving the quality of life of PHC patients (P<0.01. Fifteen studies had mentioned adverse events, but no serious adverse effects were reported in any of the included trials. In conclusion, As2O3 combined with TACE therapy appears to be potentially effective in treating PHC and is generally safe. However, further studies with rigorous designs trials and multiregional cooperation trials are needed.

  7. Application of transcatheter arterial embolization in the intractable epistaxis

    International Nuclear Information System (INIS)

    Huang Zhaodong; Li Mingjun; Zhang Chuanwen

    2005-01-01

    Objective: To evaluate the value of transcatheter arterial embolization (TAE) in the treatment of intractable epistaxis. Methods: TAE using gel form or polyvinyl alcohol (PVA) particles of forty-one patients with intractable epistaxis were undertaken by the femoral artery approach, through selective catheterization of involved maxillary artery or the bleeding arteries for the stoppage of bleeding. Results: Of the forty-one patient, 39 cases were cured by once TAE and the other 2 with recurrent bleeding on the next day after the TAE, to whom a second interventional treatment full filled the requirement. Conclusions: Transcatheter arterial embolization is a simple, safe and effective treatment for the intractable epistaxis. (authors)

  8. Aberrant hepatic artery

    International Nuclear Information System (INIS)

    Konstam, M.A.; Novelline, R.A.; Athanasoulis, C.A.

    1979-01-01

    In a patient undergoing selective hepatic arteriography for suspected liver trauma, a nonopacified area of the liver, initially thought to represent a hepatic hematoma, was later discovered to be due to the presence of an accessory right hepatic artery arising from the superior mesenteric artery. This case illustrates the need for a search for aberrant vasculature whenever a liver hematoma is suspected on the basis of a selective hepatic arteriogram. (orig.) [de

  9. Rupture of hepatocellular carcinoma following transcatheter arterial chemoembolization: A case report

    Energy Technology Data Exchange (ETDEWEB)

    Kang, Hyo Jin; Lee, Byung Hoon; Hwang, Yoon Joon; Kim, Su Young; Lee, Ji Young [Ilsan Paik Hospital/Inje Univ. School of Medicine, Goyang (Korea, Republic of); Han, Yoon Hee [Seonam Hospital/Ewha Womans Univ. School of Medicine, Seoul (Korea, Republic of)

    2012-08-15

    Transcatheter arterial chemoembolization (TACE) is known to be an effective palliative treatment for unresectable hepatocellular carcinoma (HCC). Serious complications, such as neutropenic sepsis and hepatic decompensation, are well known. A HCC rupture following TACE is a rare complication; however, it can be life threatening if it occurs. In a 75 year old male patient who subsequently developed capsular rupture of the lipiodol laden mass and several free intraperitoneal chemoembolization agents with hemoperitoneum, we report a case of a ruptured HCC that superficially located arterial enhancing and early wash out mass in the right hepatic dome following TACE.

  10. Normal variation of hepatic artery

    International Nuclear Information System (INIS)

    Kim, Inn; Nam, Myung Hyun; Rhim, Hyun Chul; Koh, Byung Hee; Seo, Heung Suk; Kim, Soon Yong

    1987-01-01

    This study was an analyses of blood supply of the liver in 125 patients who received hepatic arteriography and abdominal aortography from Jan. 1984 to Dec. 1986 at the Department of Radiology of Hanyang University Hospital. A. Variations in extrahepatic arteries: 1. The normal extrahepatic artery pattern occurred in 106 of 125 cases (84.8%) ; Right hepatic and left hepatic arteries arising from the hepatic artery proper and hepatic artery proper arising from the common hepatic artery. 2. The most common type of variation of extrahepatic artery was replaced right hepatic artery from superior mesenteric artery: 6 of 125 cases (4.8%). B. Variations in intrahepatic arteries: 1. The normal intrahepatic artery pattern occurred in 83 of 125 cases (66.4%). Right hepatic and left hepatic arteries arising from the hepatic artery proper and middle hepatic artery arising from lower portion of the umbilical point of left hepatic artery. 2. The most common variation of intrahepatic arteries was middle hepatic artery. 3. Among the variation of middle hepatic artery; Right, middle and left hepatic arteries arising from the same location at the hepatic artery proper was the most common type; 17 of 125 cases (13.6%)

  11. Hepatic artery aneurysms (HAAs)

    International Nuclear Information System (INIS)

    Nosratini, H.

    2004-01-01

    The hepatic artery aneurysms are rare, especially in interahepatic branches, The frequency consists of 75-80% extrahepatic and 20-25% intrahepatic. Catheterization is achieved usually from common femoral artery, other methods implemented in the case of unsuccessful catheterization from femoral artery, are translumbar and brachial catheterization. The study consist of 565 patients that were referred to the angiography ward, During seven years of assessment, five cases of hepatic artery aneurysm were found; this is a rare condition reported in the English literature. In the literature as well as in this case report the hepatic artery aneurysms are rare. In reported series the extrahepatic artery aneurysms are found more often than in the intrahepatic artery aneurysm but in this case report intrahepatic artery aneurysms are more than extrahepatic one. (author)

  12. Transcatheter embolization of celiac artery pseudoaneurysm following pancreatico-duodenectomy for pancreatic cancer. A case report

    International Nuclear Information System (INIS)

    Mori, K.; Yoshioka, H.; Kuramochi, M.; Saida, Y.; Itai, Y.; Murata, S.; Michishita, N.; Oda, T.

    1998-01-01

    A case of transcatheter embolization of a celiac artery pseudoaneurysm in a 70-year-old man is reported. The pseudoaneurysm was considered to be the result of pancreatic anastomotic leakage and an intra-abdominal abscess following pancreaticoduodenectomy with irradiation of 66 Gy for pancreatic carcinoma. To avoid recanalization of the pseudoaneurysm due to retrograde blood flow, first all branches of the celiac artery were embolized with metallic coils, and then the celiac trunk was also occluded. Hepatic arterial flow was preserved by the right hepatic artery arising from the superior mesenteric artery. After the procedure, the patient had no noticeable complications associated with the embolization nor any recurrence of the pancreatic cancer, and he achieved a 2-year survival. (orig.)

  13. Transcatheter embolization of celiac artery pseudoaneurysm following pancreatico-duodenectomy for pancreatic cancer. A case report

    Energy Technology Data Exchange (ETDEWEB)

    Mori, K.; Yoshioka, H.; Kuramochi, M.; Saida, Y.; Itai, Y. [Dept. of Radiology, Tsukuba Univ. Hospital (Japan); Murata, S. [Dept. of Diagnostic Radiology, Univ. Hospital, Malmoe (Sweden); Michishita, N. [Dept. of Radiology, Tsuchiura Kyodo Hospital (Japan); Oda, T. [Dept. of Surgery, Tsukuba Univ. Hospital (Japan)

    1998-11-01

    A case of transcatheter embolization of a celiac artery pseudoaneurysm in a 70-year-old man is reported. The pseudoaneurysm was considered to be the result of pancreatic anastomotic leakage and an intra-abdominal abscess following pancreaticoduodenectomy with irradiation of 66 Gy for pancreatic carcinoma. To avoid recanalization of the pseudoaneurysm due to retrograde blood flow, first all branches of the celiac artery were embolized with metallic coils, and then the celiac trunk was also occluded. Hepatic arterial flow was preserved by the right hepatic artery arising from the superior mesenteric artery. After the procedure, the patient had no noticeable complications associated with the embolization nor any recurrence of the pancreatic cancer, and he achieved a 2-year survival. (orig.)

  14. The value of multislice spiral CT in transcatheter arterial chemoembolization of the hepatocellular carcinoma

    International Nuclear Information System (INIS)

    Li Zhigang; Zhao Junjing; Shi Gaofeng; Li Shunzong; Han Pengyin; Yang Guang; Liang Guoqing; Wang Hongguang; Huang Jingxiang

    2006-01-01

    Objective: To evaluate the value of multislice spiral CT (MSCT) in transcatheter arterial chemoembolization of the hepatocellular carcinoma. Methods: MSCT were performed in 54 cases of HCC before interventional procedure. CT findings of hepatic artery phase, portal venous phase and hepatic venous phase were observed respectively. CTA were done in 12 cases, the anatomy of celiac artery and its branches were observed. The schemes of interventional therapy were worked out according to the findings of MSCT. The demonstration of lesions and its complications were compared between CT and DSA. Reconstruction of celiac artery branches used the technique of VRT, MIP or MPR. Results: MSCT showed 225 lesions, 10 cases tumor thrombosis of portal vein, 1 case hepatic arteriovenous shunt, and 13 cases hepatic arterioportal shunt. Positive rate of MSCT in showing number of tumor lesions, tumor thrombosis in portal vein was slightly higher than that of DSA, but there was no significant difference (P>0.05). Showing of 3D reconstruction of celiac artery branches in CTA is better than that in DSA, Showing of angles between celiac artery and abdominal aorta in MSCT is more convenient than that in DSA. MSCT showed 5 cases hepatic artery original abnormality. The results were in accord with that in DSA. Five cases were demonstrated of multiple supply blood vessels of tumor in MSCT, It was slightly lower than that of DSA. Conclusion: MSCT is of importance for guidance of transcatheter arterial chemoembolization of the hepatocellular carcinoma, delay time of CT scan is the key to the showing of lesions and blood vessels. (authors)

  15. Spontaneous Hepatic Rupture Associated with Preeclampsia: Treatment with Hepatic Artery Embolization

    Energy Technology Data Exchange (ETDEWEB)

    Yang, Seung Boo; Goo, Dong Erk; Chang, Yun Woo; Kim, Yong Jae; Hwang, In Cheol; Han, Hyo Sang; Yoon, Jong Hyun; Lee, Tae Il [Soonchunhyang University Hospital, Gumi (Korea, Republic of)

    2010-02-15

    Spontaneous rupture of the liver due to preeclampsia is a rare condition of pregnant women, and it can be very dangerous if not treated. We report here on a case of successfully treating spontaneous liver rupture associated with preeclampsia by performing transcatheter hepatic arterial embolization. A 41-year-old woman with spontaneous rupture of the liver associated with preeclampsia was treated by hepatic arterial embolization

  16. Spontaneous Hepatic Rupture Associated with Preeclampsia: Treatment with Hepatic Artery Embolization

    International Nuclear Information System (INIS)

    Yang, Seung Boo; Goo, Dong Erk; Chang, Yun Woo; Kim, Yong Jae; Hwang, In Cheol; Han, Hyo Sang; Yoon, Jong Hyun; Lee, Tae Il

    2010-01-01

    Spontaneous rupture of the liver due to preeclampsia is a rare condition of pregnant women, and it can be very dangerous if not treated. We report here on a case of successfully treating spontaneous liver rupture associated with preeclampsia by performing transcatheter hepatic arterial embolization. A 41-year-old woman with spontaneous rupture of the liver associated with preeclampsia was treated by hepatic arterial embolization

  17. Transcatheter arterial embolization for upper gastrointestinal tract bleeding.

    Science.gov (United States)

    Širvinskas, Audrius; Smolskas, Edgaras; Mikelis, Kipras; Brimienė, Vilma; Brimas, Gintautas

    2017-12-01

    Transcatheter arterial embolization is a possible treatment for patients with recurrent bleeding from the upper gastrointestinal tract after failed endoscopic management and is also an alternative to surgical treatment. To analyze the outcomes of transcatheter arterial embolization and identify the clinical and technical factors that influenced the rates of morbidity and mortality. A retrospective analysis was carried out, based on the data of 36 patients who underwent transcatheter arterial embolization for acute nonvariceal upper gastrointestinal bleeding in 2013 to 2015 in our center. An analysis was performed between early rebleeding rates, mortality and the following factors: patient sex, age, number of units of packed red blood cells and packed plasma administered to the patients, length of hospital stay, therapeutic or prophylactic embolization. The technical success rate of the embolization procedure was 100%. There were 15 (41.70%) therapeutic embolizations and 21 (58.3%) prophylactic embolizations. There was a 77.8% clinical success rate. Following embolization, 10 (27.80%) patients had repeated bleeding and 9 (25.0%) patients died. Significant associations were found between rebleeding and prophylactic embolization (OR = 10.53; p = 0.04) and between mortality and prophylactic embolization (OR = 10.53; p = 0.04) and units of packed red blood cells (OR = 1.25; p < 0.01). In our experience, transcatheter arterial embolization is a safe treatment method for acute nonvariceal upper gastrointestinal bleeding and a possible alternative to surgery for high-risk patients.

  18. Transcatheter lipiodol chemo-embolization of the inferior phrenic artery in hepatocellular carcinoma

    International Nuclear Information System (INIS)

    Chen Fanghong; Luo Zuyan; Yuan Jianhua; Yu Wenqiang; Cai Xuexiang; Hu Tingyang; Liu Zijiang

    2002-01-01

    Objective: To evaluate the efficacy of transcatheter lipiodol chemo-embolization therapy (TOCE) for HCC via inferior phrenic artery (IPA) and to analyse the location of the tumor feeding inferior phrenic artery. Methods: Twenty-five cases of HCC underwent the procedure of TOCE via the IPA, as well as the hepatic artery using Seldinger's method. The patterns of tumor growth included huge type in 12 cases, solitary nodular type in 8 cases and multiple nodular type in 5 cases. Hepatic artery and inferior phrenic artery chemo-embolization were performed in all cases. Results: Inferior phrenic artery originated from celiac trunk in 16 cases (64%); abdomen aorta around celiac trunk in 8(32%). The site-sort tumors supplied by IPA in right lobe (VII, VIII segment) were 23 cases and left lobe (IV segment) 2 cases. The cumulative survival rates of IPA chemo-embolization for hepatocellular carcinoma were 84%(1 year) and 68%(2 years). No severe complications occurred. Conclusions: TOCE of the IPA is a safe and effective method in the management of HCC supplied by IPA. When the tumor site is adjacent to diaphragm, hepatic ligaments or bare area, may arouse the blood supply by IPA, especially in no tumor staining or staining defect in hepatic artery angiography but tumor enhancement on CT, and increase of the level of serum α-fetoprotein

  19. Evaluation of the angiographic findings for extrahepatic arterial supply to primary hepatic cancer and interventional therapy

    International Nuclear Information System (INIS)

    Wang Weiyu; Lv Weifu; Hou Changlong; Zhang Xingming; Zhang Zhengfeng; Lu Dong; Gao Zonggen

    2007-01-01

    Objective: To study the angiographic characteristics of extrahepatic arterial supply for primary hepatic cancer (PHC)and the significance of interventional therapy. Methods: 32 cases of primary. hepatic cancer were undertaken routine celiac arterial angiography and explored the extrahepatic arterial supply for the tumor, then followed by superselective transcatheter arterial chemoembolization (TACE). Results: 37 extrahepatic feeding arteries to hepatic cancers in 32 cases were found including 12 from superior mesenteric arteries(SMA), 9 right inferior phrenic arteries (RIPA), 1 left inferior phrenic arteries (LIPA), 2 pancreatic arterial arch, 1 right internal thoracic artery(RITA), 1 right intercostal artery(RICA), 6 left gastric arteries (LGA), 1 splenic artery, 2 omental arteries (OTA), 2 gastroduodenal arteries. The most common extrahepatic feeding arteries were originated from SMA and RIPA. The rest 33 were performed with superselective transcatheter arterial chemoembolization and the other 4 with only transcatheter arterial chemotherapeutic perfusion due to failure of superselective catheterization. Conclusion: The extrahepatic feeding artery is commonly seen with various kinds and also necessary for interventional treatment same as the primary ones for hepatic cancers. (authors)

  20. Transcatheter arterial chemoembolization of liver metastasis of gastrointestinal leiomyosarcoma

    Energy Technology Data Exchange (ETDEWEB)

    Won, Hyung Jin; Chung, Jin Wook; Kim, Tae Kyoung; Han Dae Hee; Kim, Sun Ho; Cheon, Jung Eun; Han, Joon Koo; Park, Jae Hyung [Seoul National Univ. College of Medicine, Seoul (Korea, Republic of)

    1997-10-01

    To evaluate the usefulness of transcatheter arterial chemoembolization (TACE) in the management of gastrointestinal leiomyosarcoma metastatic to the liver. Ten patients with gastrointestinal leiomyosarcoma and hepatic metastasis underwent TACE after surgical resection of the primary tumor. All of the leiomyosarcomas originated from the stomach(n=3D5), duodenum (n=3D1) or jejunum(n=3D4), and the interval between primary tumor resection and hepatic metastasis was 1-120(mean 26) months. Using an emulsion of 3-20mL of Lipiodol and 15-60mg of doxorubicin. TACE was performed, and in five patients, gelfoam embolization was added. Therapeutic response was evaluated by follow-up CT, and nine patients underwent repeated TACE (range:2-9 times;interval:1-9 months). On celiac arteriography, all cases showed hypervascular tumor staining. As an initial therapeutic response based on CT assessment, more than 50% regression of the tumor (partial remission) was achieved in seven patients, and in the remaining three, regression was 20-30%(stable disease); neither complete remission nor progression was seen. With regard to long-term survival, five patients died at 5, 8, 14, 20 and 49 (median, 19) months after initial TACE. The remaining five, in whom follow-up has extended for 13-54 months, are still alive. Overall, survival time ranged from 5-54(median, 19) months, and except for postembolization syndrome, there was no specific complication. The period of durable tumor regression before progression ranged from 6 to 54 (median, 17) months. TACE can be a safe and effective method for the palliation of gastrointestinal leiomyosarcoma metastatic to the liver.=20.

  1. Transcatheter arterial embolization for congenital renal arteriovenous malformation

    International Nuclear Information System (INIS)

    Zhou Jun; Hu Tingyang; Yuan Jianhua; Yu Wenqiang

    2008-01-01

    Objective: To evaluate the effectiveness of transcatheter arterial embolization for congenital renal arteriovenous malformation. Methods: Seven cases of congenital renal arteriovenous malformation causing gross hematuria were retrospectively studied. All of 7 cases were demonstrated by means of angiography and then the catheter was placed superselectively into the involved arterial end of the malformation undertaking embolization with gelfoam, dehydrated ethanol, coils, etc. Results: All the malformations of the 7 cases were successfully embolized with stoppage of gross hematuria within 24 hours. No serious complications occurred except lumbago, fever, gastrointestinal reaction for one week. There was no recurrence of haematuria and the renal function was also normal in all cases during the follow-up for 36 to 98 months. Conclusions: Transcatheter renal arterial angiography and embolization are the important and effective management for the diagnosis and treatment of congenital renal arteriovenous malformation. (authors)

  2. Clinical implications of bile duct injury after transcatheter arterial chemoembolization

    International Nuclear Information System (INIS)

    Wang Maoqiang; Tang Wenjie; Lin Hanying; Ye Huiyi; Dai Guanghai; Wang Zhiqiang

    2005-01-01

    Objective: To evaluate the incidence, risk factors , and clinical course of bile duct injury after transcatheter arterial chemoembolization (TACE) for treatment of hepatic malignancy. Methods: A total of 1240 consecutive patients with hepatic malignancies underwent 2680 TACE procedures. None of these patients were found to have any radiographic evidence of biliary abnormalities pre-TACE. Eighteen patients developed bile duct injuries at 3 weeks to 3 months after TACE. A retrospective review of medical records and imaging studies were carried out to evaluate the occurrence of TACE-induced bile duct injury, the clinical outcome, and the statistical significance of potential predisposing factors. Results: The TACE-induced bile duct injuries occurred in 13 of 148 patients with liver metastatic tumors (8.8%), 5 of 1092 patients with HCC (0.5%). Biliary injuries, including focal (n=4) and multiple intrahepatic bile duct dilatation (n=8), and cystic lesion or biloma (n=6), were identified on the follow-up imaging studies after TACE. Three patients with multiple bile duct injuries had mild jaundice at the presentation, two of them responded well to the conservative treatment, one died of irreversible deterioration of liver function at 2 weeks after the onset of jaundice. Four patients with a large biloma had associated serious bacterial infections; 3 of which were treated with percutaneous catheter drainage and antibiotics, 2 of them died of purulent peritonitis due to rupture of the cystic lesions and 1 cured with antibiotic. The remaining 11 patients were asymptomatic. The mortality related to the biliary injury occurred in 3 patients (16.7%). The incidences of bile duct injury were higher in patients with metastatic tumors in non-cirrhotic livers than in patients with hepatocellular carcinoma associated with cirrhosis (P<0.01), higher in patient with hypovascular lesions (P<0.01), and higher in patients using an emulsion of lipiodol-platinum for selective embolization

  3. Complications after transcatheter arterial chemoembolization via the inferior phrenic arteries: incidence, risk factors, and prophylaxis

    International Nuclear Information System (INIS)

    Wang Maoqiang; Liu Fengyong; Guan Jun; Gu Xiaofang; Lin Hanying; Wang Zhiqiang

    2004-01-01

    Objective: To investigate the frequency, patterns of the angiographic findings and risk factors for development of complications after transcatheter arterial chemoembolization (TACE) via the inferior phrenic artery (IPA). Methods: One hundred and sixty eight patients with hepatic tumor fed by the IPA underwent a total of 226 procedures of TACE of the IPA, with combined routine TACEO (88.7%) or without (11.3%) the combination of routine TACE of the hepatic artery. TACE of the malignancy was performed with an emulsion of iodized oil and anti-cancer agents and then followed by gelatin sponge particle injection. The complications were assessed on clinical observation, laboratory tests, and computed tomographic (CT) images after TACE of the IPA; and finally were correlated with the angiographic findings of the IPA. Results: The tumor supplied by IPA was noted at initial TACE in 25 (14.9%), at successive TACE in 97 (57.8%), after percutaneous tumor ablation guided by ultrasound in 28 (16.7%), and after hepatic surgery in 18 (10.7%) cases. The abnormal findings on arteriography showed enlargement of the IPA with tumor staining in all cases, dense non-tumor staining in 61 (36.3%), artery-to-artery anastomosis in 62(36.9%), arteriovenous shunts in 12(7.1%) cases. 96.4% of these patients complained of shoulder pain during TACE of the IPA. The cumulative complication rate after the procedure was 8.9%, including hiccup in 13 cases (5.8%), chest pain with cough and mild hemoptysis in 9 (4.0%), phrenoparalysis in 8 (3.5%), angina with abnormal ECG in 4 (1.8%), increasing of CPK, AST, and ALT significantly in 6 (2.7%), transient myeloparalysis in 2 (0.9%), and subphrenic abscess in 2 cases (0.9%). Two patients with the subphrenic abscess were successfully treated with percutaneous catheter drainage and antibiotics. The symptoms of these mild complications subsided with symptomatic treatment. Conclusions: Complications of TACE via the IPA occur in about 9% of the patients and

  4. Neurofibromatosis Type 1: Transcatheter Arterial Embolization for Ruptured Occipital Arterial Aneurysms

    International Nuclear Information System (INIS)

    Kanematsu, Masayuki; Kato, Hiroki; Kondo, Hiroshi; Goshima, Satoshi; Tsuge, Yusuke; Kojima, Toshiaki; Watanabe, Haruo

    2011-01-01

    Two cases of ruptured aneurysms in the posterior cervical regions associated with type-1 neurofibromatosis treated by transcatheter embolization are reported. Patients presented with acute onset of swelling and pain in the affected areas. Emergently performed contrast-enhanced CT demonstrated aneurysms and large hematomas widespread in the posterior cervical regions. Angiography revealed aneurysms and extravasations of the occipital artery. Patients were successfully treated by percutaneous transcatheter arterial microcoil embolization. Transcatheter arterial embolization therapy was found to be an effective method for treating aneurysmal rupture in the posterior cervical regions occurring in association with type-1 neurofibromatosis. A literature review revealed that rupture of an occipital arterial aneurysm, in the setting of neurofibromatosis type 1, has not been reported previously.

  5. Topography of the accessory left gastric artery (ALGA) analyzed by CT angiography from the left hepatic artery

    International Nuclear Information System (INIS)

    Shioyama, Yasukazu; Takasaka, Isao; Onaya, Hiroaki

    2003-01-01

    To avoid gastric complications when we perform transcatheter treatment via left hepatic artery, we analyzed the topography of ALGA (accessory left gastric artery) by left hepatic arteriography and CT angiography from left hepatic artery. Six hundred seventy eight cases of CT angiography were performed between 1995 and 2000. Among them, selective left hepatic arteriography was done in 85 cases. We analyzed the frequency and the course of ALGA on the hepatic angiogram and CT angiogram. ALGA were identified in eighteen (21.2 %) of the 85 cases. We classified them into eleven cases of the proximal type and six cases of the distal type. When ALGA bifurcated from the left hepatic artery very close to the bifurcation of A2 (dorsolateral branch) and A3 (ventrolateral branch), we classified them as the distal type on hepatic angiogram. On the other hand, when ALGA bifurcated from the left hepatic artery apart from the bifurcation of A2 and A3 they were classified as the proximal type. In one rare case ALGA originated from the dorsolateral branch of the left hepatic artery. ALGA were classified as the distal and proximal types. Distal type of ALGA often overlapped dorsolateral branch of the left hepatic artery, and it was sometimes difficult to notice the existence of them. We should check the existence of ALGA on the arterial phase of dynamic CT before we plan to make a transcatheter treatment from the left hepatic artery. Then we can avoid gastric complications caused by a transcatheter treatment from the left hepatic artery. (author)

  6. Transcatheter Arterial Embolization of Cystic Artery Pseudoaneurysm in Acalculous Cholecystitis: A Case Report

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Hyung Ook; Lee, Young Hwan [Dept. of Radiology, Daegu Catholic University College of Medicine, Daegu (Korea, Republic of); Kim, Young Hwan [Dept. of Diagnostic Radiology, Dongsan Medical Center, Keimyung University College of Medicine, Daegu (Korea, Republic of)

    2011-04-15

    A pseudoaneurysm of the cystic artery is a rare complication of cholecystitis, and is manifested by hemobilia or hematemesis. An early diagnosis is required for the successful treatment by cholecystectomy and ligation of the cystic artery. Herein, we report a case of a pseudoaneurysm of the cystic artery diagnosed by color Doppler ultrasonography and CT, and successfully treated by transcatheter arterial embolization with N-butyl cyanoacrylate in a high-risk surgical patient.

  7. The effect of transcatheter arterial embolisation for nonvariceal upper gastrointestinal bleeding

    DEFF Research Database (Denmark)

    Andersen, Poul Erik; Duvnjak, Stevo

    2010-01-01

    The aim of this investigation was to evaluate the clinical efficacy and safety of transcatheter arterial embolisation with coils for nonvariceal upper gastrointestinal (GI) bleeding after failed endoscopic therapy.......The aim of this investigation was to evaluate the clinical efficacy and safety of transcatheter arterial embolisation with coils for nonvariceal upper gastrointestinal (GI) bleeding after failed endoscopic therapy....

  8. Transcatheter arterial embolization of a pseudoaneurysm of gastroduodenal artery: a case report

    Energy Technology Data Exchange (ETDEWEB)

    Han, Young Min; Kang, Sung Soo; Lee, Jeong Min; Chung, Jin Young; Lee, Sang Yong; Chung, Gyung Ho; Kim, Chong Soo; Sohn, Myung Hee; Choi, Ki Chul [Chonbuk National University School of Medicine, Chonju (Korea, Republic of)

    1997-01-01

    Gastroduodenal artery pseudoaneurysm is a relatively rare and potentionally life-threatening complication of chronic pancreatitis, which is thought to occur because of autodigestion of arterial walls by pancreatic enzymes. Embolotherapy should probably be the first method of treatment, since surgical treatment carries a high risk of mortality and morbidity. We report the case of 30-year-old male with gastroduodenal artery pseudoaneurysm caused by chronic pancreatitis which was successfully treated by transcatheter embolization using Gianturco spring coils.

  9. Transcatheter arterial embolization of a pseudoaneurysm of gastroduodenal artery: a case report

    International Nuclear Information System (INIS)

    Han, Young Min; Kang, Sung Soo; Lee, Jeong Min; Chung, Jin Young; Lee, Sang Yong; Chung, Gyung Ho; Kim, Chong Soo; Sohn, Myung Hee; Choi, Ki Chul

    1997-01-01

    Gastroduodenal artery pseudoaneurysm is a relatively rare and potentionally life-threatening complication of chronic pancreatitis, which is thought to occur because of autodigestion of arterial walls by pancreatic enzymes. Embolotherapy should probably be the first method of treatment, since surgical treatment carries a high risk of mortality and morbidity. We report the case of 30-year-old male with gastroduodenal artery pseudoaneurysm caused by chronic pancreatitis which was successfully treated by transcatheter embolization using Gianturco spring coils

  10. Hepatic parenchymal changes following transcatheter embolization and chemoembolization in a rabbit tumor model.

    Directory of Open Access Journals (Sweden)

    Yong Wang

    Full Text Available 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

  11. Recanalization of Splenic Artery Aneurysm After Transcatheter Arterial Embolization Using N-Butyl Cyanoacrylate

    International Nuclear Information System (INIS)

    Matsumoto, Keiji; Ushijima, Yasuhiro; Tajima, Tsuyoshi; Nishie, Akihiro; Hirakawa, Masakazu; Ishigami, Kousei; Yamaji, Yukiko; Honda, Hiroshi

    2010-01-01

    A 65-year-old woman who had been diagnosed as having microscopic polyangiitis developed sudden abdominal pain and entered a state of shock. Abdominal CT showed massive hemoperitoneum, and emergent angiography revealed a ruptured splenic artery aneurysm. After direct catheterization attempts failed due to tortuous vessels and angiospasm, transcatheter arterial embolization using an n-butyl cyanoacrylate (NBCA)-lipiodol mixture was successfully performed. Fifty days later, the patient developed sudden abdominal pain again. Repeated angiography demonstrated recanalization of the splenic artery and splenic artery aneurysm. This time, the recanalized aneurysm was embolized using metallic coils with the isolation method. Physicians should keep in mind that recanalization can occur after transcatheter arterial embolization using N-butyl cyanoacrylate, which has been used as a permanent embolic agent.

  12. Right hepatic artery aneurysm.

    Science.gov (United States)

    Bernal, Astrid Del Pilar Ardila; Loures, Paulo; Calle, Juan Cristóbal Ospina; Cunha, Beatriz; Córdoba, Juan Camilo

    2016-01-01

    We report a case of an aneurysm of the right hepatic artery and its multidisciplinary management by general surgery, endoscopy and radiology services. Being a case of extremely low incidence, it is important to show its diagnostic and therapeutic approach. RESUMO Relatamos um caso de aneurisma da artéria hepática direita conduzido de forma multidisciplinar pelos Serviços de Cirurgia Geral, Endoscopia e Radiologia. Em se tratando de caso de incidência baixíssima, é importante mostrar o enfoque diagnóstico e terapêutico usado em seu manejo.

  13. Prognostic factors in transcatheter arterial chemoembolization of hepatocellular carcinoma : analysis of more than 3 year survivors

    International Nuclear Information System (INIS)

    Seo, Heung Suk

    1999-01-01

    To determine which prognostic factors contribute to long-term survival after transcatheter arterial chemoembolization(TACE) of hepatocellular carcinoma. In 100 patients who expired within one year and 84 who survived or have survived for more than 3 years after TACE, prognostic factors were retrospectively evaluated. TACE was accomplished by hepatic arterial infusion of a suspension of Lipiodol and anticancer drugs(Mitomycin-C and Adriamycin), either alone or followed by gelfoam embolization. Fisher's exact test of probability was used to determine which prognostic factors were statistically significant. Statistically significant prognostic factors were as follows : Child classification(p 0.05). The prognosis of patients with hepatocellular carcinoma treated by TACE was affected favorably by good liver function(Child classification A), low alpha-fetoprotein value, nodular or massive-type tumor, patent main and first-order portal vein, and hypervascular tumor

  14. Evaluation of emergency transcatheter arterial embolization in intractable postpartum hemorrhage

    International Nuclear Information System (INIS)

    Qi Weihong; Wang Song; Zhan Ying

    2008-01-01

    Objective: To assess the efficacy and safety of emergency transcatheter arterial embolization in the management of intractable postpartum hemorrhage. Methods: Twenty-five patients with intractable postpartum hemorrhage were undertaken superselective catheterization into the bilateral internal iliac arteries or uterial arteries to find the causes and sites of bleeding through DSA and then followed by arterial embolization with gelfoam particles. Result: All of the 25 patients with obstetrical bleeding were successfully controlled by TAE, the procedure lasted for 25-60 min, (mean 42.5 ± 4.6 min); with both catheterization and bleeding halt successful rates of 100%. Comparison of hemoglobin and heartbeat before and after the procedure showed significance (t=29.49, P<0.01; t=16.51, P<0.01). The uterus showed reintegration on time and menstruation resumed in all patients. Conclusions: Emergency arterial embolization is a safe and effective means for control of intractable postpartum hemorrhage, providing less trauma and no severe complications, especially as an unique management for fetal postpartum hemorrhage. (authors)

  15. Hepatic artery perfusion imaging

    International Nuclear Information System (INIS)

    Thrall, J.H.; Gyves, J.W.; Ziessman, H.A.; Ensminger, W.D.

    1985-01-01

    Organ and region-selective intra-arterial chemotherapy have been used for more than two decades to treat malignant neoplasms in the extremities, head and neck region, pelvis, liver, and other areas. Substantial evidence of improved response to regional chemotherapy now exists, but there are stringent requirements for successful application of the regional technique. First, the chemotherapeutic agent employed must have appropriate pharmacokinetic and pharmacodynamic properties. Second, the drug must be reliably delivered to the tumor-bearing area. This typically requires an arteriographic assessment of the vascular supply of the tumor, followed by placement of a therapeutic catheter and confirmation that the ''watershed'' perfusion distribution from the catheter truly encompasses the tumor. Optimal catheter placement also minimizes perfusion of nontarget organs. Radionuclide perfusion imaging with technetium 99m-labeled particles, either microspheres or macroaggregates of albumin, has become the method of choice for making these assessments. Catheter placement itself is considered by many to represent a type of ''therapeutic'' intervention. However, once the catheter is in the hepatic artery the radionuclide perfusion technique can be used to assess adjunctive pharmacologic maneuvers designed to further exploit the regional approach to chemotherapy. This chapter presents the technetium Tc 99m macroaggregated albumin method for assessing catheter placement and the pharmacokinetic rationale for regional chemotherapy, and discusses two promising avenues for further intervention

  16. Efficacy of Transcatheter Arterial Embolization in the Traumatic Injury

    Energy Technology Data Exchange (ETDEWEB)

    Park, Dae Hong; Kim, Jeong Ho; Byun, Sung Su; Kim, Hyung Sik [Dept. of Radiology, Gachon University School of Medicine, Gil Hospital, Incheon (Korea, Republic of)

    2012-09-15

    This study evaluated technical and clinical outcomes and identified factors associated with clinical success in trauma patients that underwent transcatheter arterial embolization (TAE) in a single regional hospital. A retrospective study was performed of 106 patients with a variety of trauma who were suspected of active arterial bleeding and underwent angiography. Technical success was defined as non-visualization of extravasation and pseudoaneurysm in injured arteries. Clinical success was defined as the patient was not expired within 30 days from the date of TAE. Electronic medical records were reviewed. The risk factors between groups of clinical success and failure were analyzed statistically. Technical and clinical success rates of TAE were 96% (102/106) and 70% (74/106) respectively. Of the factors we assessed, age, older than 60 years, systolic blood pressure and heart rate at admission and after TAE, and combined brain injury were statistically significant (p < 0.05). Old age, low systolic blood pressure after TAE, and combined brain injury were significant predictors of poor prognosis in multivariate analysis. TAE is an effective treatment for active arterial bleeding of the traumatic injury patient.

  17. Efficacy of Transcatheter Arterial Embolization in the Traumatic Injury

    International Nuclear Information System (INIS)

    Park, Dae Hong; Kim, Jeong Ho; Byun, Sung Su; Kim, Hyung Sik

    2012-01-01

    This study evaluated technical and clinical outcomes and identified factors associated with clinical success in trauma patients that underwent transcatheter arterial embolization (TAE) in a single regional hospital. A retrospective study was performed of 106 patients with a variety of trauma who were suspected of active arterial bleeding and underwent angiography. Technical success was defined as non-visualization of extravasation and pseudoaneurysm in injured arteries. Clinical success was defined as the patient was not expired within 30 days from the date of TAE. Electronic medical records were reviewed. The risk factors between groups of clinical success and failure were analyzed statistically. Technical and clinical success rates of TAE were 96% (102/106) and 70% (74/106) respectively. Of the factors we assessed, age, older than 60 years, systolic blood pressure and heart rate at admission and after TAE, and combined brain injury were statistically significant (p < 0.05). Old age, low systolic blood pressure after TAE, and combined brain injury were significant predictors of poor prognosis in multivariate analysis. TAE is an effective treatment for active arterial bleeding of the traumatic injury patient.

  18. Transcatheter arterial ethanol embolization for congenital renal arteriovenous malformations

    International Nuclear Information System (INIS)

    Wang Jingbing; Wang Han; An Xiao; Wang Linchuan; Gao Liqiang; Zhou Zhiguo; Zhang Guixiang

    2010-01-01

    Objective: To discuss the effect and safety of trans-microcatheter arterial embolization with ethanol for the treatment of congenital renal arteriovenous malformations. Methods: Clinical data of 11 patients with congenital renal arteriovenous malformations manifested mainly as gross hematuria were retrospectively analyzed. Selective renal angiography was performed in all 11 patients. After the diagnosis was confirmed, super-selective catheterization of the diseased arteries was carried out and the trans-microcatheter arterial embolization with ethanol was conducted. Results: A total of 12 procedures were completed in 11 patients. The ethanol dose used in one procedure was 5-25 ml. Successful embolization of the congenital renal arteriovenous malformations was obtained in all patients. The gross hematuria disappeared within 24-48 hours after the treatment. Lumbago at treated side, low fever, abdominal distension, nausea, vomiting, etc. occurred within one week and no other serious complications developed. During the follow-up period lasting for 4-96 months, no recurrence of hematuria was observed and the renal function remained normal. Conclusion: Transcatheter arterial ethanol embolization is an economic, safe and effective treatment for congenital renal arteriovenous malformations. (authors)

  19. Interventional treatment of emergent hepatic artery thrombosis after liver transplantation

    International Nuclear Information System (INIS)

    Liu Fengyong; Wang Maoqiang; Wang Zhijun; Wang Zhongpu; Shi Xianjie; Zhou Ningxin

    2006-01-01

    Objective: To evaluate the safety and efficacy of the endovascular interventional techniques for the management of emergent hepatic artery thrombosis (HAT) after orthotopic liver transplantation (OLT). Methods: Ten patients (8 men and 2 women with mean age of 47 years) diagnosed with HAT after OLT were treated with interventional procedures. All patients presented with elevation of liver enzymes and bilirubin levels. The diagnosis of the HAT was suggested by doppler ultrasonography and confirmed by angiography at 16 hours to 10 days (mean, 4.5 days) after OLT. Interventional techniques consisted of indwelling transcatheter hepatic arterial thrombolysis with a low dose of urokinase monitored under ultrasonography every 6-12 hours and stent placement in the stenotic segment of the hepatic artery was undertaken. Systemic intravenous low dose of heparin was given contemporaneously. Results: Complete occlusion of the proper HA was achieved in 10 patients. Hepatic arterial flow was re-established in 8 of the 10 patients (80%) at 12 hours to 9 days (mean, 4.8 days) after the intra-arterial thrombolysis, with significant improvement of liver function. Hepatic artery stenosis at the anastomosis was found in the 8 patients, and a stent placement in the stenotic segment was performed successfully in 7 patients with degree of stenosis over 90%.Intra-arterial thrombolysis was failed in 2 cases. Intraperitoneal hemorrhage from the anastomosis occurred in 1 patient at 12 hours after the treatment, and was emergently taken for the graft revision with reanastomosis. One patient with complete occlusion of the hepatic artery at 7 days after the treatment, but having collateral flow of the liver for maintaining liver function and thus sparing further intervention. 8 patients with successful hepatic arterial recanalization carried along a good clinical course with normal graft function at a median 12 months (range, 4 to 20 months), and patent hepatic arterial flow was identified by

  20. An intractable case of lower gastrointestinal hemorrhage due to radiation colitis. Usefulness of transcatheter arterial embolization

    Energy Technology Data Exchange (ETDEWEB)

    Inoue, Koichi; Koyama, Tukasa [Yoka Hospital, Hyogo (Japan); Sugamura, Kenji; Ogawa, Toshihide [Tottori Univ., Yonago (Japan). Faculty of Medicine

    2003-05-01

    We tried transcatheter arterial embolization for lower gastrointestinal hemorrhage due to radiation colitis. In this case, colostomy and endoscopic therapy were not effective. We succeeded in arresting the hemorrhage without any complications. Transcatheter embolization is a low-invasive and safe method of treatment. For prevention of inflammation and iatrogenic abscess formation, we repeated this therapy and we tried arterial injection of antibiotics and steroid. And so, this therapy is one of the effective methods. (author)

  1. The Features of Extrahepatic Collateral Arteries Related to Hepatic Artery Occlusion and Benefits in the Transarterial Management of Liver Tumors

    International Nuclear Information System (INIS)

    Yang, Lin; Zhang, Xiao Ming; Ren, Yong Jun; Miao, Nan Dong; Huang, Xiao Hua; Dong, Guo Li

    2013-01-01

    Purpose. To investigate the extrahepatic collateral arteries related to hepatic artery occlusion (HAO) and to determine its benefits in the transarterial management of liver tumors. Methods and Findings. Eleven patients (7 hepatocellular carcinomas, 3 liver metastases, and 1 with hemangioma) with HAO confirmed with digital subtraction angiography (DSA) were admitted to our hospital. Of the 11 patients, 7 were men and 4 were women, with an average age of 41.5 ± 15.5 years (range: 29 to 70 years). DSA was performed to evaluate the collateral routes to the liver. In the 11 patients with HAO, DSA showed complete occlusion of the common hepatic artery in 9 patients and the proper hepatic artery (PHA) in 2 patients. Extrahepatic collateral arteries supplying the liver were readily evident. The collateral arteries originated from the superior mesenteric artery (SMA) in 8 patients, from the gastroduodenal artery in 2 patients, and from the left gastric artery (LGA) in 1 patient. Transcatheter treatment was successfully performed via the collateral artery in all patients except the one who had hemangioma. Conclusions. DSA is an effective method for detecting collateral circulation related to HAO and may provide information to guide transcatheter management decisions

  2. Severe postpartum haemorrhage from ruptured pseudoaneurysm: successful treatment with transcatheter arterial embolization

    Energy Technology Data Exchange (ETDEWEB)

    Soyer, Philippe; Fargeaudou, Yann; Boudiaf, Mourad; Le Dref, Olivier; Rymer, Roland [Hopital Lariboisiere-AP-HP Universite Paris 7, Department of Abdominal Imaging, Paris cedex 10 (France); Morel, Olivier [Hopital Lariboisiere-AP-HP Universite Paris 7, Department of Obstetrics, Paris cedex 10 (France)

    2008-06-15

    The purpose of this retrospective study was to evaluate the role of transcatheter arterial embolization in the management of severe postpartum haemorrhage due to a ruptured pseudoaneurysm and to analyse the clinical symptoms that may suggest a pseudoaneurysm as a cause of postpartum haemorrhage. A retrospective search of our database disclosed seven women with severe postpartum haemorrhage in whom angiography revealed the presence of a uterine or vaginal artery pseudoaneurysm and who were treated using transcatheter arterial embolization. Clinical files were reviewed for possible clinical findings that could suggest pseudoaneurysm as a cause of bleeding. Angiography revealed extravasation of contrast material in five out of seven patients. Transcatheter arterial embolization allowed to control the bleeding in all patients and subsequently achieve vaginal suture in four patients with vaginal laceration. No complications related to transcatheter arterial embolization were noted. Only two patients had uterine atony, and inefficiency of sulprostone was observed in all patients. Transcatheter arterial embolization is an effective and secure technique for the treatment of severe postpartum haemorrhage due to uterine or vaginal artery pseudoaneurysm. Ineffectiveness of suprostone and absence of uterine atony should raise the possibility of a ruptured pseudoaneurysm. (orig.)

  3. Severe postpartum haemorrhage from ruptured pseudoaneurysm: successful treatment with transcatheter arterial embolization

    International Nuclear Information System (INIS)

    Soyer, Philippe; Fargeaudou, Yann; Boudiaf, Mourad; Le Dref, Olivier; Rymer, Roland; Morel, Olivier

    2008-01-01

    The purpose of this retrospective study was to evaluate the role of transcatheter arterial embolization in the management of severe postpartum haemorrhage due to a ruptured pseudoaneurysm and to analyse the clinical symptoms that may suggest a pseudoaneurysm as a cause of postpartum haemorrhage. A retrospective search of our database disclosed seven women with severe postpartum haemorrhage in whom angiography revealed the presence of a uterine or vaginal artery pseudoaneurysm and who were treated using transcatheter arterial embolization. Clinical files were reviewed for possible clinical findings that could suggest pseudoaneurysm as a cause of bleeding. Angiography revealed extravasation of contrast material in five out of seven patients. Transcatheter arterial embolization allowed to control the bleeding in all patients and subsequently achieve vaginal suture in four patients with vaginal laceration. No complications related to transcatheter arterial embolization were noted. Only two patients had uterine atony, and inefficiency of sulprostone was observed in all patients. Transcatheter arterial embolization is an effective and secure technique for the treatment of severe postpartum haemorrhage due to uterine or vaginal artery pseudoaneurysm. Ineffectiveness of suprostone and absence of uterine atony should raise the possibility of a ruptured pseudoaneurysm. (orig.)

  4. The Features of Extrahepatic Collateral Arteries Related to Hepatic Artery Occlusion and Benefits in the Trans arterial Management of Liver Tumors

    International Nuclear Information System (INIS)

    Yang, L.; Zhang, X.M.; Ren, Y.J.; Miao, N.D.; Huang, X.H.; Dong, G.L.

    2013-01-01

    To investigate the extrahepatic collateral arteries related to hepatic artery occlusion (HAO) and to determine its benefits in the trans arterial management of liver tumors. Methods and Findings. Eleven patients (7 hepatocellular carcinomas, 3 liver metastases, and 1 with hemangioma) with HAO confirmed with digital subtraction angiography (DSA) were admitted to our hospital. Of the 11 patients, 7 were men and 4 were women, with an average age of 41.5 ± 15.5 years (range: 29 to 70 years). DSA was performed to evaluate the collateral routes to the liver. In the 11 patients with HAO, DSA showed complete occlusion of the common hepatic artery in 9 patients and the proper hepatic artery (PHA) in 2 patients. Extrahepatic collateral arteries supplying the liver were readily evident. The collateral arteries originated from the superior mesenteric artery (SMA) in 8 patients, from the gastroduodenal artery in 2 patients, and from the left gastric artery (LGA) in 1 patient. Transcatheter treatment was successfully performed via the collateral artery in all patients except the one who had hemangioma. Conclusions. DSA is an effective method for detecting collateral circulation related to HAO and may provide information to guide transcatheter management decisions.

  5. Transcatheter arterial embolization for bone metastases from hepatocellular carcinoma

    International Nuclear Information System (INIS)

    Uemura, Akihiro; Fujimoto, Hajime; Osaka, Iwao; Yasuda, Shigeo; Goto, Nobuaki; Shinozaki, Masami; Ito, Hisao

    2001-01-01

    The objective of this study was to determine which of the following three methods is the most effective for the treatment of bone metastases from hepatocellular carcinoma (HCC): transcatheter arterial embolization (TAE); combination of TAE and external radiotherapy; or external radiotherapy alone. Thirty-nine metastatic bone lesions from HCC in 33 patients were retrospectively reviewed. Each lesion underwent either TAE alone (group A, n=11), TAE followed by radiotherapy (group B, n=17), or radiotherapy alone (group C, n=11). They were evaluated on the following subjects: pain relief; improvement of daily activities; and complications. Each treatment was effective for pain relief (89-94%) and improvement of daily activities (73-82%). The mean time interval from the beginning of each treatment to the onset of initial pain relief was 4.7 days in group A, 4.8 days in group B, and 15 days in group C. Recurrence of the pain after the initial pain relief was noted in 75% in group A, 20% in group B, and 88% in group C. Pyrexia and local pain commonly occurred after TAE. In conclusion, TAE is effective in relieving pain immediately and in improving the patients' daily activities. The combination of TAE and radiotherapy is recommended for permanent pain relief. (orig.)

  6. Transcatheter arterial chemoembolization of hepatocellular carcinoma with portal vein invasion

    International Nuclear Information System (INIS)

    Lee, Young Rahn; Lee, Ki Yeol; Cho, Seong Beom; Cha, In Ho; Chung, Kyoo Byung

    1993-01-01

    Transcatheter arterial chemoembolization(TACE) is an imperative method for the management of inoperable hepatocellular carcinoma(HCC). It is well known that primary HCC frequently invades the portal venous system and forms a tumor thrombus obstructing the portal blood flow which makes unfavorable prognosis of patient. We retrospectively reviewed 58 patients who reviewed TACE(minimum 3 times) of HCC invading into portal venous system. Group 1(n=29) which showed peripheral portal vein invasion had better clinical and laboratory response. Group 2(n=17) which showed first order portal branch invasion had similar response to Group 3(n=12), which had main portal invasion. Group 1 showed no difference in survival time between TAC and TACE, but, in Group 2 and 3, embolization with chemotherapy made longer survival than chemotherapy only. Clinical level of AFP was meaningful in Group 1 and 2 as decreasing value. Our results provides that careful selection of TAE and case by case Coil/Gelfoam embolization can improve the mean survival and clinical response when HCC evidently invades portal venous system

  7. Transcatheter arterial embolization for hepatoma; I. Short-term evaluation

    Energy Technology Data Exchange (ETDEWEB)

    Seo, Heung Suk; Koh, Byung Hee; Cho, On Koo; Hahm, Chang Kok; Rhee, Jong Chul; Lee, Min Ho; Kee, Choon Suhk [Hanyang University College of Medicine, Seoul (Korea, Republic of)

    1985-12-15

    Anticancer effect and complications were evaluated after transcatheter arterial embolization (TAE) in 12 patients with hepatocellular carcinoma until 2 weeks and 4 weeks after TAE, respectively. The results were as follows; 1. Serum alpha-fetoprotein value decreased in 7 out of 9 patients with high value prior to TAE. 2. Loss of enhancement and better definition on enhanced computed tomography (CT) were seen in the tumors in all caes, and low density areas in 9/10.Gas bubbles were seen in low-density areas in 4/10 and high density areas caused by lipiodol in 6/10. 3. Post-embolization syndrome was developed in most patients but improved clinically within a week after TAE. 4. On laboratory examination, impairment of liver function was developed in most patients but improved within 4 weeks after TAE. 5. Complications on CT included splenic infarction and thickening of wall of the gallbladder, which didn't require specific treatment. The authors conclude that TAE for hepatocellular carcinoma reveals apparent anticancer effect on short-term evaluation, and resultant complications are transient and improved by conservative treatment.

  8. Transcatheter arterial embolization for hepatoma; I. Short-term evaluation

    International Nuclear Information System (INIS)

    Seo, Heung Suk; Koh, Byung Hee; Cho, On Koo; Hahm, Chang Kok; Rhee, Jong Chul; Lee, Min Ho; Kee, Choon Suhk

    1985-01-01

    Anticancer effect and complications were evaluated after transcatheter arterial embolization (TAE) in 12 patients with hepatocellular carcinoma until 2 weeks and 4 weeks after TAE, respectively. The results were as follows; 1. Serum alpha-fetoprotein value decreased in 7 out of 9 patients with high value prior to TAE. 2. Loss of enhancement and better definition on enhanced computed tomography (CT) were seen in the tumors in all caes, and low density areas in 9/10.Gas bubbles were seen in low-density areas in 4/10 and high density areas caused by lipiodol in 6/10. 3. Post-embolization syndrome was developed in most patients but improved clinically within a week after TAE. 4. On laboratory examination, impairment of liver function was developed in most patients but improved within 4 weeks after TAE. 5. Complications on CT included splenic infarction and thickening of wall of the gallbladder, which didn't require specific treatment. The authors conclude that TAE for hepatocellular carcinoma reveals apparent anticancer effect on short-term evaluation, and resultant complications are transient and improved by conservative treatment

  9. Transcatheter Arterial Embolization for Gastrointestinal Bleeding Secondary to Gastrointestinal Lymphoma

    Energy Technology Data Exchange (ETDEWEB)

    Zheng, Lin [Henan Cancer Hospital, The Affiliated Cancer Hospital of Zhengzhou University, Department of Radiology (China); Shin, Ji Hoon, E-mail: jhshin@amc.seoul.kr; Han, Kichang; Tsauo, Jiaywei; Yoon, Hyun-Ki; Ko, Gi-Young [University of Ulsan, College of Medicine, Asan Medical Center, Department of Radiology and Research Institute of Radiology (Korea, Republic of); Shin, Jong-Soo [Kyunghee University, College of Medicine, Kangdong Kyunghee University Hospital, Department of Radiology (Korea, Republic of); Sung, Kyu-Bo [University of Ulsan, College of Medicine, Asan Medical Center, Department of Radiology and Research Institute of Radiology (Korea, Republic of)

    2016-11-15

    PurposeTo evaluate the effectiveness of transcatheter arterial embolization (TAE) for gastrointestinal (GI) bleeding caused by GI lymphoma.Materials and MethodsThe medical records of 11 patients who underwent TAE for GI bleeding caused by GI lymphoma between 2001 and 2015 were reviewed retrospectively.ResultsA total of 20 TAE procedures were performed. On angiography, contrast extravasation, and both contrast extravasation and tumor staining were seen in 95 % (19/20) and 5 % (1/20) of the procedures, respectively. The most frequently embolized arteries were jejunal (n = 13) and ileal (n = 5) branches. Technical and clinical success rates were 100 % (20/20) and 27 % (3/11), respectively. The causes of clinical failure in eight patients were rebleeding at new sites. In four patients who underwent repeat angiography, the bleeding focus was new each time. Three patients underwent small bowel resection due to rebleeding after one (n = 2) or four (n = 1) times of TAEs. Another two patients underwent small bowel resection due to small bowel ischemia/perforation after three or four times of TAEs. The 30-day mortality rate was 18 % due to hypovolemic shock (n = 1) and multiorgan failure (n = 1).ConclusionAngiogram with TAE shows limited therapeutic efficacy to manage GI lymphoma-related bleeding due to high rebleeding at new sites. Although TAE can be an initial hemostatic measure, surgery should be considered for rebleeding due to possible bowel ischemic complication after repeated TAE procedures.

  10. Therapeutic effect of transcatheter arterial infusion chemotherapy in the treatment of advanced pancreatic cancer

    International Nuclear Information System (INIS)

    Lin Junhua; Song Mingzhi; Zhang Yuanyuan; Xu Yiyu; Chen Jing

    2001-01-01

    Objective: To evaluate the clinical efficacy of transcatheter arterial infusion (TAI) or transcatheter arterial chemo-embolization (TACE) in the treatment of advanced pancreatic cancer. Methods: 36 cases of advanced pancreatic cancer were divided into two groups, 18 cases were treated with TAI or TACE (group A), other 18 cases were treated with systemic chemotherapy (group B). Results: The clinical benefit response rate of the group A was 55.6% (10/18) and that of the group B was 16.7%(3/18), respectively (P 0.05). Conclusions: In the transcatheter arterial infusion group, no survival advantage could be demonstrated when compared with the controls, but TAI could effectively increase clinical benefit response and improve the quality of life of advanced pancreatic cancer

  11. Prognostic factors in transcatheter arterial chemoembolization of hepatocellular carcinoma : analysis of more than 3 year survivors

    Energy Technology Data Exchange (ETDEWEB)

    Seo, Heung Suk [Hanyang Univ. College of Medicine, Seoul (Korea, Republic of)

    1999-06-01

    To determine which prognostic factors contribute to long-term survival after transcatheter arterial chemoembolization(TACE) of hepatocellular carcinoma. In 100 patients who expired within one year and 84 who survived or have survived for more than 3 years after TACE, prognostic factors were retrospectively evaluated. TACE was accomplished by hepatic arterial infusion of a suspension of Lipiodol and anticancer drugs(Mitomycin-C and Adriamycin), either alone or followed by gelfoam embolization. Fisher's exact test of probability was used to determine which prognostic factors were statistically significant. Statistically significant prognostic factors were as follows : Child classification(p<0.01), alpha-fetoprotein value(p<0.05), type of tumor(p<0.01), portal vein status(p<0.01), and vascularity of the tumor(p<0.05). HBsAg, tumor size, and method of chemoembolization were not statistically significant(p>0.05). The prognosis of patients with hepatocellular carcinoma treated by TACE was affected favorably by good liver function(Child classification A), low alpha-fetoprotein value, nodular or massive-type tumor, patent main and first-order portal vein, and hypervascular tumor.

  12. Lumbar artery pseudoaneurysm and arteriovenous fistula as a complication of laparoscopic splenectomy: treatment by transcatheter embolization

    International Nuclear Information System (INIS)

    Maleux, G.; Wilms, G.; Vermylen, J.

    2002-01-01

    Iatrogenic injury of a lumbar artery is very rare and mostly causes retroperitoneal hemorrhage. We report a case of a lumbar artery pseudoaneurysm and a concomitant arteriovenous fistula complicating laparoscopic splenectomy and provoking renal colic-like flank pain due to mass effect on the left ureter. Definitive treatment of both vascular lesions was obtained after percutaneous transcatheter embolization of several lumbar arteries. Control computed tomography scan 3 months after embolization showed almost complete resorption of the retroperitoneal hematoma. (orig.)

  13. Lumbar artery pseudoaneurysm and arteriovenous fistula as a complication of laparoscopic splenectomy: treatment by transcatheter embolization

    Energy Technology Data Exchange (ETDEWEB)

    Maleux, G.; Wilms, G. [Department of Radiology, University Hospitals, Leuven (Belgium); Vermylen, J. [Department of Internal Medicine-Vascular Diseases, University Hospitals, Leuven (Belgium)

    2002-06-01

    Iatrogenic injury of a lumbar artery is very rare and mostly causes retroperitoneal hemorrhage. We report a case of a lumbar artery pseudoaneurysm and a concomitant arteriovenous fistula complicating laparoscopic splenectomy and provoking renal colic-like flank pain due to mass effect on the left ureter. Definitive treatment of both vascular lesions was obtained after percutaneous transcatheter embolization of several lumbar arteries. Control computed tomography scan 3 months after embolization showed almost complete resorption of the retroperitoneal hematoma. (orig.)

  14. Transcatheter Arterial Embolization of Arterial Esophageal Bleeding with the Use of N-Butyl Cyanoacrylate

    Energy Technology Data Exchange (ETDEWEB)

    Park, Ji Hoon; Kim, Hyo Cheol; Chung, Jin Wook; Jae, Hwan Jun; Park, Jae Hyung [Seoul National University Hospita, Seoul (Korea, Republic of)

    2009-08-15

    To evaluate the clinical efficacy and safety of a transcatheter arterial embolization (TAE) with N-butyl cyanoacrylate (NBCA) for the treatment of arterial esophageal bleeding. Between August 2000 and April 2008, five patients diagnosed with arterial esophageal bleeding by conventional angiography, CT angiography or endoscopy, underwent a TAE with NBCA. We mixed NBCA with iodized oil at ratios of 1:1 to 1:4 to supply radiopacity and achieve a proper polymerization time. After embolization, we evaluated the angiographic and clinical success, recurrent bleeding, and procedure-related complications. The bleeding esophageal artery directly originated from the aorta in four patients and from the left inferior phrenic artery in one patient. Although four patients had an underlying coagulopathy at the time of the TAE, angiographic and clinical success was achieved in all five patients. In addition, no procedurerelated complications such as esophageal infarction were observed during this study. NBCA can be an effective and feasible embolic agent in patients with active arterial esophageal bleeding, even with pre-existing coagulopathy.

  15. Transcatheter Arterial Embolization of Arterial Esophageal Bleeding with the Use of N-Butyl Cyanoacrylate

    International Nuclear Information System (INIS)

    Park, Ji Hoon; Kim, Hyo Cheol; Chung, Jin Wook; Jae, Hwan Jun; Park, Jae Hyung

    2009-01-01

    To evaluate the clinical efficacy and safety of a transcatheter arterial embolization (TAE) with N-butyl cyanoacrylate (NBCA) for the treatment of arterial esophageal bleeding. Between August 2000 and April 2008, five patients diagnosed with arterial esophageal bleeding by conventional angiography, CT angiography or endoscopy, underwent a TAE with NBCA. We mixed NBCA with iodized oil at ratios of 1:1 to 1:4 to supply radiopacity and achieve a proper polymerization time. After embolization, we evaluated the angiographic and clinical success, recurrent bleeding, and procedure-related complications. The bleeding esophageal artery directly originated from the aorta in four patients and from the left inferior phrenic artery in one patient. Although four patients had an underlying coagulopathy at the time of the TAE, angiographic and clinical success was achieved in all five patients. In addition, no procedurerelated complications such as esophageal infarction were observed during this study. NBCA can be an effective and feasible embolic agent in patients with active arterial esophageal bleeding, even with pre-existing coagulopathy

  16. Detection of the origin of the cystic artery during transcatheter arterial embolization of hepatocellular carcinomas. Comparison of cone beam CT and digital subtraction angiography

    International Nuclear Information System (INIS)

    Hashizume, Takashi; Honda, Minoru; Seino, Noritaka; Gokan, Takehiko; Hashimoto, Toshi

    2009-01-01

    In this study, we retrospectively compared the usefulness of cone beam CT (CBCT) with that of digital subtraction angiography (DSA) in the identification of the origin of the cystic artery during arterial embolization for hepatocellular carcinoma. Subjects were sixty-four patients who underwent transcatheter arterial embolization (TAE) for hepatocellular carcinoma, in whom both CBCT and DSA were performed. Two radiologists independently examined CBCT and DSA images, and attempted to identify the origin of the cystic artery in each image. For DSA, en face views were reviewed on the monitor. For CBCT, 5 mm thick horizontal sections were generated using Workstation software, and the MPR (multi-planner reconstruction) method was used for coronary sections. These were then investigated with OsiriX. Of the sixty-four patients, the cystic arterial origin could be identified using DSA in 21 (32.8%) and CBCT in 62 (96.8%). The cystic artery was shown to originate in the proper, right, middle, and left hepatic artery in one, 58, two, and one patient, respectively. These results show that CBCT was more useful than DSA for identifying cystic arterial origin. Therefore CBCT should be positively applied during TAE. (author)

  17. Transcatheter Splenic Artery Occlusion for Treatment of Splenic Artery Steal Syndrome After Orthotopic Liver Transplantation

    International Nuclear Information System (INIS)

    Uflacker, Renan; Selby, J. Bayne; Chavin, Kenneth; Rogers, Jeffrey; Baliga, Prabhakar

    2002-01-01

    Purpose: To review some aspects of the problem of splenic artery steal syndrome as cause of ischemia in transplanted livers and treatment by selective splenic artery occlusion. Materials and Methods: Eleven liver transplant patients from a group of 350 patients, nine men and two women,ranging in age from 40 years to 61 years (mean 52 years), presented with biochemical evidences of liver ischemia and failure, ranging from one to 60 days following orthotopic liver transplantation. Diagnosis of splenic artery steal syndrome was suspected by elevated enzymes, Doppler ultrasound and confirmed by celiac angiogram. Patients with confirmed hepatic artery thrombosis before angiography were excluded from the study. Embolization with Gianturco coils was performed. Results: All patients were treated by splenic artery embolization with Gianturco coils. The 11 patients improved clinically within 24 hours of the procedure with significant change in the biochemical and clinical parameters. Followup ranged from one month to two years. One of the 11 patient initially improved, but developed hepatic artery thrombosis within 24 hours of the embolic treatment,requiring surgical repair. Conclusion: Splenicartery steal syndrome following liver transplantation surgery can be diagnosed by celiac angiography, and effectively treated by splenic artery embolization with coils. Embolization is one of the treatments available, it is minimally invasive, and leads to immediate clinical improvement. Hepatic artery thrombosis is a possible complication of the procedure

  18. Angiographic manifestation and transcatheter arterial embolization of proper esophageal artery in hemoptysis

    International Nuclear Information System (INIS)

    Jiang Sen; Zhu Xiaohua; Sun Xiwen; Zhi Wenxiang; Jie Bing; You Zhengqian; Yu Dong; Peng Gang

    2008-01-01

    Objective: To investigate the angiographic manifestation of the proper esophageal artery (PEA), the high risk factors for the presence of the anomalous PEA in hemoptysis and to evaluate the safety of transcatheter arterial embolization (TAE) of the PEA using gelatin sponge (GS). Methods: Selective esophageal arteriography was performed in forty-three patients with hemoptysis, including 15 cases of pulmonary tuberculosis, 18 cases of bronchiectasis, 7 cases of posttuberculous bronchiectasis and three cases of lung cancer. One case experienced failure of bronchial arterial embolization. The angiographic manifestation of the PEAs was studied. The complications of the procedure and clinical results were observed in the patients who underwent TAE using GS. Results: Thirty-nine PEAs were catheterized selectively in 37 patients (86.0%). Eighteen anomalous PEAs (46.2%) were catheterized selectively in 17 patients (45.9%). The anomalous PEAs showed tortuosity, dilatation, hyperplasia, shunting with pulmonary artery and anastomosis with the bronchial artery. All lesions involved basal segment of inferior pulmonary lobar. Bronchiectasis was the most frequent disease for PEA abnormality. No complications occurred and satisfactory curative effect was achieved with TAE of the anomalous PEAs. Conclusions: It is necessary to perform selective proper esophageal arteriography when the lesion involves basal segment of inferior pulmonary lobar in hemoptysis. Supplemental TAE of the anomalous PEA using GS is safe and valuable in the management of hemoptysis. (authors)

  19. Successful transcatheter closure of coronary artery fistula in a child with single coronary artery: a heavy load and a long road.

    Science.gov (United States)

    Phasalkar, Manjunath; Thakkar, Bhavesh; Poptani, Vishal

    2013-07-01

    Single coronary artery is an uncommon variation of the coronary circulation. After transposition of great arteries, coronary artery fistulas are the most common associated cardiac anomalies in these patients. Transcatheter closure of coronary artery fistula (CAF) involving single coronary artery is a challenging intervention. In the absence of contralateral coronary artery, a complex anatomy of the CAF and a large myocardial perfusion territory of the dominant circulation pose an additional risk during interventional procedure. We report our experience of a successful transcatheter closure of a coronary artery fistula in a patient with single coronary artery. Copyright © 2013 Wiley Periodicals, Inc.

  20. The study of correlation between HBV genotype and the response to transcatheter arterial chemoembolization therapy in hepatocellular carcinoma patients

    International Nuclear Information System (INIS)

    Huang Keyao; Yang Weizhu; Jiang Na; Zheng Qubing

    2004-01-01

    Objective: To evaluate the influence of hepatitis B virus(HBV) genotype on response to transcatheter arterial embolization therapy in patients with HBV-related HCC. Methods: Transcatheter arterial chemoem-bolization therapy was conducted in patients with HBV-related HCC and response to embolization therapy were observed according to the tumor necrosis rate, the HCC recurrence rate, the cumulative incidence of survival rate and the change of AFP. The HBV genotype was determined by sequencing directly the polymerase chain reaction products of the HBV S gene. The response of HCC to embolization therapy was compared between patients who were infected with different genotypic HBV. Results: The tumor necrosis rate of genotype C patients was similar to that of genotype B patients (P=0.099). The HCC recurrence rate of genotype B was lower than that of genotype C patients (P=0.036). The cumulative incidence of survival rates of 2 and 3 years were significantly higher in the genotype B patients (P=0.036 and P=0.013). There was no difference between the two genotypes, patients in the change of AFP (P>0.05). Conclusions: HBV genotype B patients seem to have a better response to embolization therapy as compared to genotype C patients. Determination of HBV genotype may be useful in predicting the outcomes of TACE therapy in HBV-related HCC. (authors)

  1. Hepatic artery infusion (HAI) for hepatic metastases in combination with hepatic resection and hepatic radiation

    International Nuclear Information System (INIS)

    Merrick, H.W.; Dobelbower, R.R.; Ringleint, J.F.; Skeel, R.T.

    1986-01-01

    Renewed interest in hepatic artery infusion has been stimulated by the development of a totally implantable pump which eliminates many of the problems encountered by the external pumps and catheters. As the potential benefit of hepatic artery infusion would be greater if either all gross disease were removed by prior resection, or alternatively, if non-resectable disease were irradiated in conjunction with hepatic artery infusion, the authors initiated a phase I-II trial to evaluate combined modality therapy

  2. Main Bile Duct Stricture Occurring After Transcatheter Arterial Chemoembolization for Hepatocellular Carcinoma

    International Nuclear Information System (INIS)

    Miyayama, Shiro; Yamashiro, Masashi; Okuda, Miho; Yoshie, Yuichi; Nakashima, Yoshiko; Ikeno, Hiroshi; Orito, Nobuaki; Notsumata, Kazuo; Watanabe, Hiroyuki; Toya, Daisyu; Tanaka, Nobuyoshi; Matsui, Osamu

    2010-01-01

    The purpose of this study was to evaluate the clinical course of main bile duct stricture at the hepatic hilum after transcatheter arterial chemoembolization (TACE) for hepatocellular carcinoma (HCC). Among 446 consecutive patients with HCC treated by TACE, main bile duct stricture developed in 18 (4.0%). All imaging and laboratory data, treatment course, and outcomes were retrospectively analyzed. All patients had 1 to 2 tumors measuring 10 to 100 mm in diameter (mean ± SD 24.5 ± 5.4 mm) near the hepatic hilum fed by the caudate arterial branch (A1) and/or medial segmental artery (A4) of the liver. During the TACE procedure that caused bile duct injury, A1 was embolized in 8, A4 was embolized in 5, and both were embolized in 5 patients. Nine patients (50.0%) had a history of TACE in either A1 or A4. Iodized oil accumulation in the bile duct wall was seen in all patients on computed tomography obtained 1 week later. Bile duct dilatation caused by main bile duct stricture developed in both lobes (n = 9), in the right lobe (n = 3), in the left lobe (n = 4), in segment (S) 2 (n = 1), and in S3 (n = 1). Serum levels of alkaline phosphatase and γ-glutamyltranspeptidase increased in 13 patients. Biloma requiring drainage developed in 2 patients; jaundice developed in 4 patients; and metallic stents were placed in 3 patients. Complications after additional TACE sessions, including biloma (n = 3) and/or jaundice (n = 5), occurred in 7 patients and were treated by additional intervention, including metallic stent placement in 2 patients. After initial TACE of A1 and/or A4, 8 patients (44.4%), including 5 with uncontrollable jaundice or cholangitis, died at 37.9 ± 34.9 months after TACE, and 10 (55.6%) have survived for 38.4 ± 37.9 months. Selective TACE of A1 and/or A4 carries a risk of main bile duct stricture at the hepatic hilum. Biloma and jaundice are serious complications associated with bile duct strictures.

  3. Transcatheter embolization of hepatic arteriovenous fistulas for control of hemobilia

    Energy Technology Data Exchange (ETDEWEB)

    Clark, R A; Colley, D P; Frey, R T; Eiseman, W R

    1981-10-15

    Two cases of traumatic hemobilia are presented in which hemorrhage was controlled by transcatheter vascular occlusion with stainless steel coils. Embolic therapy was safely performed without liver necrosis, despite the presence of portal hypertension in 1 patient. The technique is a useful alternative to surgery, which did not control hemorrhage in 1 case.

  4. Giant liver hemangioma resected by trisectorectomy after efficient volume reduction by transcatheter arterial embolization: a case report

    Directory of Open Access Journals (Sweden)

    Akamatsu Nobuhisa

    2010-08-01

    Full Text Available Abstract Introduction Liver hemangiomas are the most common benign liver tumors, usually small in size and requiring no treatment. Giant hemangiomas complicated with consumptive coagulopathy (Kasabach-Merritt syndrome or causing severe incapacitating symptoms, however, are generally considered an absolute indication for surgical resection. Here, we present the case of a giant hemangioma, which was, to the best of our knowledge, one of the largest ever reported. Case presentation A 38-year-old Asian man was referred to our hospital with complaints of severe abdominal distension and pancytopenia. Examinations at the first visit revealed a right liver hemangioma occupying the abdominal cavity, protruding into the right diaphragm up to the right thoracic cavity and extending down to the pelvic cavity, with a maximum diameter of 43 cm, complicated with "asymptomatic" Kasabach-Merritt syndrome. Based on the tumor size and the anatomic relationship between the tumor and hepatic vena cava, primary resection seemed difficult and dangerous, leading us to first perform transcatheter arterial embolization to reduce the tumor volume and to ensure the safety of future resection. The tumor volume was significantly decreased by two successive transcatheter arterial embolizations, and a conventional right trisectorectomy was then performed without difficulty to resect the tumor. Conclusions To date, there have been several reports of aggressive surgical treatments, including extra-corporeal hepatic resection and liver transplantation, for huge hemangiomas like the present case, but because of its benign nature, every effort should be made to avoid life-threatening surgical stress for patients. Our experience demonstrates that a pre-operative arterial embolization may effectively enable the resection of large hemangiomas.

  5. Percutaneous microwave coagulation therapy combined with transcatheter arterial chmoembolization for hepatocellular carcinoma: preliminary results

    International Nuclear Information System (INIS)

    Won, Yoo Dong; Hahn, Seong Tai; Chung, Kyu Won; Park, Seog Hee

    2000-01-01

    To evaluate the efficacy of percutaneous microwave coagulation therapy (PMCT) combined with transcatheter arterial chemoemboization (TACE) for the treatment of hepatocellular carcinoma (HCC). Twenty-five nodular HCCs (long diameter of 1.2-10 (mean, 3.4) cm) in 19 patients (15 males and 4 females) were treated by PMCT 4-138 days after TACE. Under ultrasound guidance, the carcinoma were punctured with a 14-G guideneedle through which a microwave electrode (25.0 cm in length, 1.6 mm in diameter) was inserted. To coagulate the HCCs and surrounding hepatic parenchyma, microwave irradiation at 60W for 45-60 seconds was then applied. One to three sessions of PMCT were performed at intervals of 2-6 days, and one week to 29 months later, the therapeutic effect was evaluated by spiral CT, angiography, and serum alpha-fetoprotein. Eighteen of 25 HCCs (72.0%) were necrotized completely, but seven (28.0%) recurred. Ninety percent of HCCs smaller than 4 cm in long diameter showed complete remission, but all those larger than 4 cm recurred. Alpha-fetoprotein levels decreased markedly in five patients (26.3 %), while in 12 (63.2%), asparate aminotransferase (AST)/alanine aminotransferase (ALT) showed transient elevation. Minor complications occurred after PMCT (mild abdominal pain in 8 patients, fever in 7, pleural effusion in 3, portal vein thrombosis in 1, and hepatic abscess in 1), but in no case was this serious. PMCT combined with TACE provides effective and safe treatment for nodular HCCs with a long diameter of less than 4 cm. (author)

  6. Percutaneous microwave coagulation therapy combined with transcatheter arterial chmoembolization for hepatocellular carcinoma: preliminary results

    Energy Technology Data Exchange (ETDEWEB)

    Won, Yoo Dong; Hahn, Seong Tai; Chung, Kyu Won; Park, Seog Hee [College of Medicine, The Catholic University of Korea, Seoul (Korea, Republic of)

    2000-10-01

    To evaluate the efficacy of percutaneous microwave coagulation therapy (PMCT) combined with transcatheter arterial chemoemboization (TACE) for the treatment of hepatocellular carcinoma (HCC). Twenty-five nodular HCCs (long diameter of 1.2-10 (mean, 3.4) cm) in 19 patients (15 males and 4 females) were treated by PMCT 4-138 days after TACE. Under ultrasound guidance, the carcinoma were punctured with a 14-G guideneedle through which a microwave electrode (25.0 cm in length, 1.6 mm in diameter) was inserted. To coagulate the HCCs and surrounding hepatic parenchyma, microwave irradiation at 60W for 45-60 seconds was then applied. One to three sessions of PMCT were performed at intervals of 2-6 days, and one week to 29 months later, the therapeutic effect was evaluated by spiral CT, angiography, and serum alpha-fetoprotein. Eighteen of 25 HCCs (72.0%) were necrotized completely, but seven (28.0%) recurred. Ninety percent of HCCs smaller than 4 cm in long diameter showed complete remission, but all those larger than 4 cm recurred. Alpha-fetoprotein levels decreased markedly in five patients (26.3 %), while in 12 (63.2%), asparate aminotransferase (AST)/alanine aminotransferase (ALT) showed transient elevation. Minor complications occurred after PMCT (mild abdominal pain in 8 patients, fever in 7, pleural effusion in 3, portal vein thrombosis in 1, and hepatic abscess in 1), but in no case was this serious. PMCT combined with TACE provides effective and safe treatment for nodular HCCs with a long diameter of less than 4 cm. (author)

  7. Multidetector-row CT angiography of hepatic artery: comparison with conventional angiography

    International Nuclear Information System (INIS)

    Kim, Jin Woong; Jeong, Yong Yeon; Yoon, Woong; Kim, Jae Kyu; Park, Jin Gyoon; Seo, Jeong Jin; Kang, Heoung Keun

    2003-01-01

    To determine the usefulness of three-dimensional CT angiography using multidetector-row CT (MD-CT) for delineating the arterial anatomy of the liver. Hepatic arterial three-dimensional CT angiography was performed using MDCT (lightspeed Qx/I; GE medical systems, milwaukee, Wis., U.S.A.) in 45 patients with HCC undergoing conventional angiography for transcatheter hepatic arterial chemoembolization. The scanning parameters during the early arterial phase were 2.5 mm slice thickness, 7.5 mm rotation of table speed, and a pitch of 3. Images were obtained by one radiologist using maximum intensity projection from axial CT images obtained during the early arterial phase. Two radiologists blinded to the findings of conventional angiography independently evaluated the hepatic arterial anatomy and the quality of the images obtained. Compared with conventional angiography, reader A correctly evaluated the hepatic arterial anatomy depicted at three-dimensional CT angiography. Reader B's evaluation was correct in 40 of 45 patients. Interobserver agreement was good (kappa value, 0.73), and both readers assessed the quality of three-dimensional CT angiography as excellent. Three-dimensional CT angiography using MDCT was accurate for delineating the arterial anatomy of the liver, and interobserver agreement was good. The modality may provide, prior to conventional angiography, valuable information regrading a patient's hepatic arterial anatomy

  8. Treatment of hepatic neoplasm through extrahepatic collaterals

    Energy Technology Data Exchange (ETDEWEB)

    Soo, C.S.; Chuang, V.P.; Wallace, S.; Charnsangavej, C.; Carrasco, H.

    1983-04-01

    Twenty-nine patients with hepatic artery occlusion were treated with additional hepatic infusion or embolization through extrahepatic collaterals. Seventeen courses of hepatic infusion were performed in 13 patients through the inferior pancreaticoduodenal artery, left gastric artery, or right gastric artery. Twenty-five hepatic embolization procedures were performed in 16 patients through the right and left phrenic arteries, left and right gastric arteries, pancreaticoduodenal artery, gastroduodenal artery, or omentoepiploic artery. In one patient gastric ulcers developed following left gastric artery infusion. No complication related to the embolization procedure was observed in the embolization group. The extrahepatic collaterals are important alternative routes for continuous transcatheter management of hepatic neoplasms following hepatic artery occlusion.

  9. Treatment of hepatic neoplasm through extrahepatic collaterals

    International Nuclear Information System (INIS)

    Soo, C.S.; Chuang, V.P.; Wallace, S.; Charnsangavej, C.; Carrasco, H.

    1983-01-01

    Twenty-nine patients with hepatic artery occlusion were treated with additional hepatic infusion or embolization through extrahepatic collaterals. Seventeen courses of hepatic infusion were performed in 13 patients through the inferior pancreaticoduodenal artery, left gastric artery, or right gastric artery. Twenty-five hepatic embolization procedures were performed in 16 patients through the right and left phrenic arteries, left and right gastric arteries, pancreaticoduodenal artery, gastroduodenal artery, or omentoepiploic artery. In one patient gastric ulcers developed following left gastric artery infusion. No complication related to the embolization procedure was observed in the embolization group. The extrahepatic collaterals are important alternative routes for continuous transcatheter management of hepatic neoplasms following hepatic artery occlusion

  10. Clinical value of arteriography in postpartum hemorrhage by transcatheter arterial embolization

    International Nuclear Information System (INIS)

    Wang Kai; Jiang Guomin; Zhao Jinwei; Huang Wenhua; Liu Yizhi; Jin Yonghai

    2010-01-01

    Objective: To analyze the arterial supply in postpartum hemorrhage and to evaluate the clinical value of arteriography in transcatheter arterial embolization (TAE) for treating postpartum hemorrhage. Methods: The arteriography of 37 patients with postpartum hemorrhage was analyzed. TAE were performed after the bleeding artery was identified. Post TAE angiography was performed to confirm the success of embolization. Results: The bleeding artery in atonic uterus and abnormal placenta was the uterine artery. The bleeding artery in birth canal laceration is mainly non-uterine artery. Postpartum hemorrhage was successfully controlled in all 37 patients without sever complication of TAE. Conclusion: Arteriography in postpartum hemorrhage can demonstrate the bleeding artery and is potential collaterals allowing adequate embolization without complication. (authors)

  11. Transcatheter arterial embolization for endoscopically unmanageable non-variceal upper gastrointestinal bleeding.

    Science.gov (United States)

    Lee, Han Hee; Park, Jae Myung; Chun, Ho Jong; Oh, Jung Suk; Ahn, Hyo Jun; Choi, Myung-Gyu

    2015-07-01

    Transcatheter arterial embolization (TAE) is a therapeutic option for endoscopically unmanageable upper gastrointestinal (GI) bleeding. We aimed to assess the efficacy and clinical outcomes of TAE for acute non-variceal upper GI bleeding and to identify predictors of recurrent bleeding within 30 days. Visceral angiography was performed in 66 patients (42 men, 24 women; mean age, 60.3 ± 12.7 years) who experienced acute non-variceal upper GI bleeding that failed to be controlled by endoscopy during a 7-year period. Clinical information was reviewed retrospectively. Outcomes included technical success rates, complications, and 30-day rebleeding and mortality rates. TAE was feasible in 59 patients. The technical success rate was 98%. Rebleeding within 30 days was observed in 47% after an initial TAE and was managed with re-embolization in 8, by endoscopic intervention in 5, by surgery in 2, and by conservative care in 12 patients. The 30-day overall mortality rate was 42.4%. In the case of initial endoscopic hemostasis failure (n = 34), 31 patients underwent angiographic embolization, which was successful in 30 patients (96.8%). Rebleeding occurred in 15 patients (50%), mainly because of malignancy. Two factors were independent predictors of rebleeding within 30 days by multivariate analysis: coagulopathy (odds ratio [OR] = 4.37; 95% confidence interval [CI]: 1.25-15.29; p = 0.021) and embolization in ≥2 territories (OR = 4.93; 95% CI: 1.43-17.04; p = 0.012). Catheterization-related complications included hepatic artery dissection and splenic embolization. TAE controlled acute non-variceal upper GI bleeding effectively. TAE may be considered when endoscopic therapy is unavailable or unsuccessful. Correction of coagulopathy before TAE is recommended.

  12. Left main coronary artery obstruction by dislodged native-valve calculus after transcatheter aortic valve replacement.

    Science.gov (United States)

    Durmaz, Tahir; Ayhan, Huseyin; Keles, Telat; Aslan, Abdullah Nabi; Erdogan, Kemal Esref; Sari, Cenk; Bilen, Emine; Akcay, Murat; Bozkurt, Engin

    2014-08-01

    Transcatheter aortic valve replacement can be an effective, reliable treatment for severe aortic stenosis in surgically high-risk or ineligible patients. However, various sequelae like coronary artery obstruction can occur, not only in the long term, but also immediately after the procedure. We present the case of a 78-year-old woman whose left main coronary artery became obstructed with calculus 2 hours after the transfemoral implantation of an Edwards Sapien XT aortic valve. Despite percutaneous coronary intervention in that artery, the patient died. This case reminds us that early recognition of acute coronary obstruction and prompt intervention are crucial in patients with aortic stenosis who have undergone transcatheter aortic valve replacement.

  13. Transcatheter arterial embolization for acute nonvariceal upper gastrointestinal bleeding: Indications, techniques and outcomes.

    Science.gov (United States)

    Loffroy, R; Favelier, S; Pottecher, P; Estivalet, L; Genson, P Y; Gehin, S; Cercueil, J P; Krausé, D

    2015-01-01

    Over the past three decades, transcatheter arterial embolization has become the first-line therapy for the management of acute nonvariceal upper gastrointestinal bleeding that is refractory to endoscopic hemostasis. Advances in catheter-based techniques and newer embolic agents, as well as recognition of the effectiveness of minimally invasive treatment options, have expanded the role of interventional radiology in the treatment of bleeding for a variety of indications. Transcatheter arterial embolization is a fast, safe, and effective minimally invasive alternative to surgery, when endoscopic treatment fails to control acute bleeding from the upper gastrointestinal tract. This article describes the role of arterial embolization in the management of acute nonvariceal upper gastrointestinal bleeding and summarizes the literature evidence on the outcomes of endovascular therapy in such a setting. Copyright © 2015 Éditions françaises de radiologie. Published by Elsevier Masson SAS. All rights reserved.

  14. Evaluation of transcatheter arterial chemoembolization combined with radiofrequency capacitive heating on clinical therapeutic effect of metastatic carcinoma

    International Nuclear Information System (INIS)

    Chen Qianli; Ye Qiang; Gu Weizhong; Zhang Jiazhong; Tong Qiangang; Xi Shunfa

    2006-01-01

    Objective: To evaluate clinical therapeutic efficacy and adverse efficacy of transcatheter arterial chemoembolization (TACE) combined with radiofrequency capacitive heating (RCH) for metastatic hepatic carcinoma (MHC). Methods: Thirty-nine cases of MHC were enrolled in this study and divided into two groups: study group (n=19) and control group (n=20). Before therapy, the Karnofsky's score of the patients was all beyond 60. Results: The carcinoma growth rate of the study group was -(0.38±0.22), while that of the control group was -(0.13±0.25), showing significant statistical difference (P 0.05). Conclusion: The therapeutic effect of MHC can be further improved by the treatment of TACE combined with radiofrequency capacitive heating without increase of adverse side effects. (authors)

  15. Massive tumor pulmonary embolism following transcatheter arterial chemoembolization of hepatocellular carcinoma

    International Nuclear Information System (INIS)

    Kim, Jeong Ho; Ko, Gi Young; Yoon, Hyun Ki; Sung, Kyu Bo

    2002-01-01

    Pulmonary embolism complicated by transcatheter arterial chemoembolization (TACE) in known to be due to the use of large amount of lipiodol as an embolic agent. To our knowledge, massive tumoral pulmonary embolism following TACE and confirmed by surgery has not been described in the literature. In this report, we detail the cas of a 49-year-old man in whom cyanosis and hypotension developed abruptly on the day of TACE.. Chest CT revealed diffuse low-attenuated lesions in both pulmonary arteries. Histopathological specimens after emergent pulmonary arterial embolectomy confirmed the presence of massive tumor emboli of hepatocellular carcinoma

  16. Massive tumor pulmonary embolism following transcatheter arterial chemoembolization of hepatocellular carcinoma

    International Nuclear Information System (INIS)

    Kim, Jeong Ho; Ko, Gi Young; Yoon, Hyun Ki; Sung, Kyu Bo

    2002-01-01

    Pulmonary embolism complicated by transcatheter arterial chemoembolization (TACE) is known to be due to the use of large amount of lipiodol as an embolic agent. To our knowledge, massive tumoral pulmonary embolism following TACE and confirmed by surgery has not been described in the literature. In this report, we detail the case of a 49-year-old man in whom cyanosis and hypotension developed abruptly on the day of TACE. Chest CT revealed diffuse low-attenuated lesions in both pulmonary arteries. Histopathological specimens after emergent pulmonary arterial embolectomy confirmed the presence of massive tumor emboli of hepatocellular carcinoma

  17. Transcatheter Embolization of a Renal Artery Aneurysm Using Ethylene Vinyl Alcohol Copolymer

    International Nuclear Information System (INIS)

    Rautio, Riitta; Haapanen, Arto

    2007-01-01

    Our aim was to treat a clinically silent renal artery aneurysm. The patient was a 76-year-old man with elevated prostate-specific antigen and prostata biopsies with a gradus II-III adenocarcinoma who was incidentally found to have an aneurysm in his right renal artery. We performed a successful transcatheter embolization of the aneurysm using ethylene vinyl alcohol copolymer (Onyx). To avoid migration of the liquid material into the parent artery, a balloon was inflated in the orifice of the neck of the aneurysm while the liquid was injected. Five-month follow-up computed tomography (CT) imaging confirmed total occlusion of the aneurysm

  18. Interventional treatment of upper gastrointestinal bleeding in patients of hepatic carcinoma accompanied with hepatic artery-portal vein shunting

    International Nuclear Information System (INIS)

    Li Jijun; Shang Jianqiang; Liu Zuoqin; Tang Jun; Sun Zengtao; Chen Jie; Zhang Lei; Liu Hongjun; Zhou Zhaohai

    2011-01-01

    Objective: To explore the diagnostic and therapeutic efficacy of interventional procedure for upper gastrointestinal bleeding in patients of hepatic carcinoma accompanied with hepatic artery-portal vein shunting (HAPVS). Methods: Clinical data of 27 patients of hepatic carcinoma accompanied with HAPVS were retrospectively analyzed. All patients underwent hepatic arterial angiography and transcatheter arterial embolization. Shunts were embolized with coils, Gelfoam particles or PVA particles. Results: Of 27 patients with upper gastrointestinal bleeding, central type HAPVS was seen in 16 and peripheral type HAPVS in 11. Reversed portal venous flow was detected in 20 cases and ascites was found in 23 cases. The abnormal shunts were successfully occluded in all patients and the bleeding ceased within 2 days after embolization. No recurrent bleeding occurred in one month after the treatment. Ascites disappeared in 16 cases and subsided in 7 cases. Conclusion: HAPVS is an important cause for upper gastrointestinal bleeding in patients of hepatic carcinoma, and the arteriovenous fistula can be confirmed with hepatic artery DSA. Embolization of fistulous orifice is the most effective therapy for such patients. (authors)

  19. The Usefulness of Three-Dimensional Angiography with a Flat Panel Detector of Direct Conversion Type in a Transcatheter Arterial Chemoembolization Procedure for Hepatocellular Carcinoma: Initial Experience

    International Nuclear Information System (INIS)

    Kakeda, Shingo; Korogi, Yukunori; Hatakeyama, Yoshihisa; Ohnari, Norihiro; Oda, Nobuhiro; Nishino, Kazuyoshi; Miyamoto, Wataru

    2008-01-01

    The purpose of this study was to assess the usefulness of a three-dimensional (3D) angiography system using a flat panel detector of direct conversion type in treatments with subsegmental transcatheter arterial chemoembolization (TACE) for hepatocellular carcinomas (HCCs). Thirty-six consecutive patients who underwent hepatic angiography were prospectively examined. First, two radiologists evaluated the degree of visualization of the peripheral branches of the hepatic arteries on 3D digital subtraction angiography (DSA). Then the radiologists evaluated the visualization of tumor staining and feeding arteries in 25 patients (30 HCCs) who underwent subsegmental TACE. The two radiologists who performed the TACE assessed whether the additional information provided by 3D DSA was useful for treatments. In 34 (94.4%) of 36 patients, the subsegmental branches of the hepatic arteries were sufficiently visualized. The feeding arteries of HCCs were sufficiently visualized in 28 (93%) of 30 HCCs, whereas tumor stains were sufficiently visualized in 18 (60%). Maximum intensity projection images were significantly superior to volume recording images for visualization of the tumor staining and feeding arteries of HCCs. In 27 (90%) of 30 HCCs, 3D DSA provided additional useful information for subsegmental TACE. The high-quality 3D DSA with flat panel detector angiography system provided a precise vascular road map, which was useful for performing subsegmental TACE .of HCCs

  20. Supplemental Transcatheter Arterial Chemoembolization Through a Collateral Omental Artery: Treatment for Hepatocellular Carcinoma

    International Nuclear Information System (INIS)

    Won, Jong Yun; Lee, Do Yun; Lee, Jong Tae; Park, Sung Il; Kim, Myeong-Jin; Yoo, Hyung Sik; Suh, Sang-Hyun; Park, Sang Joon

    2003-01-01

    Purpose: To evaluate the therapeutic efficacy and safety of supplemental transcatheter arterialchemoembolization (TACE) through the extrahepatic collateral omentalartery (OA) for the treatment of hepatocellular carcinoma (HCC). Methods: We studied 21 patients with extrahepatic collaterals of the OA, among 1,512 patients with HCC who had undergone angiography. HCCs supplied by collateral OAs were located at: segment IV in seven, segment V in five, segment III in three, segment VI in three and segment VIII in three patients (Couinaud classification of segments). On preoperative CT scans, every HCC was abutting the liver surface. Adjacent omental infiltration or engorgement was noted in 11 patients. Celiac and hepatic arteriograms showed hypertrophy of the feeding OA in all patients. TACE of the OA was performed in 19 patients with an emulsion of iodized oil and doxorubicin hydrochloride.Embolization with gelatin sponge particles was added in five patients. Results: Collaterals of the OA to the HCC were found on the first to seventeenth sessions of TACE. On follow-up CT scans, five patients showed complete uptake of iodized oil in the tumor. Partial uptake of iodized oil was noted in 13 patients and no uptake in one patient. There was no serious complication that related to the omental embolization, such as omental or bowel ischemia. The cumulative survival rates from the time of the TACE of the OA were 81% at 6 months and 68% at 12 months. Conclusion: TACE of the OA is safe and has a potential therapeutic effect in the treatment of HCC

  1. Primary hepatic artery embolization in pediatric blunt hepatic trauma.

    Science.gov (United States)

    Ong, Caroline C P; Toh, Luke; Lo, Richard H G; Yap, Te-Lu; Narasimhan, Kannan

    2012-12-01

    Non-operative management of isolated blunt hepatic trauma is recommended except when hemodynamic instability requires immediate laparotomy. Hepatic artery angioembolization is increasingly used for hepatic injuries with ongoing bleeding as demonstrated by contrast extravasation on the CT scan. It is used primarily or after laparotomy to control ongoing hemorrhage. Hepatic angioembolization as part of multimodality management of hepatic trauma is reported mainly in adults, with few pediatric case reports. We describe our institution experience with primary pediatric hepatic angioembolization and review the literature with regard to indications and complications. Two cases (3 and 8 years old), with high-grade blunt hepatic injuries with contrast extravasation on the CT scan were successfully managed by emergency primary hepatic angioembolization with minimal morbidity and avoided laparotomy. To date, the only reports of pediatric hepatic angioembolization for trauma are 5 cases for acute bleeding and 15 delayed cases for pseudoaneurysm. The role of hepatic angioembolization in the presence of an arterial blush on CT in adults is accepted, but contested in a pediatric series, despite higher transfusion rate and mortality rate. We propose that hepatic angioembolization should be considered adjunct treatment, in lieu of, or in addition to emergency laparotomy for hemostasis in pediatric blunt hepatic injury. Copyright © 2012 Elsevier Inc. All rights reserved.

  2. Treatment of hemobilia by transcatheter vascular occlusion

    International Nuclear Information System (INIS)

    Vaughan, R.; Roesch, J.; Keller, F.S.; Antonovic, R.; Veterans Administration Medical Center, Portland, OR

    1984-01-01

    Four cases of hemobilia treated by transcatheter arterial occlusion are presented and reviewed with 30 similar cases reported in the literature. Transcatheter vascular occlusion successfully controlled hemorrhage in all 34 patients. No obvious liver parenchymal damage appeared in 26 patients; transient elevation of liver enzymes occurred in 6 patients (18%) including one in our series; two of the patients reviewed died of acute hepatic insufficiency following nonselective hepatic artery embolization. Hemobilia should be considered when gastrointestinal hemorrhage occurs after abdominal trauma, liver biopsy or other manipulative liver procedures. Hepatic angiography establishes the diagnosis and selective vascular occlusion is the treatment of choice for control of intractable or recurrent hemorrhage. Techniques and precautions for the diagnosis and transcatheter therapy of hemobilia are discussed. (orig.)

  3. Giant anurysin of the common hepatic artery

    International Nuclear Information System (INIS)

    Montenegro Gaite, T.; Gonzalez Garcia, A.; Cortes Gonzalez, A.; Mayol Deya, A.; Fernandez de Bobadilla, M.

    1994-01-01

    Hepatic artery aneurysms are relatively infrequent and asymptomatic processes, but are very important since their rupture can prove fatal. We present a case of partially thrombosed giant aneurysm of the common hepatic artery in a 55-year-old man. The patient presented relatively nonspecific clinical signs (pain in right abdomen was the major symptom), and was diagnosed by ultrasound computerized tomography (CT) and digital subtraction angiography. (Author) 12 refs

  4. The efficacy and benefits of transcatheter arterial embolization (TAE) in patients with blunt splenic injury

    International Nuclear Information System (INIS)

    Kwack, Kyu Sung; Kim, Young Ju; Lee, Myung Sub; Kim, Dong Jin; Hong, In Soo

    2000-01-01

    To evaluate the efficacy and benefits of transcatheter arterial embolization (TAE) in patients with blunt splenic injury after blunt abdominal trauma. We retrospectively analyzed the results of transcatheter arterial embolization in 23 patients who suffered splenic injury after blunt abdominal trauma. Fourteen of the patients were male, and 9 were female; 13 were adults, and 10 were children. Transcatheter arterial embolization was performed in patients with hypotension, tachycardia, evidence of hemodynamic instability due, for example, to low levels of Hgb and Hct, or those who needed fluid therapy or blood transfusion. After embolization the patients' progress was monitored by CT scanning, abdominal sonography, or 99m Tc-sulfur colloid scintigraphy. The degree of splenic injury was classified according to the system devised by Mirvis et al.; nine cases were CT grade III, and 14 were grade IV. After demonstrating angiographically the site of contrast leakage, embolization was performed; for this, a coil only was used in 16 cases, gelfoam only in four, and both coil and gelfoam in three. There were three sites of vascular embolization: 16 procedures were performed in the proximal part of the main trunk of the splenic artery, four in a superselected branch of this same artery, and three in both the splenic artery and one of its superselected branches. Of the 23 cases, 18 recovered without splenectomy after embolization, three adult patients died from coexisting conditions (spinal or cerebral injuries, liver cirrhosis, or pelvic bone fracture) or complications (acute renal failure or disseminated intravascular coagulation). Due to co-existing pancreatic and mesenteric vessel injury, two of the adult patients who underwent TAE also underwent delayed surgery; intraoperatively, there was no evidence of splenic rebleeding. In all patients who did not undergo surgery, follow-up observation revealed a decreased volume of hemoperitoneum, increased uptake of radionuclide in

  5. The efficacy and benefits of transcatheter arterial embolization (TAE) in patients with blunt splenic injury

    Energy Technology Data Exchange (ETDEWEB)

    Kwack, Kyu Sung; Kim, Young Ju; Lee, Myung Sub; Kim, Dong Jin; Hong, In Soo [Wonju Christian Hospital, College of Medicine, Yonsei University, Wonju (Korea, Republic of)

    2000-07-01

    To evaluate the efficacy and benefits of transcatheter arterial embolization (TAE) in patients with blunt splenic injury after blunt abdominal trauma. We retrospectively analyzed the results of transcatheter arterial embolization in 23 patients who suffered splenic injury after blunt abdominal trauma. Fourteen of the patients were male, and 9 were female; 13 were adults, and 10 were children. Transcatheter arterial embolization was performed in patients with hypotension, tachycardia, evidence of hemodynamic instability due, for example, to low levels of Hgb and Hct, or those who needed fluid therapy or blood transfusion. After embolization the patients' progress was monitored by CT scanning, abdominal sonography, or {sup 99m}Tc-sulfur colloid scintigraphy. The degree of splenic injury was classified according to the system devised by Mirvis et al.; nine cases were CT grade III, and 14 were grade IV. After demonstrating angiographically the site of contrast leakage, embolization was performed; for this, a coil only was used in 16 cases, gelfoam only in four, and both coil and gelfoam in three. There were three sites of vascular embolization: 16 procedures were performed in the proximal part of the main trunk of the splenic artery, four in a superselected branch of this same artery, and three in both the splenic artery and one of its superselected branches. Of the 23 cases, 18 recovered without splenectomy after embolization, three adult patients died from coexisting conditions (spinal or cerebral injuries, liver cirrhosis, or pelvic bone fracture) or complications (acute renal failure or disseminated intravascular coagulation). Due to co-existing pancreatic and mesenteric vessel injury, two of the adult patients who underwent TAE also underwent delayed surgery; intraoperatively, there was no evidence of splenic rebleeding. In all patients who did not undergo surgery, follow-up observation revealed a decreased volume of hemoperitoneum, increased uptake of

  6. Hepatocellular carcinoma after transcatheter arterial chemoembolization: difficulties on imaging follow-up

    International Nuclear Information System (INIS)

    Yu, Jeong Sik

    2005-01-01

    Due to the narrow surgical indications for hepatocellular carcinoma (HCC) in the cirrhotic liver with decreased liver function, transcatheter arterial chemoembolization (TACE) has been generally performed in the worldwide institutions for the curative or palliative treatment of this tumor. In the majority of the cases, however, the tumors are not completely necrotized, and the recurrence rate after TACE is still high even for the patients who have received curative TACE for grossly uncomplicated localized lesions. Thus, on the follow-up imaging studies after TACE, accurate diagnosis of a residual or locally recurrent tumor is crucial and this can facilitate successful management at an early stage of the disease so as to avoid more complicated or advanced disease that has an unfavorable prognosis. Multiphase dynamic CT, including the pre-contrast phase, the arterial phase and the more delayed phase imaging, is popularly used for evaluating the therapeutic effect of TACE because the degree of uptake and the distribution of the iodized oil within the tumor and the surrounding hepatic parenchyma can provide useful information on the degree of tumor necrosis, and so a strategy can be planned for the subsequent therapeutic approach. The article by Jang et al. in this issue of the Korean Journal of Radiology is one of the studies that have assessed the diagnostic ability of multiphase dynamic CT to depict a viable tumor in HCC treated with TACE. In that study, a review of the previous serial CT images provided more accurate information for the determination of the viability of the lesion than did a review of the last CT alone in several cases that were roughly verified by subsequent pathological review of the resected specimens. The overall false positive interpretation rate for the totally necrotic tumors was just 3%; however, false negative interpretation for viable tumors was 22%, which was still too high to get reliable results with using the serial follow-up CT as

  7. The efficacy of transcatheter arterial embolization (TAE) in children with blunt splenic injury

    International Nuclear Information System (INIS)

    Park, Si Kyun; Kim, Young Ju; Kwon, Taek Sang; Kim, Jong Jin; Ko, Sung Min; Sung, Ki Joon

    1998-01-01

    The purpose of this study is to evaluate the efficacy of transcatheter arterial embolization (TAE) in children with blunt splenic injury. The results of transcatheter splenic arterial embolization in nine children who suffered splenic injury after blunt abdominal trauma were retrospectively studied. This injury was demonstrated by CT, and the findings were evaluated according to the classification of Mirvis et al.; two patients were grade 3 and seven were grade 4. All were carefully observed in intensive care before embolization. TAE was performed if a patient satisfied the following criteria : (1) transfusion and/or fluid replacement required to maintain hemodynamic stability; or (2) rapid Hb/Hct decrease; or (3) both. Splenic function was subsequently estimated according to the results of 09m Tc-sulfur colloid scintigraphy and/or CT scanning. TAE was successful in all nine children. Two were embolized with a coil only, three with gelfoam, and four with gelfoam and a coil. Seven were embolized in the main trunk of the splenic artery and others in both the main trunk and its branches. Splenic function was preserved in all nine children, during follow-up, none suffered rebleeding. TAE of the splenic artery can be a safe and effective nonsurgical approach to the management of blunt splenic injury in children, and can preserve splenic function. (author). 18 refs., 2 tabs., 3 figs

  8. The efficacy of transcatheter arterial embolization (TAE) in children with blunt splenic injury

    Energy Technology Data Exchange (ETDEWEB)

    Park, Si Kyun; Kim, Young Ju; Kwon, Taek Sang; Kim, Jong Jin; Ko, Sung Min; Sung, Ki Joon [Yonsei University, Wonju (Korea, Republic of). Wonju Coll. of Medicine

    1998-06-01

    The purpose of this study is to evaluate the efficacy of transcatheter arterial embolization (TAE) in children with blunt splenic injury. The results of transcatheter splenic arterial embolization in nine children who suffered splenic injury after blunt abdominal trauma were retrospectively studied. This injury was demonstrated by CT, and the findings were evaluated according to the classification of Mirvis et al.; two patients were grade 3 and seven were grade 4. All were carefully observed in intensive care before embolization. TAE was performed if a patient satisfied the following criteria : (1) transfusion and/or fluid replacement required to maintain hemodynamic stability; or (2) rapid Hb/Hct decrease; or (3) both. Splenic function was subsequently estimated according to the results of {sup 09m}Tc-sulfur colloid scintigraphy and/or CT scanning. TAE was successful in all nine children. Two were embolized with a coil only, three with gelfoam, and four with gelfoam and a coil. Seven were embolized in the main trunk of the splenic artery and others in both the main trunk and its branches. Splenic function was preserved in all nine children, during follow-up, none suffered rebleeding. TAE of the splenic artery can be a safe and effective nonsurgical approach to the management of blunt splenic injury in children, and can preserve splenic function. (author). 18 refs., 2 tabs., 3 figs.

  9. Emergency percutaneous transcatheter embolisation of acute arterial haemorrhage.

    LENUS (Irish Health Repository)

    Keeling, A N

    2010-09-01

    The purpose of this study was to review indications, source of haemorrhage, method of embolisation and clinical outcome in patients referred to Interventional Radiology for the emergency management of acute arterial haemorrhage.

  10. Transcatheter Embolization for Giant Splenic Artery Aneurisms: Still an Open Question

    Directory of Open Access Journals (Sweden)

    Marianna Mastroroberto

    2012-01-01

    patients with portal hypertension. It is indicated when the SAA diameter reaches 20 mm. Although endovascular techniques are effective and safe for the treatment of medium-sized SAAs, little is known about their applicability to large-sized SAAs. Herein, we report a case of giant SAA, which was treated with transcatheter coil embolization. The case was not considered suitable for surgery because of the presence of severe portal hypertension. The procedure was complicated by bacterial infection of the coils within the aneurismatic sac, leading to the development of hepatic failure. A liver transplant was then successfully performed despite the presence of a nonresponsive infection.

  11. Transcatheter Coil Embolization of an Aneurysm of the Pancreatico-duodenal Artery with Occluded Celiac Trunk

    International Nuclear Information System (INIS)

    Weber, C.H.; Pfeifer, K.J.; Tato, F.; Reiser, M.; Rieger, J.

    2005-01-01

    We report on a case of a wide-necked aneurysm of the pancreatico-duodenal artery with occlusion of the celiac trunk in an asymptomatic patient. The aneurysm was considered to be at high risk of rupture. Successful embolization after interdisciplinary consultation was followed with color-coded duplex ultrasound (CCDS) demonstrating significant flow reduction. Three weeks later CCDS and angiography demonstrated exclusion of the aneurysm and a patent arterial supply of the liver and spleen fed by superior mesenteric artery (SMA) collaterals. The patient has done well so far, without major adverse clinical events or evidence for tissue necrosis of the liver, pancreas or spleen. Discussion of the case and review of the literature indicate that transcatheter embolization is the therapy of choice even in complicated cases

  12. Imaging and transcatheter arterial embolization for traumatic splenic injuries: review of the literature.

    Science.gov (United States)

    Raikhlin, Antony; Baerlocher, Mark Otto; Asch, Murray R; Myers, Andy

    2008-12-01

    The spleen is the most commonly injured visceral organ in blunt abdominal trauma in both adults and children. Nonoperative management is the current standard of practice for patients who are hemodynamically stable. However, simple observation alone has been reported to have a failure rate as high as 34%; the rate is even higher among patients with high-grade splenic injuries (American Association for the Surgery of Trauma [AAST] grade III-V). Over the past decade, angiography with transcatheter splenic artery embolization, an alternative nonoperative treatment for splenic injuries, has increased splenic salvage rates to as high as 97%. With the help of splenic artery embolization, success rates of more than 80% have also been described for high-grade splenic injuries. We discuss the role of computed tomography and transcatheter splenic artery embolization in the diagnosis and treatment of blunt splenic trauma. We review technical considerations, indications, efficacy and complication rates. We also propose an algorithm to guide the use of angiography and splenic embolization in patients with traumatic splenic injury.

  13. Deep Circumflex Iliac Artery-Related Hemoperitoneum Formation After Surgical Drain Placement: Successful Transcatheter Embolization

    International Nuclear Information System (INIS)

    Park, Sang Woo; Chang, Seong-Hwan; Yun, Ik Jin; Lee, Hae Won

    2010-01-01

    A 53-year-old woman with liver cirrhosis and hepatocellular carcinoma underwent living donor liver transplantation. After transplantation, her hemoglobin and hematocrit levels decreased to 6.3 g/dl and 18.5%, respectively, during the course of 3 days. A contrast-enhanced abdominal computed axial tomography (CAT) scan showed a hemoperitoneum in the right perihepatic space with no evidence of abdominal wall hematoma or pseudoaneurysm formation. An angiogram of the deep circumflex iliac artery (DCIA) showed extravasation of contrast media along the surgical drain, which had been inserted during the transplantation procedure. Transcatheter embolization of the branches of the DCIA was successfully performed using N-butyl cyanoacrylate.

  14. [Clinical features and risk factors of biloma formation after transcatheter arterial chemoembolization].

    Science.gov (United States)

    Zhaolin, Zeng; Xuelian, Liu; Wensou, Huang; Mingyue, Cai; Haofan, Wang; Ming'an, Li; Hong, Shan; Zhu, Kangshun

    2015-04-07

    To explore the risk factors, treatment and outcomes of biloma after transcatheter arterial chemoembolization (TACE) for hepatocellular carcinoma (HCC). A total of 481 patients with a diagnosis of HCC underwent TACE at our hospital from January 2011 to December 2013. Biloma was tracked by the follow-ups of computed tomography or magnetic resonance imaging (CT/ MRI) . Retrospective analyses were conducted for their clinical features, treatments and prognosis. The statistically significant factors for univariate analysis were introduced into Logistic regression models for multivariate analysis to obtain the risk factors of biloma post-TACE. There were 43 cases of complicated biloma after TACE. And 38 patients (88.4% ) developed biloma at 0.5-3 months post-TACE while another 5 (9.7%) did so at 3-5 months. The multivariate analysis showed that bile duct dilation, a history of hepatectomy prior to TACE, use of polyvinyl alcohol (PVA) particles and nonsuperselective embolization were the risk factors of biloma formation after TACE. Among 9 symptomatics, there were jaundice (n =2) and fever (n =7). The diameter of bilomas was (8.07 ± 3.53) cm for 9 symptomatics and (2.81 ± 1.26) cm for 35 asymptomatics. And the difference was statistically significant (P <0. 01). Nine symptomatic patients underwent percutaneous drainage with tube and biloma diminished (n = 7) and even vanished (n = 2). Only conservative treatment was offered for 35 asymptomatics. During the follow-ups, it showed no change (n = 24) , diminishing (n = 8) and disappearance (n = 2). One case died from a greatly enlarged biloma due to hepatic failure and septic shock via a rupture into abdominal cavity and choleperitonitis. The risk factors of biloma formation after TACE for HCC are bile duct dilation, a history of hepatectomy before TACE, use of PVA particles and nonsuperselective embolization. For symptomatics, drainage must be performed timely and the prognosis is fair. For asymptomatics, regular imaging

  15. Transcatheter arterial chemoembolization combined with radiotherapy for the treatment of advanced cervical cancer

    International Nuclear Information System (INIS)

    Zhu Jun; Luo Jianjun; Zhang Wen; Huang Yong; Li Dengke; Cao Yueyong

    2010-01-01

    Objective: To discuss the clinical value of interventional transcatheter arterial chemoembolization (TACE) combined with subsequent pelvic radiotherapy in treating patients with advanced cervical cancer. Methods: According to the therapeutic scheme, 195 patients with phase IIb or beyond advanced cervical cancer were divided into two groups: (1) study group (n = 99), treated with TACE combined with subsequent pelvic radiotherapy (i.e. combination group); (2) control group(n = 96), treated with radiotherapy alone (i. e. radiotherapy alone group). The short-term and long-term clinical results as well as the occurrence of complications were compared between two groups. Results: Different degrees of the tumor shrinkage were found in patients of both groups after treatment. The short-term remission rate of the study group was significantly higher than that of the control group, and the difference between two groups was statistically significant (P = 0.012). After the procedure, the anaemia in patients of study group was markedly corrected. The difference in hemoglobin between preoperative levels and postoperative ones was significant (T-test, P < 0.01). Long-term follow-up for 3 years the survival rate of the study group was higher than that of the control group (P = 0.032). Both the recurrence rate and metastatic rate at one and three years after the therapy in the study group were distinctly lower than that in the control group (P < 0.05). No significant difference in one-year, five-year survival rate and in five-year recurrent rate existed between two groups. The main short-term complications included digestive untoward reaction, bone marrow depression, hepatic and renal toxicity, etc., which could be well relieved after active symptomatic medication. The long-term complications included radiodermatitis, radiocystitis and / or radioproctitis. The incidence of radiocystitis and radioproctitis in the study group was significantly lower than that in the control group (P

  16. Extrahepatic Blood Supply to Hepatocellular Carcinoma: Angiographic Demonstration and Transcatheter Arterial Chemoembolization

    International Nuclear Information System (INIS)

    Miyayama, Shiro; Matsui, Osamu; Taki, Keiichi; Minami, Tetsuya; Ryu, Yasuji; Ito, Chiharu; Nakamura, Koichi; Inoue, Dai; Notsumata, Kazuo; Toya, Daisyu; Tanaka, Nobuyoshi; Mitsui, Takeshi

    2006-01-01

    Purpose. To evaluate the incidence of each extrahepatic collateral pathway to hepatocellular carcinoma (HCC) and to assess technical success rates and complications of transcatheter arterial chemoembolization (TACE) through each collateral. Methods. We retrospective evaluated extrahepatic collateral pathways to HCC on angiography in 386 procedures on 181 consecutive patients. One hundred and seventy patients had previously undergone TACE. TACE through extrahepatic collaterals using iodized oil and gelatin sponge particles was performed when a catheter was advanced into the tumor-feeding branch to avoid nontarget embolization. Results. A single collateral was revealed in 275 TACE procedures, two were revealed in 74, and three or more were revealed in 34. Incidences of collateral source to HCC were 83% from the right inferior phrenic artery (IPA), 24% from the cystic artery, 13% from the omental artery, 12% from the right renal capsular artery (RCA) and left IPA, 8% from the right internal mammary artery (IMA) and right intercostal artery (ICA), and 7% from the right inferior adrenal artery (IAA). Technical success rates of TACE were 53% in the right ICA, 70% in the cystic artery, 74% in the omental artery, 93% in the left IPA, 96% in the right IPA, and 100% in the right RCA, right IMA, and right IAA. Complications included skin necrosis after TACE through the right IMA (n = 1), cholecystitis after TACE through the cystic artery (n = 1), and ulcer formation after TACE through the right gastric artery (n = 1), in addition to pleural effusion and basal atelectasis after TACE through the IPA and IMA. Conclusion. Our study suggests that TACE through extrahepatic collaterals is possible with high success rates, and is also relatively safe

  17. Post-Operative hemorrhage after myomectomy: Safety and efficacy of transcatheter uterine artery embolization

    International Nuclear Information System (INIS)

    Wan, Alvin Yu Hon; Shin, Ji Hoon; Yoon, Hyun Ki; Ko, Gi Young; Park, Sang Gik; Seong, Nak Jong; Yoon, Chang Jin

    2014-01-01

    To evaluate the safety and clinical efficacy of transcatheter uterine artery embolization (UAE) for post-myomectomy hemorrhage. We identified eight female patients (age ranged from 29 to 51 years and with a median age of 37) in two regional hospitals who suffered from post-myomectomy hemorrhage requiring UAE during the time period from 2004 to 2012. A retrospective review of the patients' clinical data, uterine artery angiographic findings, embolization details, and clinical outcomes was conducted. The pelvic angiography findings were as follows: hypervascular staining without bleeding focus (n = 5); active contrast extravasation from the uterine artery (n = 2); and pseudoaneurysm in the uterus (n = 1). Gelatin sponge particle was used in bilateral uterine arteries of all eight patients, acting as an empirical or therapeutic embolization agent for the various angiographic findings. N-butyl-2-cyanoacrylate was administered to the target bleeding uterine arteries in the two patients with active contrast extravasation. Technical and clinical success were achieved in all patients (100%) with bleeding cessation and no further related surgical intervention or embolization procedure was required for hemorrhage control. Uterine artery dissection occurred in one patient as a minor complication. Normal menstrual cycles were restored in all patients. Uterine artery embolization is a safe, minimally invasive, and effective management option for controlling post-myomectomy hemorrhage without the need for hysterectomy.

  18. Blood Pressure and Arterial Load After Transcatheter Aortic Valve Replacement for Aortic Stenosis.

    Science.gov (United States)

    Lindman, Brian R; Otto, Catherine M; Douglas, Pamela S; Hahn, Rebecca T; Elmariah, Sammy; Weissman, Neil J; Stewart, William J; Ayele, Girma M; Zhang, Feifan; Zajarias, Alan; Maniar, Hersh S; Jilaihawi, Hasan; Blackstone, Eugene; Chinnakondepalli, Khaja M; Tuzcu, E Murat; Leon, Martin B; Pibarot, Philippe

    2017-07-01

    After aortic valve replacement, left ventricular afterload is often characterized by the residual valve obstruction. Our objective was to determine whether higher systemic arterial afterload-as reflected in blood pressure, pulsatile and resistive load-is associated with adverse clinical outcomes after transcatheter aortic valve replacement (TAVR). Total, pulsatile, and resistive arterial load were measured in 2141 patients with severe aortic stenosis treated with TAVR in the PARTNER I trial (Placement of Aortic Transcatheter Valve) who had systolic blood pressure (SBP) and an echocardiogram obtained 30 days after TAVR. The primary end point was 30-day to 1-year all-cause mortality. Lower SBP at 30 days after TAVR was associated with higher mortality (20.0% for SBP 100-129 mm Hg versus 12.0% for SBP 130-170 mm Hg; P <0.001). This association remained significant after adjustment, was consistent across subgroups, and confirmed in sensitivity analyses. In adjusted models that included SBP, higher total and pulsatile arterial load were associated with increased mortality ( P <0.001 for all), but resistive load was not. Patients with low 30-day SBP and high pulsatile load had a 3-fold higher mortality than those with high 30-day SBP and low pulsatile load (26.1% versus 8.1%; hazard ratio, 3.62; 95% confidence interval, 2.36-5.55). Even after relief of valve obstruction in patients with aortic stenosis, there is an independent association between post-TAVR blood pressure, systemic arterial load, and mortality. Blood pressure goals in patients with a history of aortic stenosis may need to be redefined. Increased pulsatile arterial load, rather than blood pressure, may be a target for adjunctive medical therapy to improve outcomes after TAVR. URL: http://www.clinicaltrials.gov. Unique identifier: NCT00530894. © 2017 American Heart Association, Inc.

  19. Variation of hepatic artery on arteriogram and its clinical significance in interventional therapy for hepatic cancer

    International Nuclear Information System (INIS)

    Wang Xiaodong; Yang Renjie

    2009-01-01

    Objective: To investigate the variations of hepatic artery and its extrahepatic arteries on hepatic arteriogram and to provide benefit for transhepatic arterical chemoemblization. Methods: The hepatic arteriograms of 200 cases with unresectable hepatic malignant tumor before interventional therapy were analysed. Two interventional radiologists in common reviewed the incidences of various types according to Michels' classification, the absence of proper hepatic artery, and the variations of extrahepatic arteries originating from hepatic artery. Results: The most common hepatic artery variation was Michels type III(n=17,8.5%), followed by type II(n=10,5.0%) and V(n=9,4.5%). Proper hepatic absence was found in 25 cases and appeared as 5 subtypes. 5 kinds of extrahepatic arteries were found. The most common extrahepatic artery was the right gastric artery (n=156,78.0%), followed by cystic artery (n=126,63.0%), accessory left gastric artery (n=19,9.5%), the hepatic falciform artery (n=5,2.5%), and accessory left inferior phrenic artery (n=4,2.0%). Conclusion: There are some other variations of hepatic artery beside Michels' classification,and there are many variations of extrahepatic arteries originating from hepatic artery, it is important to assure interventional therapy effect for hepatic cancer and prevent complication. (authors)

  20. Evaluation of the therapeutic effect of hepatic arterial chemoembolization combined with portal chemoembolization for advanced hepatic carcinomas

    International Nuclear Information System (INIS)

    He Hongde; He Jing; Luo Zhonghua; Xu Jian; Sun Lijun; Li Jingbang; Zhang Xuexin

    2010-01-01

    Objective: To evaluate the effect of transcatheter arterial chemoembolization (TACE) together with portal vein chemoembolization (PVCE) for the treatment of advanced liver carcinomas. Methods: Forty-eight patients with liver carcinoma were randomly divided into two groups. Patients in study group (n = 22) were treated with TACE together with PVCE, and patients in control group (n = 26) were treated with TACE alone. Results: Based on the postoperative CT findings and AFP levels, the effective rate of the study group was markedly higher than that of control group and the difference between two groups was statistically significant (P < 0.05). The volume of un-embolized liver tissue in the patients of study group was obviously increased after treatment. Conclusion: TACE together with PVCE is superior to TACE alone in treating advanced hepatic carcinomas. The combination of TACE and PVCE can effectively increase the successful rate of surgical resection for the advanced hepatic carcinomas. (authors)

  1. Change in Imaging Findings on Angiography-Assisted CT During Balloon-Occluded Transcatheter Arterial Chemoembolization for Hepatocellular Carcinoma

    Energy Technology Data Exchange (ETDEWEB)

    Yoshimatsu, Rika [Hiroshima University, Department of Diagnostic Radiology, Institute and Graduate School of Biomedical Sciences (Japan); Yamagami, Takuji, E-mail: yamagami@kochi-u.ac.jp [Kochi University, Department of Radiology (Japan); Ishikawa, Masaki; Kajiwara, Kenji [Hiroshima University, Department of Diagnostic Radiology, Institute and Graduate School of Biomedical Sciences (Japan); Aikata, Hiroshi; Chayama, Kazuaki [Hiroshima University, Department of Gastroenterology and Metabolism, Institute of Biomedical and Health Sciences (Japan); Awai, Kazuo [Hiroshima University, Department of Diagnostic Radiology, Institute and Graduate School of Biomedical Sciences (Japan)

    2016-06-15

    PurposeTo evaluate changes in imaging findings on CT during hepatic arteriography (CTHA) and CT during arterial portography (CTAP) by balloon occlusion of the treated artery and their relationship with iodized oil accumulation in the tumor during balloon-occluded transcatheter arterial chemoembolization (B-TACE).MethodsBoth B-TACE and angiography-assisted CT were performed for 27 hepatocellular carcinomas. Tumor enhancement on selective CTHA with/without balloon occlusion and iodized oil accumulation after B-TACE were evaluated. Tumorous portal perfusion defect size on CTAP was compared with/without balloon occlusion. Factors influencing discrepancies between selective CTHA with/without balloon occlusion and the degree of iodized oil accumulation were investigated.ResultsAmong 27 tumors, tumor enhancement on selective CTHA changed after balloon occlusion in 14 (decreased, 11; increased, 3). In 18 tumors, there was a discrepancy between tumor enhancement on selective CTHA with balloon occlusion and the degree of accumulated iodized oil, which was higher than the tumor enhancement grade in all 18. The tumorous portal perfusion defect on CTAP significantly decreased after balloon occlusion in 18 of 20 tumors (mean decrease from 21.9 to 19.1 mm in diameter; p = 0.0001). No significant factors influenced discrepancies between selective CTHA with/without balloon occlusion. Central area tumor location, poor tumor enhancement on selective CTHA with balloon occlusion, and no decrease in the tumorous portal perfusion defect area on CTAP after balloon occlusion significantly influenced poor iodized oil accumulation in the tumor.ConclusionsTumor enhancement on selective CTHA frequently changed after balloon occlusion, which did not correspond to accumulated iodized oil in most cases.

  2. Transcatheter Arterial Embolization for Postpartum Hemorrhage: Indications, Technique, Results, and Complications

    Energy Technology Data Exchange (ETDEWEB)

    Soyer, Philippe, E-mail: philippe.soyer@lrb.aphp.fr; Dohan, Anthony, E-mail: anthony.dohan@lrb.aphp.fr; Dautry, Raphael, E-mail: raphael-dautry@yahoo.fr; Guerrache, Youcef, E-mail: docyoucef05@yahoo.fr [Hôpital Lariboisière-AP-HP, Department of Abdominal and Interventional Imaging (France); Ricbourg, Aude, E-mail: aude.ricbourg@lrb.aphp.fr [Hôpital Lariboisière-AP-HP, Department of Obstetrics and Gynecology (France); Gayat, Etienne, E-mail: etienne.gayat@lrb.aphp.fr [Diderot-Paris 7, Université-Sorbonne Paris-Cité (France); Boudiaf, Mourad, E-mail: mourad.boudiaf@lrb.aphp.fr; Sirol, Marc, E-mail: marc.sirol@lrb.aphp.fr; Ledref, Olivier, E-mail: olivier.ledref@lrb.aphp.fr [Hôpital Lariboisière-AP-HP, Department of Abdominal and Interventional Imaging (France)

    2015-10-15

    Postpartum hemorrhage (PPH) is a potentially life-threatening condition, which needs multidisciplinary management. Uterine atony represents up to 80 % of all causes of PPH. Transcatheter arterial embolization (TAE) has now a well-established role in the management of severe PPH. TAE allows stopping the bleeding in 90 % of women with severe PHH, obviating surgery. Pledgets of gelatin sponge as torpedoes are commonly used for safe TAE, and coils, glue, and microspheres have been primarily used in specific situations such as arterial rupture, pseudoaneurysm, and arteriovenous fistula. TAE is a minimally invasive procedure with a low rate of complications, which preserves future fertility. Knowledge of causes of PPH, potential risks, and limitations of TAE is essential for a timely decision, optimizing TAE, preventing irreversible complications, avoiding hysterectomy, and ultimately preserving fertility.

  3. Transcatheter Arterial Embolization for Postpartum Hemorrhage: Indications, Technique, Results, and Complications

    International Nuclear Information System (INIS)

    Soyer, Philippe; Dohan, Anthony; Dautry, Raphael; Guerrache, Youcef; Ricbourg, Aude; Gayat, Etienne; Boudiaf, Mourad; Sirol, Marc; Ledref, Olivier

    2015-01-01

    Postpartum hemorrhage (PPH) is a potentially life-threatening condition, which needs multidisciplinary management. Uterine atony represents up to 80 % of all causes of PPH. Transcatheter arterial embolization (TAE) has now a well-established role in the management of severe PPH. TAE allows stopping the bleeding in 90 % of women with severe PHH, obviating surgery. Pledgets of gelatin sponge as torpedoes are commonly used for safe TAE, and coils, glue, and microspheres have been primarily used in specific situations such as arterial rupture, pseudoaneurysm, and arteriovenous fistula. TAE is a minimally invasive procedure with a low rate of complications, which preserves future fertility. Knowledge of causes of PPH, potential risks, and limitations of TAE is essential for a timely decision, optimizing TAE, preventing irreversible complications, avoiding hysterectomy, and ultimately preserving fertility

  4. A Case of Traumatic Mesenteric Bleeding Controlled by only Transcatheter Arterial Embolization

    International Nuclear Information System (INIS)

    Asayama, Yoshiki; Matsumoto, Shunichi; Isoda, Takuro; Kunitake, Naonobu; Nakashima, Hideaki

    2005-01-01

    We report a case of mesenteric hematoma following blunt abdominal trauma that was successfully treated with transcatheter arterial embolization (TAE) and did not require surgical repair. A 43-year-old man with blunt abdominal trauma caused in a factory accident was admitted with a stable general condition and laboratory data. On CT examination, a large mesenteric hematoma with extravasation of contrast media was observed. TAE was first attempted to control the bleeding. A superior mesenteric angiogram showed extravasation of contrast medium from a branch of the ileocolic artery and obstruction of the cecal branch. After successful TAE using microcoils, the distal portion of the cecal branch was still preserved via collateral circulation. No abdominal symptoms have occurred during the 7 months following TAE. In mesenteric injury cases with limited intestinal damage, TAE may therefore be a reasonable alternative to emergent laparotomy

  5. Blunt splenic injury in a child with situs inversus totalis treated with transcatheter arterial embolization

    Directory of Open Access Journals (Sweden)

    Naoki Hashizume

    2016-10-01

    Full Text Available We report the first case of blunt splenic rupture in a child with situs inversus totalis treated with transcatheter arterial embolization (TAE. A 12-year-old girl fell roughly 4 feet onto the pavement while riding her bicycle. Contrast-enhanced computed tomography revealed situs inversus totalis, a massive hemorrhage in the abdominal cavity, and a ruptured spleen with extravasation. Arteriography showed that the internal organs were located opposite their normal positioning. TAE was carried out with gelfoam and a micro coils at the branch of the upper lobe of the splenic artery. TAE is effective for blunt splenic injury with extravasation in a child with situs inversus. In TAE, there is no technical difference about situs inversus excepted mirror image of abdominal vascular formation.

  6. Transcatheter arterial embolization is the first-line therapy of choice in peptic ulcer bleeding not responding to endoscopic therapy

    DEFF Research Database (Denmark)

    Laursen, Stig Borbjerg; Jakobsen, Mark; Nielsen, Michael Milek

    2015-01-01

    Abstract Objective. In 5-10% of patients with peptic ulcer bleeding (PUB) it is impossible to achieve endoscopic hemostasis because of severe bleeding. These patients have traditionally been treated surgically. Transcatheter arterial embolization (TAE) may, however, be associated with a better ou...

  7. Hepatic artery aneurysm repair: a case report

    Directory of Open Access Journals (Sweden)

    Jaunoo SS

    2009-01-01

    Full Text Available Abstract Introduction Hepatic artery aneurysms remain a clinically significant entity. Their incidence continues to rise slowly and mortality from spontaneous rupture is high. Repair is recommended in those aneurysms greater than 2 cm in diameter. It is not surprising that vascular comorbidities, such as ischaemic heart disease, are common in surgical patients, particularly those with arterial aneurysms such as these. The decision of when to operate on patients who require urgent surgery despite having recently suffered an acute coronary syndrome remains somewhat of a grey and controversial area. We discuss the role of delayed surgery and postoperative followup of this vascular problem. Case presentation A 58-year-old man was admitted with a 5.5 cm hepatic artery aneurysm. The aneurysm was asymptomatic and was an incidental finding as a result of an abdominal computed tomography scan to investigate an episode of haemoptysis (Figure 1. Three weeks prior to admission, the patient had suffered a large inferior myocardial infarction and was treated by thrombolysis and primary coronary angioplasty. Angiographic assessment revealed a large aneurysm of the common hepatic artery involving the origins of the hepatic, gastroduodenal, left and right gastric arteries and the splenic artery (Figures 2 and 3. Endovascular treatment was not considered feasible and immediate surgery was too high-risk in the early post-infarction period. Therefore, surgery was delayed for 3 months when aneurysm repair with reconstruction of the hepatic artery was successfully performed. Graft patency was confirmed with the aid of an abdominal arterial duplex. Plasma levels of conventional liver function enzymes and of alpha-glutathione-S-transferase were within normal limits. This was used to assess the extent of any hepatocellular damage perioperatively. The patient made a good recovery and was well at his routine outpatient check-ups. Conclusion There is no significant

  8. Radiation exposure to patient and radiologist during transcatheter arterial embolization therapy for hepatocellular carcinoma. Multicenter study in Japan

    International Nuclear Information System (INIS)

    Ishiguchi, T.; Nakamura, H.; Okazaki, M.

    2000-01-01

    Transcatheter arterial embolization (TAE) is now most commonly used as a treatment of hepatocellular carcinoma. Present multicenter study was carried out to evaluate radiation exposure to patients and interventional radiologists during the procedure. Thirty-nine procedures of TAE for hepatocellular carcinoma in eight institutes were analyzed. Radiation exposure to the patients and the interventional radiologists were evaluated with LiF thermoluminescence dosimeters (TLDs) placed on the patient's skin at the posterior hepatic portion and the pelvis and the operator's forehead and abdomen (in front and back of the lead apron). A real-time dosimeter was also used to evaluate skin dose of the patient. TAE was performed by angiographic techniques, using a microcatheter advanced to the hepatic artery branch(es) under the guidance of X-ray fluoroscopy and digital subtraction angiography (DSA), and then injecting chemotherapeutic agents mixed with oily contrast material and followed by gelatin sponge particles. The mean fluoroscopic time was 21 minutes and the mean number of DSA acquisition was 6. TLD dosimetry showed that the mean entrance surface dose of the patient at the hepatic portion was 973±681 mSv (mean±SD), and the anterior skin dose at the pelvis was 0.98±0.69 mSv. The doses of the radiologist were 0.04±0.04 mSv at the forehead, 0.15±0.19 mSv at the abdomen in front of the lead apron, and 0.005±0.01 mSv behind it. The real-time dosimetry showed that 56% of the surface dose at the hepatic portion was from DSA and 44% was from fluoroscopy. The radiation exposure to the patients and the interventional radiologists during TAE for hepatocellular carcinoma was considered to be acceptable when proper techniques are used. Further effort to reduce radiation doses during the procedure will be directed toward both digital angiographic and fluoroscopic techniques. (author)

  9. Intravascular trans-catheter fibrinolysis in acute arterial obstructions

    International Nuclear Information System (INIS)

    Roversi, R.; Rossi, C.; Ricci, S.; Gemelli, G.; Ciliberti, M.A.

    1987-01-01

    The author's experiences is reported on intravascular fibrinolytic therapy with urokinase in acute arterial obstructions. Thirty-eight patients were treated, from 1983 to 1986, for acute thrombosis and/or thromboembolization, 22 of which developed on an atherosclerotic lesion, and 10 on a surgical stenotic by-pass graft. A complete vascular recanalization has been obtained, at the end of the procedure, in 69,4% of the cases, 77,7% had a definite final clinical improvement. The results correspond to the medium statistical of the various casistics analyzed for comparison. Surgery has been performed on 27,7% of the patients. Complication have been observed in 8% of the cases. IAF technique is of greatest value in the treatment of those lesions; better results have been obtained with intra-thrombus injection of the drug (as emphasized by many authors) in association with PTA and surgery. A close cooperation between interventional radiology, vascular surgery and angiology is therefore necessary in this field

  10. Transcatheter Arterial Embolization as a Treatment for Medial Knee Pain in Patients with Mild to Moderate Osteoarthritis

    Energy Technology Data Exchange (ETDEWEB)

    Okuno, Yuji, E-mail: how-lowlow@yahoo.co.jp [Edogawa Hospital, Department of Orthopedic Surgery (Japan); Korchi, Amine Mohamed, E-mail: amine.korchi@gmail.com [Geneva University Hospitals, Department of Diagnostic and Interventional Radiology (Switzerland); Shinjo, Takuma, E-mail: shin.takuma@a7.keio.jp [Keio University, Institute for Integrated Sports Medicine, School of Medicine (Japan); Kato, Shojiro, E-mail: shojiro7@yahoo.co.jp [Edogawa Hospital, Department of Orthopedic Surgery (Japan)

    2015-04-15

    PurposeOsteoarthritis is a common cause of pain and disability. Mild to moderate knee osteoarthritis that is resistant to nonsurgical options and not severe enough to warrant joint replacement represents a challenge in its management. On the basis of the hypothesis that neovessels and accompanying nerves are possible sources of pain, previous work demonstrated that transcatheter arterial embolization for chronic painful conditions resulted in excellent pain relief. We hypothesized that transcatheter arterial embolization can relieve pain associated with knee osteoarthritis.MethodsTranscatheter arterial embolization for mild to moderate knee osteoarthritis using imipenem/cilastatin sodium or 75 μm calibrated Embozene microspheres as an embolic agent has been performed in 11 and three patients, respectively. We assessed adverse events and changes in Western Ontario and McMaster University Osteoarthritis Index (WOMAC) scores.ResultsAbnormal neovessels were identified within soft tissue surrounding knee joint in all cases by arteriography. No major adverse events were related to the procedures. Transcatheter arterial embolization rapidly improved WOMAC pain scores from 12.2 ± 1.9 to 3.3 ± 2.1 at 1 month after the procedure, with further improvement at 4 months (1.7 ± 2.2) and WOMAC total scores from 47.3 ± 5.8 to 11.6 ± 5.4 at 1 month, and to 6.3 ± 6.0 at 4 months. These improvements were maintained in most cases at the final follow-up examination at a mean of 12 ± 5 months (range 4–19 months).ConclusionTranscatheter arterial embolization for mild to moderate knee osteoarthritis was feasible, rapidly relieved resistant pain, and restored knee function.

  11. Transcatheter Arterial Embolization as a Treatment for Medial Knee Pain in Patients with Mild to Moderate Osteoarthritis

    International Nuclear Information System (INIS)

    Okuno, Yuji; Korchi, Amine Mohamed; Shinjo, Takuma; Kato, Shojiro

    2015-01-01

    PurposeOsteoarthritis is a common cause of pain and disability. Mild to moderate knee osteoarthritis that is resistant to nonsurgical options and not severe enough to warrant joint replacement represents a challenge in its management. On the basis of the hypothesis that neovessels and accompanying nerves are possible sources of pain, previous work demonstrated that transcatheter arterial embolization for chronic painful conditions resulted in excellent pain relief. We hypothesized that transcatheter arterial embolization can relieve pain associated with knee osteoarthritis.MethodsTranscatheter arterial embolization for mild to moderate knee osteoarthritis using imipenem/cilastatin sodium or 75 μm calibrated Embozene microspheres as an embolic agent has been performed in 11 and three patients, respectively. We assessed adverse events and changes in Western Ontario and McMaster University Osteoarthritis Index (WOMAC) scores.ResultsAbnormal neovessels were identified within soft tissue surrounding knee joint in all cases by arteriography. No major adverse events were related to the procedures. Transcatheter arterial embolization rapidly improved WOMAC pain scores from 12.2 ± 1.9 to 3.3 ± 2.1 at 1 month after the procedure, with further improvement at 4 months (1.7 ± 2.2) and WOMAC total scores from 47.3 ± 5.8 to 11.6 ± 5.4 at 1 month, and to 6.3 ± 6.0 at 4 months. These improvements were maintained in most cases at the final follow-up examination at a mean of 12 ± 5 months (range 4–19 months).ConclusionTranscatheter arterial embolization for mild to moderate knee osteoarthritis was feasible, rapidly relieved resistant pain, and restored knee function

  12. Emergency transcatheter arterial embolization for critical massive bleeding due to duodenal bulb ulcer

    International Nuclear Information System (INIS)

    Li Qiang; Li Yiyun; Zhao Chunmei

    2011-01-01

    Objective: To evaluate the efficacy and feasibility of emergency transcatheter arterial embolization (ETAE) in treating critical massive bleeding due to duodenal bulb ulcer. Methods: ETAE was carried out in seven patients with acute massive bleeding due to endoscopically-proved duodenal bulb ulcer, who failed to respond conservative measures and were critically ill clinically. Super-selective catheterization of gastroduodenal artery or right gastroepiploic artery was performed, which was followed by arterial angiography to identify the bleeding site. According to the angiographic findings, ETAE with Gelfoam particles and coils was carried out. After the operation medical management was given and endoscopy re-examination was conducted. All the patients were follow up for 3∼6 months. Results: Angiographically, gastroduodenal artery bleeding was detected in all seven patients. ETAE was successfully accomplished in all cases. Complete clinical effectiveness was obtained in six patients while partial effectiveness in one case. No procedure-related complications occurred. Conclusion: For critical massive bleeding due to duodenal bulb ulcer ETAE is a highly effective and safe treatment, which can be regarded as an alternative to surgery. It is worth popularizing this technique in clinical practice. (authors)

  13. Transcatheter Arterial Chemoembolization of Liver Tumors: Effects of Embolization Protocol on Injectable Volume of Chemotherapy and Subsequent Arterial Patency

    International Nuclear Information System (INIS)

    Geschwind, Jean-Francois H.; Ramsey, Douglas E.; Wal, B.C.H. van der; Kobeiter, Hicham; Juluru, Krishna; Hartnell, George G.; Choti, Michael A.

    2003-01-01

    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 Gelfoampledgets. The total volume of chemotherapy injected into the liver was recorded. Arterial patency was determined during subsequent chemoembolizations. The mean percentage of total intended chemotherapydose 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

  14. Preoperative transcatheter renal artery embolization with absolute alcohol for the treatment of renal carcinoma: a clinical efficacy analysis

    International Nuclear Information System (INIS)

    Shang Mingyi; Wang Guoliang; Han Hongjie; Xi Qian; Huang Zongliang; Tang Junjun; Gao Xiaolong; Wang Peijun; Lu Ying; Xu Weiguo

    2010-01-01

    Objective: To access the effectiveness of preoperative transcatheter renal artery embolization with absolute alcohol performed before nephrectomy in treating renal carcinoma. Methods: Preoperative transcatheter renal artery embolization with absolute alcohol was performed in 32 patients with renal carcinoma. The renal arteries of the diseased side were progressively occluded, from distal small branches to proximal larger ones, and the renal artery trunk was embolized with gelatin sponge. Radical nephrectomy was carried out 2-5 days after the embolization procedure. The resectional rate of the tumor, the blood loss during the surgery and the operation time were recorded and analyzed. Results: Angiography performed immediately after the embolization showed that complete embolization of the main renal artery was achieved in all 32 patients. The resectional rate of the tumor was 100%. During the surgery, shrinkage of tumor, collapse of renal superficial veins and marked perinephric edema were observed. The blood loss during the surgery was much less and the operation time cost was much shorter than a usual nephrectomy did. Conclusion: The preoperative transcatheter renal artery embolization with absolute alcohol is an effective therapeutic means for renal carcinoma, it can definitely reduce the surgical blood loss and shorten the operative time. (authors)

  15. Transcatheter closure of patent ductus arteriosus with severe pulmonary arterial hypertension in adults

    International Nuclear Information System (INIS)

    Zhao Shihua; Yan Chaowu; Jiang Shiliang; Xu Zhongying; Huang Lianjun; Ling Jian; Zheng Hong; Wang Cheng; Hu Haibo; Wu Wenhui; Li Shiguo; Dai Ruping

    2006-01-01

    Objective: To evaluate the effect of self-expandable occluder on closure of patent ductus arteriosus (PDA) with severe pulmonary arterial hypertension (PH) in adults. Methods: Twenty-eight adult patients underwent transcatheter closure of PDA at a mean age of (31.3±11.6) years [(18-58) years]. Either Amplatzer duct occluder or domestic device was used in the present study. X-ray, EKG and UCG were repeated in one day, one month, three months, and six months. Results: Twenty of the 28 patients had successful occlusion, and the other 8 patients were given up. In the successful group, the narrowest diameter of PDA was (10.4±2.7) mm [(6-16) mm], the diameter of selected occluder was (15.6±3.2)mm [(10-20) mm] at the end of pulmonary artery. Systemic artery oxygen saturation (SAsat) before and after oxygen inhalation was (93.5±1.8)%, (98.2±1.8)%, respectively (P<0.01). Systolic pulmonary arterial pressure decreased significantly after trial occlusion from (95.5± 24.l) mm Hg to (56.3±18.3) mm Hg (P<0.01); Mean pulmonary arterial pressures decreased significantly from (70.8±18.2) mm Hg to (41.0±13.8 )mm Hg (P<0. 01), too. Six months later UCG showed that the dimensions of left atrium, left ventricle and pulmonary artery attenuated significantly with one exception; X rays showed decreased pulmonary vascularity or cardiac size as well [cardio-thoracic ratio: (59.2±6.6)% vs (54.2±3.3)%, P<0.01]. In given up group, four patients were defined as Eisenmenger syndromes with differential cyanosis. They presented with elevated systolic pulmonary arterial pressure [(110.3±13.9) mm Hg vs (139.5±20.0)mm Hg, P<0.01], or decreased systolic aortic pressure[(116.0±20.2)mm Hg vs (106.3±16.9) mm Hg, P<0.05]after occlusion. The others included two cases with large residual shunt, and two cases with worsening of symptoms. Conclusions: Transcatheter closure of PDA with reversible severe PH is feasible, effective and safe in adults. (authors)

  16. Transcatheter closure of patent ductus arteriosus with severe pulmonary arterial hypertension in adults

    Energy Technology Data Exchange (ETDEWEB)

    Shihua, Zhao; Chaowu, Yan; Shiliang, Jiang; Zhongying, Xu; Lianjun, Huang; Jian, Ling; Hong, Zheng; Cheng, Wang; Haibo, Hu; Wenhui, Wu; Shiguo, Li; Ruping, Dai [Department of Radiology, Cardiovascular Inst. and Fuwai Hospital, Chinese Academy of Medical Sciences, Beijing Union Medical College, Beijing (China)

    2006-11-15

    Objective: To evaluate the effect of self-expandable occluder on closure of patent ductus arteriosus (PDA) with severe pulmonary arterial hypertension (PH) in adults. Methods: Twenty-eight adult patients underwent transcatheter closure of PDA at a mean age of (31.3{+-}11.6) years [(18-58) years]. Either Amplatzer duct occluder or domestic device was used in the present study. X-ray, EKG and UCG were repeated in one day, one month, three months, and six months. Results: Twenty of the 28 patients had successful occlusion, and the other 8 patients were given up. In the successful group, the narrowest diameter of PDA was (10.4{+-}2.7) mm [(6-16) mm], the diameter of selected occluder was (15.6{+-}3.2)mm [(10-20) mm] at the end of pulmonary artery. Systemic artery oxygen saturation (SAsat) before and after oxygen inhalation was (93.5{+-}1.8)%, (98.2{+-}1.8)%, respectively (P<0.01). Systolic pulmonary arterial pressure decreased significantly after trial occlusion from (95.5{+-} 24.l) mm Hg to (56.3{+-}18.3) mm Hg (P<0.01); Mean pulmonary arterial pressures decreased significantly from (70.8{+-}18.2) mm Hg to (41.0{+-}13.8 )mm Hg (P<0. 01), too. Six months later UCG showed that the dimensions of left atrium, left ventricle and pulmonary artery attenuated significantly with one exception; X rays showed decreased pulmonary vascularity or cardiac size as well [cardio-thoracic ratio: (59.2{+-}6.6)% vs (54.2{+-}3.3)%, P<0.01]. In given up group, four patients were defined as Eisenmenger syndromes with differential cyanosis. They presented with elevated systolic pulmonary arterial pressure [(110.3{+-}13.9) mm Hg vs (139.5{+-}20.0)mm Hg, P<0.01], or decreased systolic aortic pressure[(116.0{+-}20.2)mm Hg vs (106.3{+-}16.9) mm Hg, P<0.05]after occlusion. The others included two cases with large residual shunt, and two cases with worsening of symptoms. Conclusions: Transcatheter closure of PDA with reversible severe PH is feasible, effective and safe in adults. (authors)

  17. Right Hepatic Artery: A Cadaver Investigation and Its Clinical Significance

    Directory of Open Access Journals (Sweden)

    Usha Dandekar

    2015-01-01

    Full Text Available The right hepatic artery is an end artery and contributes sole arterial supply to right lobe of the liver. Misinterpretation of normal anatomy and anatomical variations of the right hepatic artery contribute to the major intraoperative mishaps and complications in hepatobiliary surgery. The frequency of inadvertent or iatrogenic hepatobiliary vascular injury rises with the event of an aberrant anatomy. This descriptive study was carried out to document the normal anatomy and different variations of right hepatic artery to contribute to existing knowledge of right hepatic artery to improve surgical safety. This study conducted on 60 cadavers revealed aberrant replaced right hepatic artery in 18.3% and aberrant accessory right hepatic artery in 3.4%. Considering the course, the right hepatic artery ran outside Calot’s triangle in 5% of cases and caterpillar hump right hepatic artery was seen in 13.3% of cases. The right hepatic artery (normal and aberrant crossed anteriorly to the common hepatic duct in 8.3% and posteriorly to it in 71.6%. It has posterior relations with the common bile duct in 16.7% while in 3.4% it did not cross the common hepatic duct or common bile duct. The knowledge of such anomalies is important since their awareness will decrease morbidity and help to keep away from a number of surgical complications.

  18. Effect of transcatheter arterial embolization according to angiographic findings in hepatocellular carcinoma

    International Nuclear Information System (INIS)

    Wang, Chi Hyung; Shim, Hyung Jin; Lee, Jong Ik; Yu, Hyun; Kim, Young Goo; Lee, Jong Beum; Kim, Kun Sang

    1994-01-01

    The purpose of this study is to assess the effect of Transcatheter Arterial Embolization(TAE) according to angiographic findings in hepatocellular carcinoma. We retrospectively reviewed 50 cases who received TAE for unresectable hepatocellular carcinoma. We analyzed the angiographic findings which were correlated with the effect of TAE. The common angiographic findings of the hepatocellular carcinoma were tumor staining, neo vascularity and enlargement of feeding artery. These angiographic findings were classified into grade 0, +1, +2. Effect of TAE were classified into five patterns; good response, partial response, minimal response, no response and more aggravation. In grading of tumor staining, among 50 cases, the grade 0, +1, +2 were seen in 1 case(2%), 14 cases(28%), 35 cases(70%) each. In grading of enlargement of feeding artery, the grade 0, +1, +2 were seen in 7 cases(14%), 19 cases(38%), 24 cases(48%) each. In grading of neo vascularity, the grade 0, +1, +2 were seen in 6 cases(12%), 15 cases(30%), 29 cases(58%) each. This study showed that the higher grade of angiographic finding, the better effect of TAE. A statistically significant difference was found (P<0.005). But the TAE was not effective in some cases (the maximum diameter of mass is over 10cm, portal vein thrombosis or arteriovenous shunt) in spite of high grade. We believe that these angiographic findings (tumor staining, enlargement of feeding artery, neo vascularity) are one of important indices for anticipating the effect of TAE in patients with unresectable hepatocellular carcinoma

  19. Significance of transcatheter arterial embolization in the treatment of pseudoaneurysm complicating pancreatitis

    International Nuclear Information System (INIS)

    Kim, Sang Gyee; Joo, Jung Hyun; Kim, Young Cheol; Kim, Jae Kyu; Jeong, Yong Yeon; Kang, Heoung Keun; Oh, Hee Yeon

    1998-01-01

    To evaluate the significance of transcatheter arterial embolization(TAE) of pseudoaneurysm complicating pancreatitis. This study was based on a retrospective analysis of eight cases, in which TAE for control of pseudoaneurysm complicating pancreatitis was attempted. All patients were males, and were aged between 35 and 65(mean, 47) years. Seven had a history of episodes of chronic pancreatitis and one case was the result of acute pancreatitis. All patients underwent diagnostic angiography and superselective embolization. Arteries in which pseudoaneurysm had occurred were the gastroduodenal (n=3D5), inferior pancreaticoduodenal (n=3D1), superior mesenteric artery root (n=3D1), and the celiac axis (n=3D1). Six cases were treated successfully without complications, but in two, embolization failed due to a wide aneurysmal neck arising from the superior mesenteric artery root and celiac axis. In four successful cases, pseudoaneurysms were completely resolved within three to six months of embolization. One of the other two remained as a pseudocyst, while in the other, also a pseudocyst, surgery was performed. Because TAE in patients with pseudoaneurysm complicating pancreatitis has a high success rate, and also leads to absolute resorption of a pseudocyst, TAE is the preferred pre-surgical treatment mode.=20

  20. Significance of transcatheter arterial embolization in the treatment of pseudoaneurysm complicating pancreatitis

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Sang Gyee; Joo, Jung Hyun; Kim, Young Cheol; Kim, Jae Kyu; Jeong, Yong Yeon; Kang, Heoung Keun [Chonnam Univ. School of Medicine, Kwangju (Korea, Republic of); Oh, Hee Yeon [Namkwang Hospital, Kwangju (Korea, Republic of)

    1998-11-01

    To evaluate the significance of transcatheter arterial embolization(TAE) of pseudoaneurysm complicating pancreatitis. This study was based on a retrospective analysis of eight cases, in which TAE for control of pseudoaneurysm complicating pancreatitis was attempted. All patients were males, and were aged between 35 and 65(mean, 47) years. Seven had a history of episodes of chronic pancreatitis and one case was the result of acute pancreatitis. All patients underwent diagnostic angiography and superselective embolization. Arteries in which pseudoaneurysm had occurred were the gastroduodenal (n=3D5), inferior pancreaticoduodenal (n=3D1), superior mesenteric artery root (n=3D1), and the celiac axis (n=3D1). Six cases were treated successfully without complications, but in two, embolization failed due to a wide aneurysmal neck arising from the superior mesenteric artery root and celiac axis. In four successful cases, pseudoaneurysms were completely resolved within three to six months of embolization. One of the other two remained as a pseudocyst, while in the other, also a pseudocyst, surgery was performed. Because TAE in patients with pseudoaneurysm complicating pancreatitis has a high success rate, and also leads to absolute resorption of a pseudocyst, TAE is the preferred pre-surgical treatment mode.=20.

  1. Transcatheter Arterial Embolization for Upper Gastrointestinal Nonvariceal Hemorrhage: Is Empiric Embolization Warranted?

    Energy Technology Data Exchange (ETDEWEB)

    Arrayeh, Elnasif; Fidelman, Nicholas, E-mail: nicholas.fidelman@ucsf.edu; Gordon, Roy L.; LaBerge, Jeanne M.; Kerlan, Robert K. [University of California San Francisco, Department of Radiology (United States); Klimov, Alexander; Bloom, Allan I. [Hadassah Hospital, Department of Radiology (Israel)

    2012-12-15

    Purpose: To determine whether transcatheter arterial embolization performed in the setting of active gastric or duodenal nonvariceal hemorrhage is efficacious when the bleeding source cannot be identified angiographically. Methods: Records of 115 adult patients who underwent visceral angiography for endoscopically documented gastric (50 patients) or duodenal (65 patients) nonvariceal hemorrhage were retrospectively reviewed. Patients were subdivided into three groups according to whether angiographic evidence of arterial hemorrhage was present and whether embolization was performed (group 1 = no abnormality, no embolization; group 2 = no abnormality, embolization performed [empiric embolization]; and group 3 = abnormality present, embolization performed). Thirty-day rates and duration of primary hemostasis and survival were compared.ResultsFor patients with gastric sources of hemorrhage, the rate of primary hemostasis at 30 days after embolization was greater when embolization was performed in the setting of a documented angiographic abnormality than when empiric embolization was performed (67% vs. 42%). The rate of primary hemostasis at 30 days after angiography was greater for patients with duodenal bleeding who either underwent empiric embolization (60%) or embolization in the setting of angiographically documented arterial hemorrhage (58%) compared with patients who only underwent diagnostic angiogram (33%). Patients with duodenal hemorrhage who underwent embolization were less likely to require additional invasive procedures to control rebleeding (p = 0.006). Conclusion: Empiric arterial embolization may be advantageous in patients with a duodenal source of hemorrhage but not in patients with gastric hemorrhage.

  2. Dynamic MR imaging of hepatoma treated by transcatheter arterial embolization therapy

    International Nuclear Information System (INIS)

    Yamashita, Y.; Yoshimatsu, S.; Sumi, M.; Harada, M.; Takahashi, M.

    1993-01-01

    The effect of transcatheter arterial chemo-embolization theory (TACE) for hepatoma was evaluated with dynamic MR imaging with Gd-DTPA in 37 patients (44 tumors). TACE was performed using Lipiodol/cis-platinum and gelatin sponge (or microspheres) as an embolic material. All patients were examined with dynamic CT and MR imaging before and after treatment. On conventional spin echo images, changes of signal intensity after treatment varied regardless of presence of Lipiodol. Dynamic MR imaging revealed changes of tumor vascularity before and after treatment. On histologic correlation, areas of persistent tumor enhancement on dynamic MR imaging corresponded to areas of viable tumor cells while areas of nonenhancement corresponded to areas of necrosis. Dynamic MR imaging was superior in contrast resolution and was not influenced by the presence of Lipiodol compared with dynamic CT, and therefore residual viable tumors were better defined by dynamic MR imaging. (orig.)

  3. The tumble occurred after transcatheter arterial chemoembolization: an investigation and analysis of its causes

    International Nuclear Information System (INIS)

    Xiao Shuping; Li Xiaofang; Zheng Chuansheng

    2012-01-01

    Objective: To investigate and analyze the cause of the tumble which occurs after transcatheter arterial chemoembolization (TACE), and to discuss its related factors. Methods: During the period from January 2003 to February 2010 in the Department of Interventional Radiology of Union Hospital (Wuhan city), post-TACE tumble occurred in 28 patients. The causes of the tumble were investigated and analyzed. Results: (1) The total number of the tumble occurrence after TACE was declining with the year. (2) Certain relationship existed between the occurrence of post-TACE tumble and the patient's age, drugs used in surgery, unit environment, nurse's shift, etc. Conclusion: Based on the patient's individual condition, intentionally enhancing the perioperative nursing care and adjusting the nurse's shift are very important measures to prevent the occurrence of post-TACE tumble. (authors)

  4. Evaluation on the safety of transcatheter uterine artery embolization for uterine myoma

    International Nuclear Information System (INIS)

    Li Yong; Chen Xiaoming; Du Juan; Zuo Yuewei; Hu Xiaoping; Luo Pengfei

    2005-01-01

    Objective: To observe complications of transcatheter uterine artery embolization (TUAE) for uterine fibroids and to evaluate its long-term safety. Methods: One hundred and ninety-eight women with uterine fibroids were treated by TUAE. The bilateral TUAE were performed using lipiodol-pingyangmycineemulsion (LPE) and gelatin sponge particles in 186 women. Among them, 138 patients were followed up for 1 to 3 year and complications were observed. Results: Complications included ecchymosis and ulceration on buttock (n=1); ulcer of labia minora (n=1); urinary retention (n=12); urinary tract infection (n=1); expelling of necrotic fibroids via vagina (n=5); secondary infection of chocolate cyst of ovary (n=1); increasing in endometrial thickness and calcification (n=1) and amenorrhea (n=2). Conclusion: TUAE is a treatment with long-term safety, while severe complications or sequelae may occur to a few patients, so strict indication should be insisted in patient selection. (authors)

  5. Transcatheter arterial Chemoembolization for infiltrative hepatocellular carcinoma: Clinical safety and efficacy and factors influencing patient survival

    International Nuclear Information System (INIS)

    Han, Kichang; Kim, Jin Hyoung; Yoon, Hee Mang; Kim, Eun Joung; Gwon, Dong Il; Ko, Gi Young; Yoon, Hyun Ki; Ko, Heung Kyu

    2014-01-01

    To evaluate the safety and efficacy of transcatheter arterial chemoembolization (TACE) in patients with infiltrative hepatocellular carcinoma (HCC) and to identify the prognostic factors associated with patient survival. Fifty two patients who underwent TACE for infiltrative HCC were evaluated between 2007 and 2010. The maximum diameter of the tumors ranged from 7 cm to 22 cm (median 15 cm). Of 46 infiltrative HCC patients with portal vein tumor thrombosis, 32 patients received adjuvant radiation therapy for portal vein tumor thrombosis after TACE. The tumor response by European Association for the Study of the Liver criteria was partial in 18%, stable in 47%, and progressive in 35% of the patients. The median survival time was 5.7 months (Kaplan-Meier analysis). The survival rates were 48% at six months, 25% at one year, and 12% at two years. In the multivariable Cox regression analysis, Child-Pugh class (p = 0.02), adjuvant radiotherapy (p 0.003) and tumor response after TACE (p = 0.004) were significant factors associated with patient survival. Major complications occurred in nine patients. The major complication rate was significantly higher in patients with Child-Pugh B than in patients with Child-Pugh A (p = 0.049, x 2 test). Transcatheter arterial chemoembolization can be a safe treatment option in infiltrative HCC patients with Child Pugh class A. Child Pugh class A, radiotherapy for portal vein tumor thrombosis after TACE and tumor response are good prognostic factors for an increased survival after TACE in patients with infiltrative HCCs.

  6. Spontaneous and traumatic hepatic rupture: imaging findings and minimally invasive treatment

    International Nuclear Information System (INIS)

    Palacio, Glaucia Andrade e Silva; D'Ippolito, Giuseppe

    2003-01-01

    Spontaneous hepatic bleeding is a rare condition. Our aim was to describe the imaging findings and minimally invasive treatment using transcatheter arterial embolization in patients with spontaneous and traumatic hepatic rupture. Three patients presented acute hemoperitoneum dur to hepatic rupture caused by spontaneous rupture of hepatocellular carcinoma, HELLP syndrome and a blunt hepatic trauma. The patients were submitted to ultrasound and computed tomography of the abdomen and subsequently treated by transcatheter arterial embolization. All patients underwent helical computed tomography before and after treatments. Computed tomography played an important role in the evaluation and follow-up in the therapeutic intervention. Different types of liver injuries were identified. Transcatheter arterial embolization blocked arterial hemorrhage in the patients who were hemodynamically unstable. The conclusion was: transcatheter arterial embolization is an effective and well-tolerated treatment method for the management of hepatic rupture and computed tomography is an excellent method for the diagnosis and follow-up of these patients. (author)

  7. Transformation of a Ruptured Giant Pulmonary Artery Aneurysm into an Air Cavity After Transcatheter Embolization in a Behcet's Patient

    International Nuclear Information System (INIS)

    Cil, Barbaros E.; Turkbey, Baris; Canyigit, Murat; Kumbasar, Ozlem O.; Celik, Gokhan; Demirkazik, Figen B.

    2006-01-01

    Pulmonary artery aneurysms due to Behcet's disease are mainly seen in young males and very rarely in females. To our knowledge there are only 10 cases reported in the related literature. Emergent transcatheter embolization was performed in a female patient with a known history of Behcet's disease in whom massive hemoptysis developed because of rupture of a giant pulmonary artery aneurysm. At 6-month follow-up, transformation of the aneurysm sac into an air cavity was detected. To our knowledge, such a transformation has never been reported in the literature before. Embolization of the pulmonary artery aneurysm and the mechanism of cavity transformation are reviewed and discussed

  8. Hepatitis C virus infection and risk of coronary artery disease

    DEFF Research Database (Denmark)

    Roed, Torsten; Lebech, Anne-Mette; Kjaer, Andreas

    2012-01-01

    Several chronic infections have been associated with cardiovascular diseases, including Chlamydia pneumoniae, human immunodeficiency virus and viral hepatitis. This review evaluates the literature on the association between chronic hepatitis C virus (HCV) infection and the risk of coronary artery...

  9. Radiofrequency ablation combined with transcatheter arterial embolisation in rabbit liver: investigation of the ablation zone according to the time interval between the two therapies.

    Science.gov (United States)

    Lee, I J; Kim, Y I; Kim, K W; Kim, D H; Ryoo, I; Lee, M W; Chung, J W

    2012-11-01

    This study was designed to evaluate the extent of the radiofrequency ablation zone in relation to the time interval between transcatheter arterial embolisation (TAE) and radiofrequency ablation (RFA) and, ultimately, to determine the optimal strategy of combining these two therapies for hepatocellular carcinoma. 15 rabbits were evenly divided into three groups: Group A was treated with RFA alone; Group B was treated with TAE immediately followed by RFA; and Group C was treated with TAE followed by RFA 5 days later. All animals underwent perfusion CT (PCT) scans immediately after RFA. Serum liver transaminases were measured to evaluate acute liver damage. Animals were euthanised for pathological analysis of ablated tissues 10 days after RFA. Non-parametric analyses were conducted to compare PCT indices, the RFA zone and liver transaminase levels among the three experimental groups. Group B showed a significantly larger ablation zone than the other two groups. Arterial liver perfusion and hepatic perfusion index represented well the perfusion decrease after TAE on PCT. Although Group B showed the most elevated liver transaminase levels at 1 day post RFA, the enzymes decreased to levels that were not different from the other groups at 10 days post-RFA. When combined TAE and RFA therapy is considered, TAE should be followed by RFA as quickly as possible, as it can be performed safely without serious hepatic deterioration, despite the short interval between the two procedures.

  10. A Gene-Based Prognostic for Hepatocellular Carcinoma Patient Response to Adjuvant Transcatheter Arterial Chemoembolization | NCI Technology Transfer Center | TTC

    Science.gov (United States)

    The gold standard of care for hepatocellular carcinoma patients with intermediate- to locally advanced tumors is transcatheter arterial chemoembolization (TACE), a procedure whereby the tumor is targeted both with local chemotherapy and restriction of local blood supply. NCI scientists have identified a 14-gene signature predictive of response to TACE, and NCI seeks licensees or co-development partners to develop the technology toward commercialization.

  11. Hepatic telangiectasia in Osler's disease treated with arterial embolization

    Energy Technology Data Exchange (ETDEWEB)

    Goethlin, J H; Nordgard, K; Jonsson, K; Nyman, U

    1982-02-01

    Hepatic hereditary telangiectasia in 2 females was treated with hepatic artery embolization. In one patient both peripheral and central arterial occlusion was performed; the patient died of massive gastro-intestinal bleeding 2 months later. Autopsy showed extensive regions with necrosis in the right liver lobe. In the next patient only central occlusion of the right hepatic artery was performed and the arterio-venous shunting in the left liver lobe left remaining. After a long reconvalescence period the patient recovered completely. It is advocated to centrally occlude only that hepatic artery supplying the most affected parts of the liver in Osler's disease. Thus extensive necrosis with possible ensuing death may be avoided.

  12. DSA analysis of the normal and variant hepatic arterial anatomy

    International Nuclear Information System (INIS)

    Lv Penghua; Wang Jie; Shi Haibing; Feng Yaoliang; Chen Huizhu; Chen Yuqin

    2005-01-01

    Objective: To observe and analyze the normal and variant hepatic arterial anatomy by DSA. Methods: One thousand and two hundreds patients with routine celiac and/or selective hepatic arteriography from November 1994 to March 2003 were retrospectively analyzed, some of them were further simultaneously undergone superior mesenteric arteriography, left gastric arteriography or inferior phrenic arteriography etc. Results: 873 (72.8%) patients had the standard hepatic arterial anatomy. 156(13.0%) patients had variant left hepatic arteries (LHAs), 120(10.0%) with variant right hepatic arteries (RHAs) and 21 (1.8%) of a variant anatomy involving both LHA and RHA. The common hepatic artery (CHA) of 1170 (97.5%) patients originated from the celiac artery. 92.0% proper hepatic artery (PHA) was the direct extension of CHA. The RHA was mainly (89.8%) derived from the PHA. There was some variation of the middle hepatic artery (MHA) with more than 62.2% arising from the LHA. The LHA was derived from the PHA (44.6%) or the RHA(30.2%) or other arteries (25.2%). Conclusions: The knowledge of normal and variant anatomy of hepatic vasculature by DSA may be very helpful for intervention therapy and hepatosurgery. (authors)

  13. Transcatheter Arterial Embolization With Spherical Embolic Agent for Pulmonary Metastases From Renal Cell Carcinoma

    Energy Technology Data Exchange (ETDEWEB)

    Seki, Akihiko, E-mail: sekia@igtc.jp; Hori, Shinichi, E-mail: horishin@igtc.jp; Sueyoshi, Satoru, E-mail: sueyoshis@igtc.jp; Hori, Atsushi, E-mail: horiat@igtc.jp; Kono, Michihiko, E-mail: konom@igtc.jp; Murata, Shinichi, E-mail: muratas@igtc.jp; Maeda, Masahiko, E-mail: maedam@igtc.jp [Gate Tower Institute for Image Guided Therapy, Department of Radiology (Japan)

    2013-12-15

    Purpose: This retrospective study aimed to evaluate the safety and local efficacy of transcatheter arterial embolization (TAE) with superabsorbent polymer microspheres (SAP-MS) in patients with pulmonary metastases from renal cell carcinoma (RCC). Methods: Sixteen patients with unresectable pulmonary metastases from RCC refractory to standard therapy were enrolled to undergo TAE with the purpose of mass reduction and/or palliation. The prepared SAP-MS swell to approximately two times larger than their dry-state size (100-150 {mu}m [n = 14], 50-100 {mu}m [n = 2]). Forty-nine pulmonary nodules (lung n = 22, mediastinal lymph node n = 17, and hilar lymph node n = 10) were selected as target lesions for evaluation. Local tumor response was evaluated 3 months after TAE according to Response Evaluation Criteria in Solid Tumors (RECIST; version 1.1). The relationship between tumor enhancement ratio by CT during selective angiography and local tumor response was evaluated. Results: The number of TAE sessions per patient ranged from 1 to 5 (median 2.9). Embolized arteries at initial TAE were bronchial arteries in 14 patients (87.5 %) and nonbronchial systemic arteries in 11 patients (68.8 %). Nodule-based evaluation showed that 5 (10.2 %) nodules had complete response, 17 (34.7 %) had partial response, 15 (30.6 %) had stable disease, and 12 (24.5 %) had progressive disease. The response rate was significantly greater in 22 lesions that had a high tumor enhancement ratio than in 27 lesions that had a slight or moderate ratio (90.9 vs. 7.4 %, p = 0.01). Severe TAE-related adverse events did not occur. Conclusion: TAE with SAP-MS might be a well-tolerated and locally efficacious palliative option for patients with pulmonary metastases from RCC.

  14. Transcatheter Arterial Embolization with N-Butyl-2-Cyanoacrylate in the Management of Spontaneous Hematomas

    Energy Technology Data Exchange (ETDEWEB)

    Ozyer, Umut, E-mail: umutozyer@gmail.com [Baskent University, Department of Radiology, Faculty of Medicine (Turkey)

    2017-01-15

    IntroductionSpontaneous hematoma refractory to conservative management is a potentially serious condition that requires prompt diagnosis and intervention. The purpose of this study was to evaluate the performance of computed tomography (CT) in the treatment planning and to report the effectiveness of transcatheter embolization with N-butyl-2-cyanoacrylate (NBCA).Materials and MethodsForty-one interventions in 38 patients within a 12-year period were evaluated. CT and angiograms were reviewed for the location of the hematoma, the presence of extravasation, and the correlation of CT and angiography findings.ResultsArterial extravasation was present on 34/39 CT scans. Angiograms confirmed the CT scans in 29 cases. Angiograms revealed extravasation in four cases which CT showed venous bleeding (n = 2) or no bleeding (n = 2). Five patients with arterial and 1 patient with venous extravasation on CT images had no extravasation on angiograms. Embolization was performed to all arteries with extravasation on angiograms. Empiric embolization of the corresponding artery on the CT was performed when there was no extravasation on angiograms. Embolization procedures were performed with 15 % NBCA diluted with iodized oil. Technical success was achieved in 40/41 (97.6 %) interventions. Clinical success was achieved in 35 patients with a single, in 1 patient with 2, and in 1 patient with 3 interventions. No complications related to embolization procedure occurred. None of the patients died due to a progression of the hematoma.ConclusionNBCA is an effective and safe embolic agent to treat hematoma refractory to conservative management. Contrast-enhanced CT may provide faster and more effective intervention.Level of Evidence IIIRetrospective.

  15. Transcatheter Arterial Embolization with N-Butyl-2-Cyanoacrylate in the Management of Spontaneous Hematomas.

    Science.gov (United States)

    Ozyer, Umut

    2017-01-01

    Spontaneous hematoma refractory to conservative management is a potentially serious condition that requires prompt diagnosis and intervention. The purpose of this study was to evaluate the performance of computed tomography (CT) in the treatment planning and to report the effectiveness of transcatheter embolization with N-butyl-2-cyanoacrylate (NBCA). Forty-one interventions in 38 patients within a 12-year period were evaluated. CT and angiograms were reviewed for the location of the hematoma, the presence of extravasation, and the correlation of CT and angiography findings. Arterial extravasation was present on 34/39 CT scans. Angiograms confirmed the CT scans in 29 cases. Angiograms revealed extravasation in four cases which CT showed venous bleeding (n = 2) or no bleeding (n = 2). Five patients with arterial and 1 patient with venous extravasation on CT images had no extravasation on angiograms. Embolization was performed to all arteries with extravasation on angiograms. Empiric embolization of the corresponding artery on the CT was performed when there was no extravasation on angiograms. Embolization procedures were performed with 15 % NBCA diluted with iodized oil. Technical success was achieved in 40/41 (97.6 %) interventions. Clinical success was achieved in 35 patients with a single, in 1 patient with 2, and in 1 patient with 3 interventions. No complications related to embolization procedure occurred. None of the patients died due to a progression of the hematoma. NBCA is an effective and safe embolic agent to treat hematoma refractory to conservative management. Contrast-enhanced CT may provide faster and more effective intervention. Retrospective.

  16. Analysis of amenorrhea after transcatheter uterine artery embolization for uterine fibroids

    International Nuclear Information System (INIS)

    Chen Xiaoming; Li Yong; Lu Ligong; Hu Baoshan; Luo Pengfei; Du Juan; Zuo Yuewei; Hu Xiaoping; Hong Danhua

    2005-01-01

    Objective: To investigate the causes of amenorrhea after transcatheter uterine artery embolization (TUAE) for uterine fibroids. Methods: Two hundreds thirty-one cases of uterine fibroids with the range of age from 29 to 51 years (mean, 39.5 years) underwent TUAE between April 1999 and May 2004. TUAE was performed by injecting lipiodol-pingyangmycine emulsion (LPE) into bilateral uterine arteries, followed by administration of gelatin sponge particles in 186 of 231 patients. LPE was prepared with pingyangmycine 8-16 mg and ultra fluid lipiodol 6-20 ml. Results: Amenorrhea occurred in 2 of 231 (0.87%) patients respectively at 3 and 4 months after TUAE. Premature ovarian failure was proved to be etiology of amenorrhea in one patient because her serum estradiol (E 2 ) became decreased and serum follicle-stimulating hormone (FSH) level increased. This woman had normal amenorrhea later after receiving estrogen-progestogen sepuential therapy for 12 months. Another patient's amenorrhea was proved to be associated with endometrial atrophy after TUAE by hysteroscope. Conclusion: Amenorrhea caused by premature ovarian failure and endometrial atrophy may occur in a tiny minority of women undergoing TUAE. (authors)

  17. Transcatheter arterial embolization as therapy of renal angiomyolipomas: The evolution in 15 years of experience

    International Nuclear Information System (INIS)

    Chatziioannou, A.; Gargas, D.; Malagari, K.; Kornezos, I.; Ioannidis, I.; Primetis, E.; Moschouris, H.; Gouliamos, A.; Mourikis, D.

    2012-01-01

    Objective: This study aims at presenting the evolution of the embolization technique in treating renal angiomyolipomas (AMLs) either diagnosed in patients with acute bleeding or discovered accidentally. Methods: Ten patients with renal AMLs have been through thirteen selective transcatheter arterial embolizations for 15 years. Two patients had tuberous sclerosis complex (TSC) with bilateral tumors and were embolized twice. Four embolic materials were employed: PVA particles, Gianturco coils, microspheres and microcoils. Catheterization was achieved by means of 5F Cobra 2 catheters and coaxial microcatheter systems. Results: On an emergency basis, embolization was a first-line treatment. In one case, surgery was necessary; in two patients, a second embolization was performed. When treatment was preventive, a single embolization proved to be sufficient, as well. There was no significant deterioration of the serum creatinine levels in the post-embolization period. Conclusion: Selective arterial embolization is a rather safe and effective technique to treat AMLs both urgently and preventively. Different embolic materials can be employed. Microspheres and microcatheters stand for new promising materials

  18. Usefulness of dynamic MR imaging for the evaluation of transcatheter arterial embolization for hepatocellular carcinoma

    International Nuclear Information System (INIS)

    Kyomasu, Yoshinori; Nakayama, Masafumi; Kawakami, Mutsumi; Mashima, Yasuoki; Ichinose, Akira; Endou, Kazuo; Chiba, Kazuo; Tanno, Munehiko; Yamada, Hideo

    1992-01-01

    Thirteen patients with hepatocellular carcinoma (HCC) were studied with dynamic MR imaging in addition to conventional T 1 - and T 2 -weighted and enhanced T 1 -weighted images before and after the treatment of HCC by transcatheter arterial embolization (TAE). Dynamic MR imaging was performed using GRASS (gradient recalled acquisition in the steady state) sequences. The imaging was started at 10 seconds after rapid injection of Gd-diethylenetriaminepentaacetic acid (Gd-DTPA) with 6s breath hold. Thereafter about 12 images were obtained during 6s breath-holding with 20 seconds intervals. On T 1 - and T 2 -weighted images, signal intensity at the tumor tended to increase during the early period after TAE and to decrease later. Intensities of the HCC, however, were heterogeneous. Differentiation among embolic area, necrosis, viable cells and recurrent area, was often difficult only by conventional images. Dynamic GRASS images could clearly demonstrate an embolic area as a region without contrast enhancement. While recurrent tumor could be diagnosed as an area with early enhancement at the arterial phase. Development of the collateral circulation and dominancy of tumor feeding vessels after TAE could also be deduced on dynamic MR images together with enhanced T 1 -weighted images. The dynamic MR imaging was concluded to be a potentially useful procedure for the clinical evaluation of HCC after TAE. (author)

  19. Transcatheter Arterial Embolization of Nonvariceal Upper Gastrointestinal Bleeding with N-Butyl Cyanoacrylate

    International Nuclear Information System (INIS)

    Jae, Hwan Jun; Chung, Jin Wook; Jung, Ah Young; Lee, Whal; Park, Jae Hyung

    2007-01-01

    To evaluate the clinical efficacy and safety of transcatheter arterial embolization (TAE) with N-Butyl Cyanoacrylate (NBCA) for nonvariceal upper gastrointestinal bleeding. Between March 1999 and December 2002, TAE for nonvariceal upper gastrointestinal bleeding was performed in 93 patients. The endoscopic approach had failed or was discarded as an approach for control of bleeding in all study patients. Among the 93 patients NBCA was used as the primary embolic material for TAE in 32 patients (28 men, four women; mean age, 59.1 years). The indications for choosing NBCA as the embolic material were: inability to advance the microcatheter to the bleeding site and effective wedging of the microcatheter into the bleeding artery. TAE was performed using 1:1 1:3 mixtures of NBCA and iodized oil. The angiographic and clinical success rate, recurrent bleeding rate, procedure related complications and clinical outcomes were evaluated. The angiographic and clinical success rates were 100% and 91% (29/32), respectively. There were no serious ischemic complications. Recurrent bleeding occurred in three patients (9%) and they were managed with emergency surgery (n = 1) and with a successful second TAE (n = 2). Eighteen patients (56%) had a coagulopathy at the time of TAE and the clinical success rate in this group of patients was 83% (15/18). TAE with NBCA is a highly effective and safe treatment modality for nonvariceal upper gastrointestinal bleeding, especially when it is not possible to advance the microcatheter to the bleeding site and when the patient has a coagulopathy

  20. Transcatheter Arterial Embolization of Nonvariceal Upper Gastrointestinal Bleeding with N-Butyl Cyanoacrylate

    Energy Technology Data Exchange (ETDEWEB)

    Jae, Hwan Jun; Chung, Jin Wook; Jung, Ah Young; Lee, Whal; Park, Jae Hyung [Seoul National University Hospital, Institute of Radiation Medicine, Seoul (Korea, Republic of)

    2007-02-15

    To evaluate the clinical efficacy and safety of transcatheter arterial embolization (TAE) with N-Butyl Cyanoacrylate (NBCA) for nonvariceal upper gastrointestinal bleeding. Between March 1999 and December 2002, TAE for nonvariceal upper gastrointestinal bleeding was performed in 93 patients. The endoscopic approach had failed or was discarded as an approach for control of bleeding in all study patients. Among the 93 patients NBCA was used as the primary embolic material for TAE in 32 patients (28 men, four women; mean age, 59.1 years). The indications for choosing NBCA as the embolic material were: inability to advance the microcatheter to the bleeding site and effective wedging of the microcatheter into the bleeding artery. TAE was performed using 1:1 1:3 mixtures of NBCA and iodized oil. The angiographic and clinical success rate, recurrent bleeding rate, procedure related complications and clinical outcomes were evaluated. The angiographic and clinical success rates were 100% and 91% (29/32), respectively. There were no serious ischemic complications. Recurrent bleeding occurred in three patients (9%) and they were managed with emergency surgery (n = 1) and with a successful second TAE (n = 2). Eighteen patients (56%) had a coagulopathy at the time of TAE and the clinical success rate in this group of patients was 83% (15/18). TAE with NBCA is a highly effective and safe treatment modality for nonvariceal upper gastrointestinal bleeding, especially when it is not possible to advance the microcatheter to the bleeding site and when the patient has a coagulopathy.

  1. Patent ductus arteriosus with persistent pulmonary artery hypertension after transcatheter closure.

    Science.gov (United States)

    Feng, Jianqi; Kong, Xiangqing; Sheng, Yanhui; Yang, Rong

    2016-01-01

    To observe the change in pulmonary artery systolic pressure (PASP) of patients with persistent pulmonary arterial hypertension (PAH) after patent ductus arteriosus (PDA) occlusion. After occlusion of PDA in patients with PAH, some patients still tend to suffer from persistent PAH. A chest X-ray, an electrocardiogram, and an echocardiogram were performed on nine patients at 24 hours, 1 and 6 months, and 1 year serially. There was a significant fall ( P 0.05). During the follow up, there was a further fall in the PASP in five patients (No 1, 5, 6, 7, and 8). Four patients (No 2, 3, 4, and 8) showed the evidence of worsening PAH and were treated with sildenafil. Patient 2 died from acute right heart failure after a period of 11 months from the time of transcatheter closure, triggered by pulmonary infection. Some patients with borderline hemodynamic data with PDA and PAH can deteriorate or keep sustained PAH after PDA closure. The treatment of permanent closure to these patients must be cautious.

  2. Spinal cord injury after conducting transcatheter arterial chemoembolization for costal metastasis of hepatocellular carcinoma

    Directory of Open Access Journals (Sweden)

    Sang Jung Park

    2012-09-01

    Full Text Available Transcatheter arterial chemoembolization (TACE has been used widely to treat patients with unresectable hepatocellular carcinoma. However, this method can induce various adverse events caused by necrosis of the tumor itself or damage to nontumor tissues. In particular, neurologic side effects such as cerebral infarction and paraplegia, although rare, may cause severe sequelae and permanent disability. Detailed information regarding the treatment process and prognosis associated with this procedure is not yet available. We experienced a case of paraplegia that occurred after conducting TACE through the intercostal artery to treat hepatocellular carcinoma that had metastasized to the rib. In this case, TACE was attempted to relieve severe bone pain, which had persisted even after palliative radiotherapy. A sudden impairment of sensory and motor functions after TACE developed in the trunk below the level of the sternum and in both lower extremities. The patient subsequently received steroid pulse therapy along with supportive care and continuous rehabilitation. At the time of discharge the patient had recovered sufficiently to enable him to walk by himself, although some paresthesia and spasticity remained.

  3. The fatal risk in hepatic artery embolization for hemostasis after pancreatic and hepatic surgery: importance of collateral arterial pathways.

    Science.gov (United States)

    Sato, Akihiro; Yamada, Takayuki; Takase, Kei; Matsuhashi, Toshio; Higano, Shuichi; Kaneda, Tomohiro; Egawa, Shinichi; Takeda, Kazunori; Ishibashi, Tadashi; Takahashi, Shoki

    2011-03-01

    To assess retrospectively the cause of hepatic failure related to hepatic arterial embolization (HAE) for hemostasis after pancreaticoduodenectomy or hepatic lobectomy. Between June 1993 and March 2006, Twenty HAEs in 17 patients (15 men, two women; mean age, 64 years) were performed. Angiographic findings, including portal vein stenosis, collateral arterial pathways after HAE, and the difference of embolic materials, were recorded. The morbidity (hepatic failure and abscess) and mortality were detailed according to collateral arterial pathways, portal vein stenosis, and embolic material used. Bleeding was controlled in all patients, although two patients required repeat embolization. Hepatic failure (n = 8) and abscess (n = 2) arose in nine of 20 HAEs. Death occurred after six of eight HAEs complicated by hepatic failure. The morbidity and mortality rates of HAE were 45% and 30%, respectively. Hepatic complication was eight times more likely to occur (P = .005) in cases with no hepatic collaterals involving hepatic, replaced, or accessory hepatic arteries. Death was observed only in the cases without hepatic collaterals (P = .011). The correlation between the embolization outcome and the presence of portal vein stenosis or the difference of embolic materials was not significant (P > .61). HAE can be used to successfully control bleeding secondary to hepatic arterial rupture. In the absence of hepatic collaterals, collateral circulation distal to the occlusion from nonhepatic sources may be inadequate and lead to hepatic failure after HAE. Copyright © 2011 SIR. Published by Elsevier Inc. All rights reserved.

  4. Hepatic arterial pseudoaneurysm: a rare complication of blunt abdominal trauma in children

    International Nuclear Information System (INIS)

    Basile, K.E.; Sivit, C.J.; Sachs, P.B.; Stallion, A.

    1999-01-01

    We report a child who developed a hepatic artery pseudoaneurysm following blunt hepatic injury. This is a rare complication of hepatic trauma in children. The imaging evaluation and clinical management of hepatic artery pseudoaneurysms are presented. (orig.)

  5. Nursing implications for Hepatic arterial perfusion scintigraphy

    International Nuclear Information System (INIS)

    Ellender, R.

    1999-01-01

    Nurses working in Nuclear Medicine assist in Hepatic Artery Catheter (HAC) perfusion studies. This scan is not widely performed in Australia, the St George hospital for example performs approximately five per year. The purpose of this article is firstly to review the indications and rationale of HAC patency studies. Secondly, this article will stress the clinical implications for the Nuclear Medicine Nurse during this study. Emphasis will be placed on the importance of patient education during the procedure. A brief overview of hepatic anatomy and the radiopharmaceuticals administered during the scan is discussed. Finally, a step by step protocol is presented to show how the perfusion/ shunt study is performed. Copyright (1999) The Australian and New Zealand Society of Nuclear Medicine Inc

  6. Development of extrahepatic arterial blood supply to the liver during hepatic arterial infusion chemotherapy

    International Nuclear Information System (INIS)

    Seki, H.; Kimura, M.; Yoshimura, N.; Yamamoto, S.; Ozaki, T.; Sakai, K.

    1998-01-01

    The aim of this study was to evaluate the correlation of development of the collateral circulation to the liver during hepatic arterial infusion chemotherapy (HAIC) with the presence of hepatic tumours adjacent to the hepatic surface, and with pretreatment occlusion of aberrant hepatic arteries. In 102 patients with unresectable malignant hepatic tumours treated with HAIC using an implantable port system, development of collaterals to the liver was assessed with CT arteriography using the implantable port and pre- and postoperative angiography. Aberrant hepatic arteries, if present, were occluded prior to treatment for hepatic arterial redistribution. Collaterals to the liver were seen in 29 patients, who had 35 areas with collateral perfusion: 22 areas were in the right posterosuperior area, 6 in the left peripheral area and 7 in the right or left lobar area. Collaterals were revealed more frequently in patients with hepatic tumours adjacent to the hepatic surface than in those without hepatic tumours in peripheral areas in the liver (p < 0.0001). In addition, collaterals developed more frequently in patients with an aberrant hepatic arterial anatomy compared with those with conventional anatomy (p = 0.0007). Our results indicated that patients with hepatic tumours adjacent to the hepatic surface and with pretreatment occlusion of aberrant hepatic arteries had the potential to develop collaterals to the liver during HAIC. (orig.)

  7. An unusual case of coronary artery compression that did not preclude successful transcatheter pulmonary valve placement.

    Science.gov (United States)

    Schwartz, Matthew C; Felix, Donald; Iacono, Karen; Nykanen, David

    2018-04-16

    During transcatheter pulmonary valve placement, coronary compression observed during simultaneous right ventricular outflow tract angioplasty and coronary angiography typically contraindicates valve implantation. We present a unique patient with tetralogy of Fallot who underwent successful transcatheter Melody valve placement despite coronary compression observed during right ventricular outflow tract balloon angioplasty. © 2018 Wiley Periodicals, Inc.

  8. Spontaneous and traumatic hepatic rupture: imaging findings and minimally invasive treatment; Ruptura hepatica espontanea e traumatica: aspectos tomograficos e do tratamento minimamente invasivo

    Energy Technology Data Exchange (ETDEWEB)

    Palacio, Glaucia Andrade e Silva; D' Ippolito, Giuseppe [Hospital Sao Luis, Sao Paulo, SP (Brazil). Setor de Disgnostico por Imagem]. E-mail: gl.palacio@bol.com.br; Farias, Andre P. [Hospital Sao Luis, Sao Paulo, SP (Brazil). Setor de Tomografia Computadorizada e Ressonancia Magnetica; Carnevale, Francisco Cesar [Hospital Sao Luis, Sao Paulo, SP (Brazil). Setor de Radiologia Intervencionista; Salem, Marcelo Zindel [Hospital Sao Luis, Sao Paulo, SP (Brazil). Setor de Gastroenterologia Cirurgica; Ricca, Artur Berti [Hospital Sao Luis, Sao Paulo, SP (Brazil)

    2003-12-01

    Spontaneous hepatic bleeding is a rare condition. Our aim was to describe the imaging findings and minimally invasive treatment using transcatheter arterial embolization in patients with spontaneous and traumatic hepatic rupture. Three patients presented acute hemoperitoneum dur to hepatic rupture caused by spontaneous rupture of hepatocellular carcinoma, HELLP syndrome and a blunt hepatic trauma. The patients were submitted to ultrasound and computed tomography of the abdomen and subsequently treated by transcatheter arterial embolization. All patients underwent helical computed tomography before and after treatments. Computed tomography played an important role in the evaluation and follow-up in the therapeutic intervention. Different types of liver injuries were identified. Transcatheter arterial embolization blocked arterial hemorrhage in the patients who were hemodynamically unstable. The conclusion was: transcatheter arterial embolization is an effective and well-tolerated treatment method for the management of hepatic rupture and computed tomography is an excellent method for the diagnosis and follow-up of these patients. (author)

  9. Current status, questions and challenges of transcatheter uterine artery embolization for the treatment of uterine fibroids

    International Nuclear Information System (INIS)

    Chen Xiaoming; Luo Pengfei

    2006-01-01

    Current status, questions and challenges of transcatheter uterine artery embolization (UAE) in the treatment of uterine fibroids were summarized and analysed. It has been proved that UAE presents a good effectiveness in controlling the symptoms and shrinkage of fibroid and uterine volumes during follow-up of 4 to 6.9 years domestically and abroad, but relapse of the fibroid may however occur in 2 years or longer after UAE. Generally speaking, UAE is safe in the treatment of uterine fibroids but has a possibility of serious complications. UAE has no damage on normal uterine tissues but may affect pregnancy and delivery of patients significantly later on the cause of hypoxia and inertia of uterus. UAE may cause amenorrhea in the minority of women with ovarian failure and endometrium atrophy. The current questions are how to improve long-term efficiency to reduce relapse of tumor and to insure the safety of UAE. It is our further task to exploit more new effective and safe embolic agents by using animal and clinical study on the basic knowledge of pathology, pharmacology, biochemistry, endocrinology and molecular biology. (authors)

  10. Combined transcatheter arterial chemoembolization and percutaneous ethanol injection for treatment of hepatocellular carcinoma: preliminary study

    Energy Technology Data Exchange (ETDEWEB)

    Hahn, Seong Tae; Ahn, Bo Young; Song, Kyung Sup; Kim, Choon Yul; Shinn, Kyung Sub; Chung, Kyu Won [Catholic University Medical College, Seoul (Korea, Republic of)

    1995-01-15

    Transcatheter arterial chemoembolization (TACE) and subsequent percutaneous ethanol injection (PEI) was attempted in 8 patients with 9 hepatocellular carcinoma (HCCs) for complete tumor necrosis of HCCs less than 5 cm in greatest diameter. PEI was performed with 2-8 ml of absolute (99.9%) ethanol two weeks after TACE under CT or ultrasound guidance. For each patient PEI was done twice to four times within 4-10 days of each procedure. After completion of a series of PEI, follow up examination (range: 3 months-1.5 year period) was done with angiography, CT or ultrasound and correlated with serum alpha-fetoprotein (AFP) level. On follow up angiograms, the lesions completely disappeared or decreased in size without tumor vessels or staining in 5 of 6 patients. On follow up CT of 6 patients, the lipiodol-laden HCCs were surrounded by non-enhancing low density and the lesion sizes were slightly decreased or not changed. These are suggestive of necrosis of tumor itself and adjacent liver parenchyma. The tumors could not be detected on follow up ultrasound examination in 2 patients. Serum AFP was decreased in 7 patients and was well corresponded to the results of imaging modalities. The authors concluded that the combined TACE and PEI is an appropriate treatment for small HCCs having high surgical risks.

  11. Serum YKL-40 independently predicts outcome after transcatheter arterial chemoembolization of hepatocellular carcinoma.

    Directory of Open Access Journals (Sweden)

    Cheng-Bao Zhu

    Full Text Available Transcatheter arterial chemoembolization (TACE is the most widely used treatment option for unresectable hepatocellular carcinoma (HCC. Elevated serum YKL-40 level has been shown to predict poor prognosis in HCC patients undergoing resection. This study was designed to validate the prognostic significance of serum YKL-40 in patients with HCC undergoing TACE treatment.Serum YKL-40 level was determined by enzyme-linked immunosorbent assay. Overall survival (OS was evaluated with the Kaplan-Meier method and compared by the log-rank test. Multivariate study with Cox proportional hazard model was used to evaluate independent prognostic variables of OS.The median pretreatment serum YKL-40 in HCC patients with was significantly higher than that in healthy controls (P<0.001. The YKL-40 could predict survival precisely either in a dichotomized or continuous fashion (P<0.001 and P = 0.001, respectively. Multivariate Cox regression analysis indicated that serum YKL-40 was an independent prognostic factor for OS in HCC patients (P = 0.001. In further stratified analyses, YKL-40 could discriminate the outcomes of patients with low and high alpha-fetoprotein (AFP level (P = 0.006 and 0.016, respectively. Furthermore, the combination of serum YKL-40 and AFP had more capacity to predict patients' outcomes.Serum YKL-40 was demonstrated to be an independent prognostic biomarker in HCC patients treated with TACE. Our results need confirmation in an independent study.

  12. Transcatheter Arterial Embolization with n-Butyl Cyanoacrylate for the Treatment of Acquired Uterine Vascular Malformations

    Energy Technology Data Exchange (ETDEWEB)

    Picel, Andrew C., E-mail: apicel@ucsd.edu [University of California, San Diego, Department of Radiology (United States); Koo, Sonya J. [University of Texas Southwestern Medical Center, Department of Radiology (United States); Roberts, Anne C. [University of California, San Diego, Department of Radiology (United States)

    2016-08-15

    PurposeThe purpose of the study was to evaluate the technique and outcomes of transcatheter arterial embolization (TAE) with n-butyl cyanoacrylate (NBCA) for the treatment of acquired uterine arteriovenous malformations (AVMs).Materials and methodsA retrospective review identified five women treated for suspected acquired uterine AVMs with TAE at our institution. Four women (80 %) presented with heavy or intermittent vaginal bleeding after obstetric manipulation. One woman (20 %) was treated for an incidental AVM discovered on ultrasound after an uncomplicated cesarean section. Three women underwent one embolization procedure and two women required two procedures. Embolization material included NBCA in six procedures (80 %) and gelatin sponge in one procedure (20 %).ResultsEmbolization resulted in angiographic stasis of flow in all seven procedures. Four women (80 %) presented with vaginal bleeding which was improved after treatment. One woman returned 24 days after unilateral embolization with recurrent bleeding, which resolved after retreatment. One woman underwent two treatments for an asymptomatic lesion identified on ultrasound. There were no major complications. Three women (60 %) experienced mild postembolization pelvic pain that was controlled with non-steroidal anti-inflammatory drugs. Three women (60 %) had pregnancies and deliveries after embolization.ConclusionsTAE is a safe alternative to surgical therapy for acquired uterine AVMs with the potential to maintain fertility. Experience from this case series suggests that NBCA provides predictable and effective occlusion.

  13. Transcatheter Arterial Embolization with n-Butyl Cyanoacrylate for the Treatment of Acquired Uterine Vascular Malformations

    International Nuclear Information System (INIS)

    Picel, Andrew C.; Koo, Sonya J.; Roberts, Anne C.

    2016-01-01

    PurposeThe purpose of the study was to evaluate the technique and outcomes of transcatheter arterial embolization (TAE) with n-butyl cyanoacrylate (NBCA) for the treatment of acquired uterine arteriovenous malformations (AVMs).Materials and methodsA retrospective review identified five women treated for suspected acquired uterine AVMs with TAE at our institution. Four women (80 %) presented with heavy or intermittent vaginal bleeding after obstetric manipulation. One woman (20 %) was treated for an incidental AVM discovered on ultrasound after an uncomplicated cesarean section. Three women underwent one embolization procedure and two women required two procedures. Embolization material included NBCA in six procedures (80 %) and gelatin sponge in one procedure (20 %).ResultsEmbolization resulted in angiographic stasis of flow in all seven procedures. Four women (80 %) presented with vaginal bleeding which was improved after treatment. One woman returned 24 days after unilateral embolization with recurrent bleeding, which resolved after retreatment. One woman underwent two treatments for an asymptomatic lesion identified on ultrasound. There were no major complications. Three women (60 %) experienced mild postembolization pelvic pain that was controlled with non-steroidal anti-inflammatory drugs. Three women (60 %) had pregnancies and deliveries after embolization.ConclusionsTAE is a safe alternative to surgical therapy for acquired uterine AVMs with the potential to maintain fertility. Experience from this case series suggests that NBCA provides predictable and effective occlusion.

  14. Transcatheter Arterial Embolization for Postpartum Hemorrhage with Disseminated Intravascular Coagulation: Outcome Assessment

    Energy Technology Data Exchange (ETDEWEB)

    An, Eun Jung; Kim, Young Hwan; Kwon, Bo Ra; Kim, See Hyung [Dept. of Radiology, Dongsan Medical Center, Keimyung University College of Medicine, Daegu (Korea, Republic of)

    2011-12-15

    We evaluated the efficacy and predictors of clinical outcome after transcatheter arterial embolization (TAE) for treatment of postpartum hemorrhage with disseminated intravascular coagulation (DIC). Of 127 patients who underwent TAE for postpartum hemorrhage, 46 progressed to DIC (group 1), 81 showed normal range hematological parameters (group 2). We retrospectively evaluated etiology, embolization methods and the efficacy of TAE for intergroup comparison Pearson Chi-Square test and logistic regression model. Overall TAE failed to control bleeding in 9 patients in spite of technical success. Lower bleeding control rate was found in group 2 (82.6%) relative to group 1 (98.8%, p = 0.001). And embolization methods were not statistically different between two groups no statistically significant predictors associated with failed hemostasis except the amount of transfusion in group 1. Although bleeding control rate is lower in postpartum hemorrhage with DIC than without DIC, we believe that TAE with correction of DIC is an effective method for postpartum hemorrhage with DIC.

  15. Transcatheter Arterial Embolization for Postpartum Hemorrhage with Disseminated Intravascular Coagulation: Outcome Assessment

    International Nuclear Information System (INIS)

    An, Eun Jung; Kim, Young Hwan; Kwon, Bo Ra; Kim, See Hyung

    2011-01-01

    We evaluated the efficacy and predictors of clinical outcome after transcatheter arterial embolization (TAE) for treatment of postpartum hemorrhage with disseminated intravascular coagulation (DIC). Of 127 patients who underwent TAE for postpartum hemorrhage, 46 progressed to DIC (group 1), 81 showed normal range hematological parameters (group 2). We retrospectively evaluated etiology, embolization methods and the efficacy of TAE for intergroup comparison Pearson Chi-Square test and logistic regression model. Overall TAE failed to control bleeding in 9 patients in spite of technical success. Lower bleeding control rate was found in group 2 (82.6%) relative to group 1 (98.8%, p = 0.001). And embolization methods were not statistically different between two groups no statistically significant predictors associated with failed hemostasis except the amount of transfusion in group 1. Although bleeding control rate is lower in postpartum hemorrhage with DIC than without DIC, we believe that TAE with correction of DIC is an effective method for postpartum hemorrhage with DIC.

  16. Efficacy of Preoperative Transcatheter Arterial Embolization for Nasopharyngeal Angiofibroma: A Comparative Study.

    Science.gov (United States)

    Tan, Guosheng; Ma, Zhenjiang; Long, Weiqing; Liu, Liangshuai; Zhang, Bing; Chen, Wei; Yang, Jianyong; Li, Heping

    2017-06-01

    This study aimed to retrospectively evaluate the efficacy and safety of preoperative transcatheter arterial embolization (pTAE) for treating nasopharyngeal angiofibroma (NPAF). Seventy-four NPAF patients were hospitalized for elective surgical treatment with pTAE (pTAE group, n = 32) or surgical treatment alone (non-pTAE group, n = 42) between January 1990 and December 2013. The following outcome measures were retrospectively analyzed and compared: intraoperative bleeding volume, surgery time (ST), duration of postoperative hospital stay (PHS), and disease recurrence. Among Radkowski stage I patients, those in pTAE group had a slightly higher but not significant bleeding volume than patients in non-pTAE group (344 ± 407 vs. 248 ± 219 mL, P = 0.899); among stage II/III patients, however, patients in pTAE group showed a significantly lower bleeding volume than patients in non-pTAE group (stage II, 829 ± 519 vs. 1339 ± 767 mL, P = 0.035; stage III, 1267 ± 592 vs. 2125  ± 479 mL, P = 0.024). The two groups presented comparable OTs, PHSs, and rates of frontal recurrence (all P>0.05). pTAE significantly reduces intraoperative bleeding in NPAF patients with Radkowski stage II/III disease, but offers no additional benefits regarding ST, PHS, or recurrence.

  17. Efficacy of Preoperative Transcatheter Arterial Embolization for Nasopharyngeal Angiofibroma: A Comparative Study

    Energy Technology Data Exchange (ETDEWEB)

    Tan, Guosheng; Ma, Zhenjiang [The First Affiliated Hospital of Sun Yat-sen University, Department of Interventional Radiology (China); Long, Weiqing [The First Affiliated Hospital of Sun Yat-sen University, Department of Clinical Laboratory (China); Liu, Liangshuai [The First Affiliated Hospital of Sun Yat-sen University, Department of Interventional Radiology (China); Zhang, Bing [The First Affiliated Hospital of Sun Yat-sen University, Department of Nuclear Medicine (China); Chen, Wei; Yang, Jianyong; Li, Heping, E-mail: jxgdhp@163.com [The First Affiliated Hospital of Sun Yat-sen University, Department of Interventional Radiology (China)

    2017-06-15

    ObjectiveThis study aimed to retrospectively evaluate the efficacy and safety of preoperative transcatheter arterial embolization (pTAE) for treating nasopharyngeal angiofibroma (NPAF).MethodsSeventy-four NPAF patients were hospitalized for elective surgical treatment with pTAE (pTAE group, n = 32) or surgical treatment alone (non-pTAE group, n = 42) between January 1990 and December 2013. The following outcome measures were retrospectively analyzed and compared: intraoperative bleeding volume, surgery time (ST), duration of postoperative hospital stay (PHS), and disease recurrence.ResultsAmong Radkowski stage I patients, those in pTAE group had a slightly higher but not significant bleeding volume than patients in non-pTAE group (344 ± 407 vs. 248 ± 219 mL, P = 0.899); among stage II/III patients, however, patients in pTAE group showed a significantly lower bleeding volume than patients in non-pTAE group (stage II, 829 ± 519 vs. 1339 ± 767 mL, P = 0.035; stage III, 1267 ± 592 vs. 2125  ± 479 mL, P = 0.024). The two groups presented comparable OTs, PHSs, and rates of frontal recurrence (all P>0.05).ConclusionspTAE significantly reduces intraoperative bleeding in NPAF patients with Radkowski stage II/III disease, but offers no additional benefits regarding ST, PHS, or recurrence.

  18. Therapeutic Effect of Transcatheter Arterial Embolization for Hypervascular Hepatocellular Carcinoma: Web-based Multicenter Analysis

    International Nuclear Information System (INIS)

    Baik, Jun Hyun; Song, Kyung Sup; Han, Joon Koo

    2011-01-01

    To evaluate the therapeutic effect of transcatheter arterial embolization (TAE) as a first treatment course for hypervascular hepatocellular carcinoma (HCC), using nationwide web-based multicenter data in Korea. Eight hundred eighty eight HCC patients who were registered in the internet homepage of primary liver cancer registry (www.plcr.or.kr) from August 2003 to August 2005 were enrolled in this study, and they were investigated till February 2007. The patients were divided into three groups according to the following treatments after first TAE; TAE only, TAE + SL (any surgical resection, transplantation or percutaneous ablation followed), TAE + RC (any radiation therapy or chemotherapy followed). The clinical and tumor characteristics, embolization factors and survival periods were analyzed. The 5-year survival rates of the groups of TAE only, TAE + SL and TAE + RC were 21.6%, 57.4%, and 13.1%, respectively. In all cases and in the TAE only group, more selective and complete embolization increased survival rates. There were tendencies that as smaller tumor and the tumor in earlier stage, more selective and complete embolizations were performed in the TAE only group, and independent prognostic factors of this group were Child-Pugh classification, tumor size and Modified 4th UICC stage. This study is the first nationwide multicenter analysis for TAE using an online registration system in Korea. Selective and complete TAE increases patient's survival, and decisive combined treatment after TAE such as surgical resection, transplantation or percutaneous ablation increases patient's survival.

  19. Empiric transcatheter arterial embolization for massive bleeding from duodenal ulcers: efficacy and complications.

    Science.gov (United States)

    Ichiro, Ikushima; Shushi, Higashi; Akihiko, Ishii; Yasuhiko, Iryo; Yasuyuki, Yamashita

    2011-07-01

    To evaluate the efficacy and safety of empiric transcatheter arterial embolization (TAE) for patients with massive bleeding from duodenal ulcers. During January 2000 and December 2009, 59 patients with duodenal ulcer bleeding in whom TAE was attempted after endoscopic therapy failed were retrospectively analyzed. The patients were divided into empiric TAE (n = 36) and identifiable TAE (n = 23) groups according to angiographic findings with or without identification of the bleeding sites. The technical and clinical success rate, recurrent bleeding rate, procedure-related complications, and clinical outcomes were evaluated. The technical and clinical success rates of TAE were 100% and 83%. The recurrent bleeding rate, clinical success, duodenal stenosis, and 30-day mortality after TAE were not significantly different between the empiric and identifiable TAE groups. A high rate of technical and clinical success was obtained with empiric TAE comparable to identifiable TAE in patients with massive bleeding from duodenal ulcers. There were no severe complications. Empiric TAE is an effective and safe method when a bleeding site cannot determined by angiography. Copyright © 2011 SIR. Published by Elsevier Inc. All rights reserved.

  20. Transcatheter Potts shunt creation in patients with severe pulmonary arterial hypertension: initial clinical experience.

    Science.gov (United States)

    Esch, Jesse J; Shah, Pinak B; Cockrill, Barbara A; Farber, Harrison W; Landzberg, Michael J; Mehra, Mandeep R; Mullen, Mary P; Opotowsky, Alexander R; Waxman, Aaron B; Lock, James E; Marshall, Audrey C

    2013-04-01

    Patients with severe pulmonary arterial hypertension (PAH) face significant morbidity and death as a consequence of progressive right heart failure. Surgical shunt placement between the left PA and descending aorta (Potts shunt) appears promising for PAH palliation in children; however, surgical mortality is likely to be unacceptably high in adults with PAH. We describe a technique for transcatheter Potts shunt (TPS) creation by fluoroscopically guided retrograde needle perforation of the descending aorta at the site of apposition to the left PA to create a tract for deployment of a covered stent between these vessels. This covered stent-anchored by the vessel walls and surrounding tissue-serves as the shunt. TPS creation was considered in 7 patients and performed in 4. The procedure was technically successful in 3 patients; 1 patient died during the procedure as a result of uncontrolled hemothorax. One acute survivor, critically ill at the time of TPS creation, later died of comorbidities. The 2 mid-term survivors (follow-up of 10 and 4 months) are well at home, with symptomatic improvement and no late complications. The 3 candidate patients in whom the procedure was not performed died within 1 month of consideration, underscoring the tenuous nature of this population. TPS creation is feasible and may offer symptomatic relief to select patients with refractory PAH. Further study of this innovative approach is warranted. Copyright © 2013 International Society for Heart and Lung Transplantation. Published by Elsevier Inc. All rights reserved.

  1. The clinical value of MR diffusion-weighted imaging in the follow-up observation of hepatocellular carcinoma after transcatheter arterial chemoembolization

    International Nuclear Information System (INIS)

    Li Zhenwu; Zhang Wei; Sun Lijun; Qi Shun

    2010-01-01

    Objective: To discuss the clinical value of MR diffusion-weighted imaging (DWI) in the follow-up of hepatocellular carcinoma after transcatheter arterial chemo embolization (TACE). Methods: MR DWI was performed in 16 patients with hepatocellular carcinoma after receiving TACE. The DWI findings were compared with DSA and/or CT signs. The mean apparent diffusion coefficient (ADC) value of each lesion was determined separately, and the mean ADC value of intra-hepatic metastatic lesion was compared with that of the primary lesion. Results: A total of 18 lesions were revealed in DSA, of which satisfactory iodinated oil deposit was seen in 11 (satisfactory group) and poor deposit in 7 (poor group). After TACE, the mean ADC value of normal hepatic parenchyma showed no obvious changes when compared to its preoperative value (t = 0.54, P > 0.05). The mean ADC value obtained in poor group was significantly lower than that obtained in satisfactory group (t = 4.81, P < 0.01). In satisfactory group the preoperative ADC values were higher than the postoperative ones (t = 6.81, P < 0.01), while in poor group no significant difference was found between preoperative and postoperative ADC values. In addition, twelve intra-hepatic metastases were detected on DWI. Statistically significant difference in the mean ADC value existed between the metastatic lesions and the primary lesions (t = 4.61, P < 0.01). Conclusion: DWI is very sensitive in detecting hepatic metastatic lesions and, therefore, can be used to evaluate the therapeutic effect of TACE. (authors)

  2. Transcatheter Arterial Infusion of Autologous CD133+ Cells for Diabetic Peripheral Artery Disease

    Directory of Open Access Journals (Sweden)

    Xiaoping Zhang

    2016-01-01

    Full Text Available Microvascular lesion in diabetic peripheral arterial disease (PAD still cannot be resolved by current surgical and interventional technique. Endothelial cells have the therapeutic potential to cure microvascular lesion. To evaluate the efficacy and immune-regulatory impact of intra-arterial infusion of autologous CD133+ cells, we recruited 53 patients with diabetic PAD (27 of CD133+ group and 26 of control group. CD133+ cells enriched from patients’ PB-MNCs were reinfused intra-arterially. The ulcer healing followed up till 18 months was 100% (3/3 in CD133+ group and 60% (3/5 in control group. The amputation rate was 0 (0/27 in CD133+ group and 11.54% (3/26 in control group. Compared with the control group, TcPO2 and ABI showed obvious improvement at 18 months and significant increasing VEGF and decreasing IL-6 level in the CD133+ group within 4 weeks. A reducing trend of proangiogenesis and anti-inflammatory regulation function at 4 weeks after the cells infusion was also found. These results indicated that autologous CD133+ cell treatment can effectively improve the perfusion of morbid limb and exert proangiogenesis and anti-inflammatory immune-regulatory impacts by paracrine on tissue microenvironment. The CD133+ progenitor cell therapy may be repeated at a fixed interval according to cell life span and immune-regulatory function.

  3. Extrahepatic Arteries Originating from Hepatic Arteries: Analysis Using CT During Hepatic Arteriography and Visualization on Digital Subtraction Angiography

    International Nuclear Information System (INIS)

    Ozaki, Kumi; Kobayashi, Satoshi; Matsui, Osamu; Minami, Tetsuya; Koda, Wataru; Gabata, Toshifumi

    2017-01-01

    PurposeTo investigate the prevalence and site of origin of extrahepatic arteries originating from hepatic arteries on early phase CT during hepatic arteriography (CTHA) was accessed. Visualization of these elements on digital subtraction hepatic angiography (DSHA) was assessed using CTHA images as a gold standard.Materials and MethodsA total of 943 patients (mean age 66.9 ± 10.3 years; male/female, 619/324) underwent CTHA and DSHA. The prevalence and site of origin of extrahepatic arteries were accessed using CTHA and visualized using DSHA.ResultsIn 924 (98.0%) patients, a total of 1555 extrahepatic branches, representing eight types, were found to originate from hepatic arteries on CTHA. CTHA indicated the following extrahepatic branch prevalence rates: right gastric artery, 890 (94.4%); falciform artery, 386 (40.9%); accessory left gastric artery, 161 (17.1%); left inferior phrenic artery (IPA), 43 (4.6%); posterior superior pancreaticoduodenal artery, 33 (3.5%); dorsal pancreatic artery, 26 (2.8%); duodenal artery, 12 (1.3%); and right IPA, 4 (0.4%). In addition, 383 patients (40.6%) had at least one undetectable branch on DSHA. The sensitivity, specificity, and accuracy of visualization on DSHA were as follows: RGA, 80.0, 86.8, and 80.4%; falciform artery, 53.9, 97.7, and 80.0%; accessory LGA, 64.6, 98.6, and 92.3%; left IPA, 76.7, 99.8, and 98.7%; PSPDA, 100, 99.7, and 99.9%; dorsal pancreatic artery, 57.7, 100, and 98.8%; duodenal artery, 8.3, 99.9, and 98.7%; and right IPA, 0, 100, and 99.6%, respectively.ConclusionExtrahepatic arteries originating from hepatic arteries were frequently identified on CTHA images. These arteries were frequently overlooked on DSHA.

  4. Extrahepatic Arteries Originating from Hepatic Arteries: Analysis Using CT During Hepatic Arteriography and Visualization on Digital Subtraction Angiography

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    Ozaki, Kumi, E-mail: ozakik-rad@umin.org [Kanazawa University Graduate School of Medical Science, Department of Radiology (Japan); Kobayashi, Satoshi [Kanazawa University Graduate School of Medical Science, Department of Quantum Medicine Technology (Japan); Matsui, Osamu; Minami, Tetsuya; Koda, Wataru; Gabata, Toshifumi [Kanazawa University Graduate School of Medical Science, Department of Radiology (Japan)

    2017-06-15

    PurposeTo investigate the prevalence and site of origin of extrahepatic arteries originating from hepatic arteries on early phase CT during hepatic arteriography (CTHA) was accessed. Visualization of these elements on digital subtraction hepatic angiography (DSHA) was assessed using CTHA images as a gold standard.Materials and MethodsA total of 943 patients (mean age 66.9 ± 10.3 years; male/female, 619/324) underwent CTHA and DSHA. The prevalence and site of origin of extrahepatic arteries were accessed using CTHA and visualized using DSHA.ResultsIn 924 (98.0%) patients, a total of 1555 extrahepatic branches, representing eight types, were found to originate from hepatic arteries on CTHA. CTHA indicated the following extrahepatic branch prevalence rates: right gastric artery, 890 (94.4%); falciform artery, 386 (40.9%); accessory left gastric artery, 161 (17.1%); left inferior phrenic artery (IPA), 43 (4.6%); posterior superior pancreaticoduodenal artery, 33 (3.5%); dorsal pancreatic artery, 26 (2.8%); duodenal artery, 12 (1.3%); and right IPA, 4 (0.4%). In addition, 383 patients (40.6%) had at least one undetectable branch on DSHA. The sensitivity, specificity, and accuracy of visualization on DSHA were as follows: RGA, 80.0, 86.8, and 80.4%; falciform artery, 53.9, 97.7, and 80.0%; accessory LGA, 64.6, 98.6, and 92.3%; left IPA, 76.7, 99.8, and 98.7%; PSPDA, 100, 99.7, and 99.9%; dorsal pancreatic artery, 57.7, 100, and 98.8%; duodenal artery, 8.3, 99.9, and 98.7%; and right IPA, 0, 100, and 99.6%, respectively.ConclusionExtrahepatic arteries originating from hepatic arteries were frequently identified on CTHA images. These arteries were frequently overlooked on DSHA.

  5. Post partum occlusion of the hepatic artery

    International Nuclear Information System (INIS)

    Buecheler, E.; Hagemann, J.; Remmecke, J.; Hamburg Univ.

    1980-01-01

    A case of post partum acute thrombosis of the hepatic artery with infarction of the liver is reported. The prognosis depends on the areas of obstruction, on the early development of a collateral circulation and on the contribution to the blood supply from the portal vein. The diagnosis of liver infarction was made by computed tomography. This was characterised by sharply demarkated hypodense areas, which did not enhance with contrast. An important clue is the lack of increase in density in the liver after intravenous injection of contrast when compared with the increased contrast of the spleen. This finding provided the indication for angiography. This confirmed the diagnosis of acute occlusion and made appropriate treatment possible. (orig.) [de

  6. Preoperative Transcatheter Selective Arterial Chemoembolization in Treatment of Unresectable Hepatoblastoma in Infants and Children

    International Nuclear Information System (INIS)

    Li Jiaping; Chu Jianping; Yang Jianyong; Chen Wei; Wang Yu; Huang Yonghui

    2008-01-01

    The purpose of this study was to evaluate the clinical feasibility and efficacy of transcatheter selective arterial chemoembolization (TACE) for unresectable hepatoblastoma in infants and children. The study was performed with the approval of our institutional review board. Sixteen patients (13 boys, 3 girls) with unresectable hepatoblastoma were treated one to three times with preoperative TACE in an effort to improve the surgical and clinical outcome. Their ages ranged from 50 days to 60 months, with a mean age of 20.4 months. All cases were pathologically proved hepatoblastoma by fine-needle biopsy. After an intra-arterial catheter was selectively inserted into the main feeding artery of the tumor, cycles of cisplatin (40 to 50 mg/m 2 ) and adriamycin (20 to 30 mg/m 2 ) mixed with lipiodol were given, followed by gelatin foam particles or stainless-steel coils. Tumor response was evaluated according to tumor shrinkage, α-fetoprotein (AFP) levels, and pathological findings. TACE procedure was performed one to three times, depending on the patient's response. Surgical resection was carried out when the tumor volume appeared sufficiently reduced to allow safe resection by either lobectomy or extended lobectomy. A marked reduction in tumor size associated with decreased AFP level occurred after treatment. According to paired-samples test, tumor shrinkage ranged from 19.0% to 82.0%, with a mean value of 59.2%. AFP levels decreased 99.0% to 29.0% from initial levels, with a mean decrease of 60.0%. TACE allowed subsequent complete surgical resection in 13 cases and the other 3 cases underwent partial resection. One patient underwent successful orthotopic liver transplantation after receiving TACE therapy. Pathological examination showed that the mean percentage of necrotic area in the surgical specimens was 87%. Overall survival rate at 1, 3, and 5 years was 87.5%, 68.7%, and 50%, respectively. Correspondingly, event-free survival rate was 75%, 62.5%, and 43

  7. Common hepatic artery aneurysm: Pseudopseudocyst of the pancreas

    International Nuclear Information System (INIS)

    Shultz, S.; Druy, E.M.; Friedman, A.C.

    1985-01-01

    The preoperative diagnosis of hepatic artery aneurysm is uncommon, and its presentation as a pancreatic mass is rare. Because of its great potential for rupture early diagnosis and treatment is essential. The authors report two cases of aneurysms of the common hepatic artery, which on CT presented as a cystic mass in the head of the pancreas. These cases illustrate the importance of using 10-mm serial sections through the pancreas after a bolus injection of intravenous contrast material in order to allow distinction between hepatic artery aneurysm and other, more common, cystic masses of the pancreas

  8. Computed tomographic and ultrasonographic evaluations of efficacy of transcatheter arterial embolization therapy for hepatocellular carcinoma

    Energy Technology Data Exchange (ETDEWEB)

    Horiguchi, Yuji; Ohsuki, Masao; Kitano, Tohru; Taguchi, Hiroko; Yamauchi, Masahiro; Itoh, Madoka

    1984-12-01

    Transcatheter arterial embolization (TAE) was performed in 50 patients with hepatocellular carcinoma, using gelatin sponge soaked with carcinostatics. The efficaciy of this therapy was evaluated by changes of serum AFP, computed tomogram (CT) and ultrasonogram(US), pathological findings, and survival rate. The most characteristic changes in CT image after TAE were decrease in attenuation value and gas-formation in the tumor. Early change after TAE was classified into 3 types, i. e. type 1; low density area with round and clear margin, type 2; low density area with irregular and obscure margin, and type 3; slightly low density area. Recurrence of tumor within 3 months was seen in only 16.7% out of 22 cases showing type 1, in contrast with 84.6% in the second type of 26. Serial CT during more than 6 months revealed that regrowing of the the tumor into necrotized lesion occured in 77.8% of type 2, in contrast with 20% of type 1. Survival rate of type 1 and type 2 was 80% and 66.7%, respectively. Therefore, it was considered that CT was valuable in detection of recurrence in the primary lesion, but nearly useful in evaluation of extracapsular extension as well as US. Serial US of most effective cases of 8 showed the decrease in echogenicity early after TAE, gradual elevation of the interior echo-level after about 3 months and change to strong echo with acoustic shadow more than 6 months later. On the other hand, the re-elevation of echo-level was not observed in recurrent cases. The effectiveness of TAE seemed to be dominated by the charactors of the tumor such as encapsulation, tumor size and invasion into the portal vein. (author).

  9. Predisposing Factors of Liver Necrosis after Transcatheter Arterial Chemoembolization in Liver Metastases from Neuroendocrine Tumor

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    Joskin, Julien, E-mail: j.joskin@gmail.com; Baere, Thierry de, E-mail: Thierry.DEBAERE@igr.fr [Institut Gustave Roussy, Department of Interventional Radiology (France); Auperin, Anne, E-mail: Anne.AUPERIN@igr.fr [Institut Gustave Roussy, Department of Epidemiology (France); Tselikas, Lambros, E-mail: lambros.tselikas@gmail.com; Guiu, Boris, E-mail: boris.guiu@chu-dijon.fr; Farouil, Geoffroy, E-mail: g.farouil@gmail.com [Institut Gustave Roussy, Department of Interventional Radiology (France); Boige, Valérie, E-mail: boige@igr.fr; Malka, David, E-mail: david.malka@igr.fr [Institut Gustave Roussy, Department of Digestive Oncology (France); Leboulleux, Sophie, E-mail: sophie.leboulleux@igr.fr [Institut Gustave Roussy, Department of Nuclear Medicine and Endocrine Oncology (France); Ducreux, Michel, E-mail: ducreux@igr.fr [Institut Gustave Roussy, Department of Digestive Oncology (France); Baudin, Eric, E-mail: baudin@igr.fr [Institut Gustave Roussy, Department of Nuclear Medicine and Endocrine Oncology (France); Deschamps, Frédéric, E-mail: frederic.deschamps@igr.fr [Institut Gustave Roussy, Department of Interventional Radiology (France)

    2015-04-15

    PurposeTo investigate predictive factors for liver necrosis after transcatheter arterial chemoembolization (TACE) of neuroendocrine liver metastases.MethodsA total of 164 patients receiving 374 TACE were reviewed retrospectively to analyze predictive factors of liver necrosis. We analyzed patient age and sex; metastasis number and location; percentage of liver involvement; baseline liver function test; and pretreatment imaging abnormalities such as bile duct dilatation (BDD), portal vein narrowing (PVN), and portal vein thrombosis (PVT). We analyzed TACE technique such as Lipiodol or drug-eluting beads (DEB) as the drug’s vector; dose of chemotherapy; diameter of DEB; and number, frequency, and selectivity of TACE.ResultsLiver necrosis developed after 23 (6.1 %) of 374 TACE. In multivariate analysis, DEB > 300 μm in size induced more liver necrosis compared to Lipiodol (odds ratio [OR] 35.20; p < 0.0001) or with DEB < 300 μm in size (OR 19.95; p < 0.010). Pretreatment BDD (OR 119.64; p < 0.0001) and PVT (OR 9.83; p = 0.030) were predictive of liver necrosis. BDD or PVT responsible for liver necrosis were present before TACE in 59 % (13 of 22) and were induced by a previous TACE in 41 % (9 of 22) of cases.ConclusionDEB > 300 μm in size, BDD, and PVT are responsible for increased rate of liver necrosis after TACE. Careful analysis of BDD or PVT on pretreatment images as well as images taken between two courses can help avoid TACE complications.

  10. Transcatheter arterial chemoembolization of hepatocellular carcinoma with ethanol and iodized-oil emulsion

    International Nuclear Information System (INIS)

    Xiao Enhua; Hu Guodong; Li Jinqing

    2005-01-01

    Objective: To evaluate the effect of transcatheter arterial chemoembolization using ethanol and iodized-oil emulsion (TACE-EIOE) on prognosis of patients with hepatocellular carcinoma (HCC). Methods: Eighteen patients with histologically-proven HCC were underwent TACE-EIOE. The extent of apoptosis was analyzed by terminal deoxynucleotidy transferase-mediated dUTP-digoxigenin nick end labeling (TUNEL) staining. The expressions of Bcl-2, Bax, p53, Ki-67 and PCNA proteins were detected by immunohistochemical method. Changes of these markers, tumor necrosis, encapsulation, volume, cumulative survival were analyzed. Results: Complete tumor necrosis was 33.33% (6/18), severe tumor necrosis was 44.44% (8/18), moderate tumor necrosis was 5.56% (1/18), lesser tumor necrosis was 16.67% (3/18). Apoptosis rate was (22.79 ±3.34)%. Complete encapsulation was 88.89% (16/18). Evident volume-lessening was 66.67% (12/18), partial volume-lessening was 22.22% (4/18), and stable volume was 11.11% (2/18). Ki-67, PCNA, p53, Bcl-2, and Bax were (30.93±18.10)%, (41.16±11.83)%, (53.41±18.13)%, (6.32±2.10)%, and (58.73±17.32)%, respectively. The cumulative 1-, 2-, and 3-year survival rates were 83.33%, 72.22%, and 66.67% for patients, respectively. Conclusions: The preoperative TACE-EIOE is safe, it might benefit patients with HCC. (authors)

  11. Analysis of branching patterns of middle hepatic artery using A-P and oblique view hepatic angiography

    International Nuclear Information System (INIS)

    Han, Kun Soo; Chang, Jae Chun; Park, Bok Hwan

    1992-01-01

    A study on branching patterns of middle hepatic artery was performed in 109 patients with A-P and oblique view hepatic angiogram, which refereed to size and location of quadrate lobe in CT and SMA photography. We could analyze the branching patterns of middle hepatic artery (MHA) in 100 among 109 patients. MHA arising as a first branch of left hepatic artery was the most common pattern (50%), and MHA arising from proper hepatic artery separately on from left hepatic artery was the next common pattern (35%). MHA originating from left gastric artery, or from anterior or posterior of the right hepatic artery was not seen. MHA was not found as an accessory or replaced artery except as replaced common hepatic artery

  12. Investigation of transfection efficacy with transcatheter arterial transporting transferring to enhance p53 gene

    International Nuclear Information System (INIS)

    Lu Qin; Niu Huanzhang; Zhu Guangyu; An Yanli; Qiu Dinghong; Teng Gaojun

    2007-01-01

    Objective: To investigate the function of transferrin-DNA complex, transported by transferrin(Tf) and trans-arterial injection via interventional approach be the duel-target-orientated delivery and the transferring into malignant cells to get more effective therapy. Methods: p53-LipofectAMINE ligand with different concentrations of Tf (0, 10, 25, 50, 100 μg)transfected the 4 strains including LM6,Hep3B,YY and L02 in vitro to evaluate the gene transfection efficiency through western blot. Then, after setting up the VX2 hepatocarcinoma models, we delivered the Tf-p53-LipofectAMlNE complex into the hepatic arteries via interventional techniques to analyse the transfection efficiency in vivo. Results: Tf, within the range of l0 100 μg, could increase gene transfection efficiency mediated by liposome, and the efficiency increases with the raise of Tf concentration. Combination with interventional technique to inject Tf-DNA complex into tumor arteries, gene transfection efficiency was enhanced in rabbit models. Conclusion: Tf can enhance gene-liposome transfection efficiency, furthermore with combination of interventional catheter technique, there would be a potential duel-target-orientated gene therapy method. (authors)

  13. Investigation of transfection efficacy with transcatheter arterial transporting transferring to enhance p53 gene

    Energy Technology Data Exchange (ETDEWEB)

    Qin, Lu; Huanzhang, Niu; Guangyu, Zhu; Yanli, An; Dinghong, Qiu; Gaojun, Teng [Radiologic Department, Zhongda Hospital, Southeast Univ., Nanjing (China)

    2007-02-15

    Objective: To investigate the function of transferrin-DNA complex, transported by transferrin(Tf) and trans-arterial injection via interventional approach be the duel-target-orientated delivery and the transferring into malignant cells to get more effective therapy. Methods: p53-LipofectAMINE ligand with different concentrations of Tf (0, 10, 25, 50, 100 {mu}g)transfected the 4 strains including LM6,Hep3B,YY and L02 in vitro to evaluate the gene transfection efficiency through western blot. Then, after setting up the VX2 hepatocarcinoma models, we delivered the Tf-p53-LipofectAMlNE complex into the hepatic arteries via interventional techniques to analyse the transfection efficiency in vivo. Results: Tf, within the range of l0 100 {mu}g, could increase gene transfection efficiency mediated by liposome, and the efficiency increases with the raise of Tf concentration. Combination with interventional technique to inject Tf-DNA complex into tumor arteries, gene transfection efficiency was enhanced in rabbit models. Conclusion: Tf can enhance gene-liposome transfection efficiency, furthermore with combination of interventional catheter technique, there would be a potential duel-target-orientated gene therapy method. (authors)

  14. Effect of preoperative S-1 combined with regional transcatheter arterial chemoembolization on malignant degree of locally advanced gastric cancer

    Directory of Open Access Journals (Sweden)

    Ru-Juan Xu

    2016-07-01

    Full Text Available Objective: To study the effect of preoperative S-1 combined with regional transcatheter arterial chemoembolization on malignant degree of locally advanced gastric cancer. Methods: A total of 134 patients who were diagnosed with advanced gastric cancer in our hospital from May 2012 to December 2014 were selected for study, received surgical resection after chemotherapy, and were divided into intravenous chemotherapy group and combined treatment group according to different chemotherapy regimens. After chemotherapy and before operation, serum tumor marker levels were detected; after operation, recurrence and metastasis-related molecule levels in tumor tissue were detected. Results: After chemotherapy and before operation, serum CEA, CA199, CA72-4, TSGF, ESM-1 and DKK-1 levels of combined treatment group were significantly lower than those of intravenous chemotherapy group; TET1, TET2, LATS1 and RUNX3 levels in tumor tissue of combined treatment group were higher than those of intravenous chemotherapy group while Sipa1, GOLPH3, AEP, MT2- MMP, OPN, Galectin-1, Galectin-3 and Galectin-9 levels were lower than those of intravenous chemotherapy group. Conclusions: Compared with systemic intravenous chemotherapy, preoperative S-1 combined with regional transcatheter arterial chemoembolization can more effectively kill gastric cancer cells and prevent tumor recurrence and metastasis at molecular level.

  15. Hepatic Artery Angiography and Embolization for Hemobilia Following Laparoscopic Cholecystectomy

    International Nuclear Information System (INIS)

    Nicholson, Tony; Travis, Simon; Ettles, Duncan; Dyet, John; Sedman, Peter; Wedgewood, Kevin; Royston, Christopher

    1999-01-01

    Purpose: The effectiveness of angiography and embolization in diagnosis and treatment were assessed in a cohort of patients presenting with upper gastrointestinal hemorrhage secondary to hepatic artery pseudoaneurysm following laparoscopic cholecystectomy. Methods: Over a 6-year period 1513 laparoscopic cholecystectomies were carried out in our region. Nine of these patients (0.6%) developed significant upper gastrointestinal bleeding, 5-43 days after surgery. All underwent emergency celiac and selective right hepatic artery angiography. All were treated by coil embolization of the right hepatic artery proximal and distal to the bleeding point. Results: Pseudoaneurysms of the hepatic artery adjacent to cholecystectomy clips were demonstrated in all nine patients at selective right hepatic angiography. In three patients celiac axis angiography alone failed to demonstrate the pseudoaneurysm. Embolization controlled hemorrhage in all patients with no further bleeding and no further intervention. One patient developed a candidal liver abscess in the post-procedure period. All patients are alive and well at follow-up. Conclusion: Selective right hepatic angiography is vital in the diagnosis of upper gastrointestinal hemorrhage following laparoscopic cholecystectomy. Embolization offers the advantage of minimally invasive treatment in unstable patients, does not disrupt recent biliary reconstruction, allows distal as well as proximal control of the hepatic artery, and is an effective treatment for this potentially life-threatening complication

  16. Prospective Evaluation of Transcatheter Arterial Chemoembolization (TACE) with Multiple Anti-Cancer Drugs (Epirubicin, Cisplatin, Mitomycin C, 5-Fluorouracil) Compared with TACE with Epirubicin for Treatment of Hepatocellular Carcinoma

    Energy Technology Data Exchange (ETDEWEB)

    Sahara, Shinya; Kawai, Nobuyuki; Sato, Morio, E-mail: morisato@mail.wakayama-med.ac.jp; Tanaka, Takami; Ikoma, Akira; Nakata, Kouhei; Sanda, Hiroki; Minamiguchi, Hiroki; Nakai, Motoki; Shirai, Shintaro; Sonomura, Tetsuo [Wakayama Medical University, Department of Radiology (Japan)

    2012-12-15

    Purpose: To compare the efficacy of transcatheter arterial chemoembolization (TACE) using multiple anticancer drugs (epirubicin, cisplatin, mitomycin C, and 5-furuorouracil: Multi group) with TACE using epirubicin (EP group) for hepatocellular carcinoma (HCC). Materials and Methods: The study design was a single-center, prospective, randomized controlled trial. Patients with unrespectable HCC confined to the liver, unsuitable for radiofrequency ablation, were assigned to the Multi group or the EP group. We assessed radiographic response as the primary endpoint; secondary endpoints were progression-free survival (PFS), safety, and hepatic branch artery abnormality (Grade I, no damage or mild vessel wall irregularity; Grade II, overt stenosis; Grade III, occlusion; Grades II and III indicated significant hepatic artery damage). A total of 51 patients were enrolled: 24 in the Multi group vs. 27 in the EP group. Results: No significant difference in HCC patient background was found between the groups. Radiographic response, PFS, and 1- and 2-year overall survival of the Multi vs. EP group were 54% vs. 48%, 6.1 months vs. 8.7 months, and 95% and 65% vs. 85% and 76%, respectively, with no significant difference. Significantly greater Grade 3 transaminase elevation was found in the Multi group (p = 0.023). Hepatic artery abnormality was observed in 34% of the Multi group and in 17.1% of the EP group (p = 0.019). Conclusion: TACE with multiple anti-cancer drugs was tolerable but appeared not to contribute to an increase in radiographic response or PFS, and caused significantly more hepatic arterial abnormalities compared with TACE with epirubicin alone.

  17. Pilot Evaluation of Angiogenesis Signaling Factor Response after Transcatheter Arterial Embolization for Hepatocellular Carcinoma.

    Science.gov (United States)

    Ronald, James; Nixon, Andrew B; Marin, Daniele; Gupta, Rajan T; Janas, Gemini; Chen, Willa; Suhocki, Paul V; Pabon-Ramos, Waleska; Sopko, David R; Starr, Mark D; Brady, John C; Hurwitz, Herbert I; Kim, Charles Y

    2017-10-01

    Purpose To identify changes in a broad panel of circulating angiogenesis factors after bland transcatheter arterial embolization (TAE), a purely ischemic treatment for hepatocellular carcinoma (HCC). Materials and Methods This prospective HIPAA-compliant study was approved by the institutional review board. Informed written consent was obtained from all participants prior to entry into the study. Twenty-five patients (21 men; mean age, 61 years; range, 30-81 years) with Liver Imaging Reporting and Data System category 5 or biopsy-proven HCC and who were undergoing TAE were enrolled from October 15, 2014, through December 2, 2015. Nineteen plasma angiogenesis factors (angiopoietin 2; hepatocyte growth factor; platelet-derived growth factor AA and BB; placental growth factor; vascular endothelial growth factor A and D; vascular endothelial growth factor receptor 1, 2, and 3; osteopontin; transforming growth factor β1 and β2; thrombospondin 2; intercellular adhesion molecule 1; interleukin 6 [IL-6]; stromal cell-derived factor 1; tissue inhibitor of metalloproteinases 1; and vascular cell adhesion molecule 1 [VCAM-1]) were measured by using enzyme-linked immunosorbent assays at 1 day, 2 weeks, and 5 weeks after TAE and were compared with baseline levels by using paired Wilcoxon tests. Tumor response was assessed according to modified Response Evaluation Criteria in Solid Tumors (mRECIST). Angiogenesis factor levels were compared between responders and nonresponders by mRECIST criteria by using unpaired Wilcoxon tests. Results All procedures were technically successful with no complications. Fourteen angiogenesis factors showed statistically significant changes following TAE, but most changes were transient. IL-6 was upregulated only 1 day after the procedure, but showed the largest increases of any factor. Osteopontin and VCAM-1 demonstrated sustained upregulation at all time points following TAE. At 3-month follow-up imaging, 11 patients had responses to TAE

  18. Blunt renal trauma: comparison of contrast-enhanced CT and angiographic findings and the usefulness of transcatheter arterial embolization

    International Nuclear Information System (INIS)

    Kitase, M.; Mizutani, M.; Tomita, H.; Kono, T.; Sugie, C.; Shibamoto, Y.

    2007-01-01

    Full text: Background: The purpose of this study was to evaluate the role of contrast-enhanced CT and the usefulness of super selective embolization therapy in the management of arterial damage in patients with severe blunt renal trauma. Patients and Methods: Nine cases of severe renal trauma were evaluated. In all cases, we compared contrast enhanced CT findings with angiographic findings, and performed transcatheter arterial embolization (TAE) in six of them with microcoils and gelatin sponge particles. Morphological changes in the kidney and site of infarction after TAE were evaluated on follow-up CT Chronological changes in blood biochemistry findings after injury, degree of anemia and renal function were investigated. Adverse effects or complications such as duration of hematuria, fever, abdominal pain, renovascular hypertension and abscess formation were also evaluated. Results: The CT finding of extravasation was a reliable sign of active bleeding and useful for determining the indication of TAE. In all cases, bleeding was effectively controlled with super selective embolization. There was minimal procedure-related loss of renal tissue. None of the patients developed abscess, hypertension or other complications. Conclusions: In blunt renal injury, contrast-enhanced CT was useful for diagnosing arterial hemorrhage. Arterial bleeding may produce massive hematoma and TAE was a useful treatment for such cases. By using selective TAE for a bleeding artery, it was possible to minimize renal parenchymal damage, with complications of TAE rarely seen. (author)

  19. Switching the Loaded Agent from Epirubicin to Cisplatin: Salvage Transcatheter Arterial Chemoembolization with Drug-eluting Microspheres for Unresectable Hepatocellular Carcinoma

    International Nuclear Information System (INIS)

    Seki, Akihiko; Hori, Shinich

    2012-01-01

    Purpose: There is no consensus on switching anticancer agents loaded onto drug carriers in transcatheter arterial chemoembolization (TACE) for hepatocellular carcinoma (HCC). This study aimed to evaluate the safety and clinical outcomes of TACE with cisplatin-loaded microspheres (CLM-TACE) in HCC patients refractory to TACE with epirubicin-loaded microspheres (ELM-TACE). Methods: Between February 2008 and June 2010, 85 patients with unresectable HCC refractory to ELM-TACE were enrolled to undergo CLM-TACE. The number of ELM-TACE sessions until judgment of resistance ranged from 1 to 4 (median, 2.1). CLM-TACE was performed using 50–100-μm superabsorbent polymer microspheres loaded with 1 mg cisplatin/1 mg microspheres together with hepatic arterial infusion of 25 mg cisplatin and 500 mg 5-fluorouracil per patient. Tumor responses were evaluated by computed tomography according to the European Association for the Study of the Liver criteria. Results: The median number of CLM-TACE treatment sessions was 1.8 (range, 1–5), and the mean total dose of cisplatin per session was 42.8 mg (range, 30.0–59.0). After 6 months, 3 (3.5%) patients achieved complete response, 31 (36.5%) had partial response, 15 (17.6%) had stable disease, and 36 (42.4%) had progressive disease. The median overall survival and time to treatment failure after initial CLM-TACE were 13.3 and 7.2 months, respectively. Overall, 9.4% of patients experienced grade 3/4 adverse events. Conclusions: witching the loaded agent from epirubicin to cisplatin is a safe, well-tolerated, and efficacious treatment strategy for salvage TACE with drug-eluting microspheres in HCC patients refractory to ELM-TACE.

  20. Comparison of post-embolization syndrome in the treatment of patients with unresectable hepatocellular carcinoma: Trans-catheter arterial chemo-embolization versus Yttrium-90 glass microspheres

    International Nuclear Information System (INIS)

    Goin, J.E.; Roberts, C.A.; Dancey, J.E.; Sickles, C.J.; Leung, D.A.; Soulen, M.C.

    2004-01-01

    Post-embolization syndrome (PES) occurs in most patients who undergo trans-catheter arterial chemoembolization (TACE) for treatment of unresectable hepatocellular carcinoma (HCC). Intra-hepatic arterial administration of TheraSphere, yttrium-90 glass microspheres, is an alternative treatment for unresectable HCC that does not require embolization of major vessels and may have a more favorable toxicity profile than TACE. This paper compares the incidence of PES after TACE vs. TheraSphere treatment in unresectable HCC patients. Data for 29 TACE-treated and 34 TheraSphere-treated patients were evaluated for PES. PES toxicities (i.e., nausea, vomiting, fever in the absence of infection, and abdominal pain) were scored according to Southwest Oncology Group (SWOG) toxicity criteria. PES was defined as a total score for the four toxicities of 2 or greater. Survival was defined from the date of treatment to the date of death. TACE patients underwent one to seven treatment procedures; TheraSphere patients underwent one to two treatment procedures. The incidence of PES was 3.8-times (95% confidence interval 1.6-16.3) higher after TACE [20/29(69%)] than after TheraSphere [6/34 (18%)] treatment; this difference was statistically significant (p=.003). Median survival was similar for TheraSphere (N=20; 378 days, CI 209-719) and TACE (N=29; 343 days, CI 217-511) patients. It was concluded that treatment of unresectable HCC with TheraSphere results in a much lower incidence of PES compared to TACE. Since TheraSphere is a pure beta emitter; it can potentially be administered safely on an outpatient basis, and appears to be at least as efficacious as TACE on survival with fewer treatments per patient. (author)

  1. Experimental research of covered stent implanted in canine hepatic artery

    International Nuclear Information System (INIS)

    Zhou Bing; Liu Linxiang; Li Minghua; Wang Yongli; Cheng Yongde

    2007-01-01

    Objective: To evaluate the feasibility of success rate of implantation, post-procedure stenosis rate, apposition ability and endothelialization level, etc. for implantation with balloon-expandable covered stent in canine hepatic artery. Methods: 8 adult canines were implanted with balloon-expendable stents covered by expandable poly Teflon ester membrane (e-PTFEM). Follow-up DSA was performed immediately, 2, 4 and 12 wk after the procedure. The canines were sacrificed for histopathologic examination and statistical analysis with correlation of implantation manenvor and angiographic manifestations. Results: 8 cases were all implanted with the covered stents in proper hepatic artery/right hepatic artery successfully; showing good apposition ability and non-opacification of the separated branches. 2 cases showed intraluminal obvious stenosis( > 50%)of the stent at 2 weeks follow-up, so did 3 cases at 12 weeks follow-up, and the total stenosis rate was 37.5% and 5 cases manifested full endothelialization (3 different locations of the sample all manifested full endothelialization), 3 cased manifested partial endothelialization (at least 1 location of the sample didn't show full endothelialization), and the two terminal parts were easier to get endothelialization than the central part. Before and after the stent implantation, hepatic function of all cases didn't demonstrate any obvious changes. Conclusions: Balloon-expandable covered stent can be implanted in canine hepatic artery. successfully, with good apposition ability, full endothelialization, and no influence on hepatic function. (authors)

  2. Implication of the presence of a variant hepatic artery during the Whipple procedure.

    Science.gov (United States)

    Rubio-Manzanares-Dorado, Mercedes; Marín-Gómez, Luis Miguel; Aparicio-Sánchez, Daniel; Suárez-Artacho, Gonzalo; Bellido, Carmen; Álamo, José María; Serrano-Díaz-Canedo, Juan; Padillo-Ruiz, Francisco Javier; Gómez-Bravo, Miguel Ángel

    2015-07-01

    The anatomical variants of the hepatic artery may have important implications for pancreatic cancer surgery. The aim of our study is to compare the outcome following a pancreatoduodenectomy (PD) in patients with or without a variant hepatic artery arising from superior mesenteric artery. We reviewed 151 patients with periampullary tumoral pathology. All patients underwent oncological PD between January 2005 and February 2012. Our series was divided into two groups: Group A: Patients with a hepatic artery arising from superior mesenteric artery; and Group B: Patients without a hepatic artery arising from superior mesenteric artery. We expressed the results as mean +/- standard deviation for continuous variables and percentages for qualitative variables. Statistical tests were considered significant if p < 0.05. We identified 11 patients with a hepatic artery arising from superior mesenteric artery (7.3%). The most frequent variant was an aberrant right hepatic artery (n = 7), following by the accessory right hepatic artery (n = 2) and the common hepatic artery trunk arising from the superior mesenteric artery (n = 2). In 73% of cases the diagnosis of the variant was intraoperative. R0 resection was performed in all patients with a hepatic artery arising from superior mesenteric artery. There were no significant differences in the tumor resection margins and the incidence of postoperative complications. Oncological PD is feasible by the presence of a hepatic artery arising from superior mesenteric artery. The complexity of having it does not seem to influence in tumor resection margins, complications and survival.

  3. Origins of feeding arteries of hepatocellular carcinoma located near the umbilical fissure of the left hepatic lobe: angiographic evaluation.

    Science.gov (United States)

    Miyayama, Shiro; Yamashiro, Masashi; Shibata, Yoshihiro; Hashimoto, Masahiro; Yoshida, Miki; Tsuji, Kazunobu; Toshima, Fumihito; Matsui, Osamu

    2012-12-01

    To analyze the origins of the feeding arteries of hepatocellular carcinomas (HCCs) near the umbilical fissure of the left hepatic lobe. Twenty-eight HCCs with a mean ± SD tumor diameter of 3.4 ± 1.0 cm (range 1-4.4 cm) in contact with the right or left side of the umbilical fissure were treated by superselective transcatheter arterial chemoembolization (TACE). The origins of the tumor-feeding arteries were analyzed with arteriograms and computed tomography or cone-beam computed tomography images obtained during and 1 week after TACE. Twenty-one HCC lesions were located in segment 3 and seven were located in segment 4. Of 21 tumors in segment 3, 13 (61.9%) were supplied by the lateral inferior subsegmental artery (A3), three (14.3%) by the medial subsegmental artery (A4), three (14.3%) by both A4 and A3, one (4.8%) by a branch arising from the left lateral hepatic artery, and one (4.8%) by a branch of the right gastric artery. In particular, all tumor-feeding branches arising from A4 were the first branch of A4. Of seven tumors in segment 4, four (57.1%) were supplied by A4 and three (42.9%) by A3. In particular, all tumor-feeding branches arising from A3 were the first branch of A3. This study demonstrates crossover blood supply to HCC lesions located near the umbilical fissure, in addition to direct feeding from a separate branch. In particular, the first branch of the opposite subsegmental artery may feed tumors when crossover blood supply is present.

  4. Origins of Feeding Arteries of Hepatocellular Carcinoma Located Near the Umbilical Fissure of the Left Hepatic Lobe: Angiographic Evaluation

    Energy Technology Data Exchange (ETDEWEB)

    Miyayama, Shiro, E-mail: s-miyayama@fukui.saiseikai.or.jp; Yamashiro, Masashi; Shibata, Yoshihiro; Hashimoto, Masahiro; Yoshida, Miki; Tsuji, Kazunobu; Toshima, Fumihito [Fukuiken Saiseikai Hospital, Department of Diagnostic Radiology (Japan); Matsui, Osamu [Kanazawa University Graduate School of Medical Science, Department of Radiology (Japan)

    2012-12-15

    Purpose: To analyze the origins of the feeding arteries of hepatocellular carcinomas (HCCs) near the umbilical fissure of the left hepatic lobe. Methods: Twenty-eight HCCs with a mean {+-} SD tumor diameter of 3.4 {+-} 1.0 cm (range 1-4.4 cm) in contact with the right or left side of the umbilical fissure were treated by superselective transcatheter arterial chemoembolization (TACE). The origins of the tumor-feeding arteries were analyzed with arteriograms and computed tomography or cone-beam computed tomography images obtained during and 1 week after TACE.ResultsTwenty-one HCC lesions were located in segment 3 and seven were located in segment 4. Of 21 tumors in segment 3, 13 (61.9%) were supplied by the lateral inferior subsegmental artery (A3), three (14.3%) by the medial subsegmental artery (A4), three (14.3%) by both A4 and A3, one (4.8%) by a branch arising from the left lateral hepatic artery, and one (4.8%) by a branch of the right gastric artery. In particular, all tumor-feeding branches arising from A4 were the first branch of A4. Of seven tumors in segment 4, four (57.1%) were supplied by A4 and three (42.9%) by A3. In particular, all tumor-feeding branches arising from A3 were the first branch of A3. Conclusion: This study demonstrates crossover blood supply to HCC lesions located near the umbilical fissure, in addition to direct feeding from a separate branch. In particular, the first branch of the opposite subsegmental artery may feed tumors when crossover blood supply is present.

  5. Establishment of a hepatic cirrhosis and portal hypertension model by hepatic arterial perfusion with 80% alcohol.

    Science.gov (United States)

    Wang, Lei; He, Fu-Liang; Liu, Fu-Quan; Yue, Zhen-Dong; Zhao, Hong-Wei

    2015-08-28

    To determine the feasibility and safety of establishing a porcine hepatic cirrhosis and portal hypertension model by hepatic arterial perfusion with 80% alcohol. Twenty-one healthy Guizhou miniature pigs were randomly divided into three experimental groups and three control groups. The pigs in the three experimental groups were subjected to hepatic arterial perfusion with 7, 12 and 17 mL of 80% alcohol, respectively, while those in the three control groups underwent hepatic arterial perfusion with 7, 12 and 17 mL of saline, respectively. Hepatic arteriography and direct portal phlebography were performed on all animals before and after perfusion, and the portal venous pressure and diameter were measured before perfusion, immediately after perfusion, and at 2, 4 and 6 wk after perfusion. The following procedures were performed at different time points: routine blood sampling, blood biochemistry, blood coagulation and blood ammonia tests before surgery, and at 2, 4 and 6 wk after surgery; hepatic biopsy before surgery, within 6 h after surgery, and at 1, 2, 3, 4 and 5 wk after surgery; abdominal enhanced computed tomography examination before surgery and at 6 wk after surgery; autopsy and multi-point sampling of various liver lobes for histological examination at 6 wk after surgery. In experimental group 1, different degrees of hepatic fibrosis were observed, and one pig developed hepatic cirrhosis. In experimental group 2, there were cases of hepatic cirrhosis, different degrees of increased portal venous pressure, and intrahepatic portal venous bypass, but neither extrahepatic portal-systemic bypass circulation nor death occurred. In experimental group 3, two animals died and three animals developed hepatic cirrhosis, and different degrees of increased portal venous pressure and intrahepatic portal venous bypass were also observed, but there was no extrahepatic portal-systemic bypass circulation. It is feasible to establish an animal model of hepatic cirrhosis and

  6. Transcatheter renal denervation for the treatment of resistant arterial hypertension: the Swiss expert consensus.

    Science.gov (United States)

    Wuerzner, Gregoire; Muller, Olivier; Erne, Paul; Cook, Stéphane; Sudano, Isabella; Lüscher, Thomas F; Noll, Georg; Kaufmann, Urs; Rickli, Hans; Waeber, Bernard; Kaiser, Christophe; Sticherling, Christian; Pechère-Bertschi, Antoinette; Baumgartner, Iris; Jacob, Augustinus L; Burnier, Michel; Qanadli, Salah D

    2014-03-20

    Transcatheter (or percutaneous) renal denervation is a novel technique developed for the treatment of resistant hypertension. So far, only one randomised controlled trial has been published, which has shown a reduction of office blood pressure. The Swiss Society of Hypertension, the Swiss Society of Cardiology, The Swiss Society of Angiology and the Swiss Society of Interventional Radiology decided to establish recommendations to practicing physicians and specialists for good clinical practice. The eligibility of patients for transcatheter renal denervation needs (1.) confirmation of truly resistant hypertension, (2.) exclusion of secondary forms of hypertension, (3.) a multidisciplinary decision confirming the eligibility, (4.) facilities that guarantee procedural safety and (5.) a long-term follow-up of the patients, if possible in cooperation with a hypertension specialist. These steps are essential until long-term data on safety and efficacy are available.

  7. Evaluation of the malignant degree of primary hepatocellular carcinoma after endostar combined with transcatheter arterial chemoembolization ( TACE treatment

    Directory of Open Access Journals (Sweden)

    Yong Zeng

    2018-01-01

    Full Text Available Objective: To analyze the malignant degree of primary hepatocellular carcinoma after endostar combined with transcatheter arterial chemoembolization (TACE treatment. Methods: A total of 68 cases of patients with primary hepatocellular carcinoma treated in our hospital from September 2011 to December 2014 were enrolled for study and divided into observation group 34 cases and control group 34 cases according to different treatment methods. Control group received transcatheter arterial chemoembolization (TACE treatment, observation group received endostar combined with TACE treatment, and then differences in serum amino acid levels, micro RNA levels, levels of GP73, GPC3, GS, etc as well as levels of ChE, TBA and AFP were compared between two groups after treatment. Results: Serum aspartic acid, leucine and arginine levels of observation group after treatment were higher than those of control group, and αα-aminoadipic acid, methionine, β-alanine and 3-methylhistidine levels were lower than those of control group; relative values of serum miR-106b, miR-222 and miR-21 expression of observation group after treatment were lower than those of control group, and relative values of miR-199a and miR-122 expression were higher than those of control group; GP73, IL-17, IL-6, GPC3, GS and HSP70 levels of observation group after treatment were lower than those of control group, and endostatin level was higher than that of control group; ChE level of observation group after treatment was higher than that of control group, and TBA and AFP levels were lower than those of control group. Conclusion: Endostar combined with TACE treatment for patients with primary hepatocellular carcinoma can effectively inhibit tumor proliferation, invasion and other malignant processes and improve liver function, and it has positive clinical significance.

  8. Transcatheter arterial embolisation in upper gastrointestinal bleeding in a sample of 29 patients in a gastrointestinal referral center in Germany.

    Science.gov (United States)

    Heining-Kruz, S; Finkenzeller, T; Schreyer, A; Dietl, K H; Kullmann, F; Paetzel, C; Schedel, J

    2015-09-01

    This is a retrospective analysis of interventional embolisation performed with catheter angiography in 29 patients with upper gastrointestinal bleeding in the setting of a secondary care hospital. From April 2007 to February 2013, 29 patients with upper gastrointestinal bleeding underwent endovascular diagnostics and treatment. The diagnosis was established by endoscopy, computed tomography or clinically based on a significant decrease in hemoglobin. Transcatheter arterial embolisation was performed with coils, liquid embolic agents, and particles. The technical and clinical outcomes were assessed by postinterventional endoscopy, hemoglobin concentrations, number of necessary transfusions, or surgical interventions, as well as by post-interventional mortality within 28 days after the procedure. Selective angiographic embolisation in upper gastrointestinal bleeding was primarily successful technically and clinically in 22 of 29 patients. In 4/29 cases an angiographic reintervention was performed, which was successful in 3 cases. In 3 cases of primarily technically unsuccessful procedures reintervention was not attempted. No catheterisation-related complications were recorded. Peri-interventional mortality was 31%, but only 2 of these patients died due to uncontrolled massive bleeding, whereas the lethal outcome in the other 7 patients was due to their underlying diseases. Transcatheter arterial embolisation is an effective and rapid method in the management of upper gastrointestinal bleeding. Radiological endovascular interventions may considerably contribute to reduced mortality in GI bleeding by avoiding a potential surgical procedure following unsuccessful endoscopic treatment. The study underlines the importance of the combination of interventional endoscopy with interventional radiology in secondary care hospitals for patient outcome in complex and complicated upper gastrointestinal bleeding situations. © Georg Thieme Verlag KG Stuttgart · New York.

  9. Clinical observation of transcatheter arterial chemoembolization combined with sorafenib on intermediate-advanced hepatocellular carcinoma

    International Nuclear Information System (INIS)

    Wei Zhaoguang; Lu Ligong; Shao Peijian; Hu Baoshan; Li Yong; Zhang Lei; He Xu; Yu Xianyi; Luo Xiaoning

    2012-01-01

    Objective: To evaluate the treatment effect and security of transcatheter arterial chemoembolization (TACE) combined with sorafenib for intermediate-advanced hepatocellular carcinoma. Methods: From July 2008 to November 2010,the treatment effects of two groups of patients with advanced hepatocellular carcinoma were retrospectively analyzed and compared, including 44 patients treated by sorafenib combined with TACE (test group) and the other 44 patients treated only with TACE (control group). To assess the treatment effect based on mRECIST, the time for patients' tumor progression (TTP), overall survival (OS) time and adverse events were recorded. Survival rate were analyzed using Kaplan-Meier method and Log-rank analysis in SPSS 18.0. Results: Till January 2011, 24 patients (54.5%) survived and 20 patients (include patients lost to visit) died (45.5%) among the test group, 13 patients survived (29.5 %) and 31 patients (include patients lost to visit) died (70.5 %) among the control group. No complete remission condition was observed in all patients. Among the test group, 1 patient got partial remission, 24 ones remain stable and 19 patients got progression. While among the control group, conditions remained stable in 21 patients and progressed in rest 23 ones. The disease control rate (DCR) in the test group and control group were 56.8% (25/44) and 47.7% (21/44) respectively, with no statistical significance (χ 2 =0.729, P=0.393). The median overall survival time (mOS) of test group and control group were 21.0 (95% CI: 14.9-27.1)months and 10.0 (95% CI: 6.4-13.6) months respectively, and the difference reached statistical significance (χ 2 =7.436, P=0.006). The median time to tumor progression (mTTP) of test group and control group was 11.0 (95% CI: 8.7-13.3) and 6.0 (95% CI: 3.9-8.1) months respectively, and the difference had statistical significance (χ 2 =10.437, P=0.001). The adverse events of test group mainly included hand-foot skin reaction, loss of

  10. Transcatheter embolization of hepatic arteriovenous fistulas in Rendu-Osler-Weber disease: a case report and review of the literature

    International Nuclear Information System (INIS)

    Stockx, L.; Raat, H.; Caerts, B.; Wilms, G.; Marchal, G.; Cutsem, E. van

    1999-01-01

    A patient with hereditary hemorrhagic telangiectasia and diffuse intrahepatic arteriovenous fistulas developed secondary high-output ventricular failure and pulmonary hypertension. A serial staged hepatic arterial coil embolization was performed with long-term resultant haemodynamic and clinical improvement. The methods of this procedure and related complications are discussed. (orig.)

  11. The safety and efficacy of hemostasis with Clo-Sur P.A.D. after transcatheter arterial chemoembolization

    International Nuclear Information System (INIS)

    Jung, Seung Chai; Jae, Hwan Jun; Kim, Sang Youn; Lee, Whal; Chung, Jin Wook; Park, Jae Hyung

    2007-01-01

    We wanted to evaluate the safety and efficacy of a new hemostatic device, Clo-Sur P.A.D., at an arterial access site after performing femoral arterial catheterization to achieve transcatheter arterial chemoembolization (TACE). From August 2002 to March 2005, 113 patients who underwent TACE and agreed on using the Clo-Sur P.A.D. were enrolled in this study. We evaluated the mean time interval from compression to the first movement and also to the first walk. We also evaluated such complications as rebleeding, pseudoaneurysm, vascular occlusion, hematoma, infection and pain. For 92 patients who had previous experiences with manual compression, we evaluated their preference of hemostatic method by asking them. Successful hemostasis was achieved with the Clo-Sur P.A.D. in 105 subjects (92%). The mean time interval from compression to the first movement was 201 minutes, and that to the first walk was 267 minutes. There was no statistical difference between the complicated and the uncomplicated groups for the mean time, prothrombin time, Child-Pugh class and platelet count (ρ > 0.05). Rebleeding occurred in 3 patients (2.7%) and mild hematoma around puncture site was noted in 5 patients (5.4%). Eighty-seven patients (95%) preferred Clo-Sur P.A.D. to the manual compression method. The Clo-Sur P.A.D. is a safe and effective hemostatic device and it provides early ambulation after TACE

  12. The suppression effect of the intrahepatic recurrence of transcatheter arterial chemoembolization with cisplatin in the hepatocellular carcinoma patients

    International Nuclear Information System (INIS)

    Moon, Tae Yong; Lee, Suck Hong; Kim, Byung Soo; Kim, Yong Woo

    1997-01-01

    To compare the suppressive effects in hepatocellular carcinoma patients of transhepatic arterial chemoembolization by the infusion of adriamycin-lipiodol emulsion and of this plus 10ml of cisplatin solution. In a total of 151 cases, the frequency of intrahepatic recurrence was compared with follow-up angiographic findings after the first and second transhepatic arterial chemoembolization with adriamycin-lipiodol emulsion and adriamycin-lipiodol emulsion plus 10ml of cisplatin solution, respectively. Among 46 patients whose first single infusion was after mean 119 days, the recurrence rate was 22% ; for 42 who were given their first multiple infusion after mean 76 days this rate was 5% ; for 35 whose second single infusion was administered after mean 147 days, the rate was 34%, and among 28 whose second multiple infusion was after mean 110 days, the rate was 43%. During the first trial of transcatheter arterial chemoembolization with adriamycinlipiodol plus cisplatin solution, hepatocellular carcinoma recurred much less frequently, but during the second trial with cisplatin, recurrence was not suppresed

  13. Rare Case of Vasculitis of the Hepatic Artery.

    Science.gov (United States)

    Mali, Padmavathi; Muduganti, Sudheer R; Goldberg, Jerry

    2015-12-01

    Vasculitis is an accumulation of inflammatory leucocytes in the blood vessels with reactive damage to mural structures. Isolated vasculitis of the gastrointestinal tract without systemic involvement is rare. We report a unique case of a female patient who presented with abdominal pain, and was found, on serology, to have elevated inflammatory markers without autoantibodies. A computed tomography scan of the abdomen and pelvis was suggestive of vasculitis of the hepatic artery. To the best of our knowledge, this is the first case, to date, of vasculitis of hepatic artery. © 2015 Marshfield Clinic.

  14. Peripheral hepatic arterial embolization with cross-linked collagen fibers

    International Nuclear Information System (INIS)

    Daniels, J.R.; Kerlan, R.K. Jr.; Dodds, L.; McLaughlin, P.; La Berge, J.M.; Harrington, D.; Daniels, A.M.; Ring, E.J.

    1986-01-01

    Hepatic artery embolization with a nonimmunogenic, cross-linked collagen preparation (Angiostat, collagen for embolization, Target Therapeutics) was studied in mongrel dogs. Flow-directed technique was used to achieve complete distal arterial occlusion. Serial liver function evaluation demonstrated marked alterations at 48 to 72 hours, partial correction at 1 week, and resolution of abnormalities by 1 month. Restoration of large-vessel blood flow was angiographically demonstrable at 1 week. Recanalization, achieved by migration of endothelial cells around the collagen, resulted in complete restoration of normal hepatic vascular and tissue anatomy at 1 month. Repeated embolization at biweekly intervals was well tolerated

  15. Aberrant hepatic arterial anatomy and the whipple procedure: lessons learned.

    Science.gov (United States)

    Chamberlain, Ronald S; El-Sedfy, Abraham; Rajkumar, Dhiraj

    2011-05-01

    Appreciation and study of hepatic arterial anatomical variability is essential to the performance of a pancreaticoduodenectomy to avoid surgical complications such as bleeding, hepatic ischemia/failure, and anastomotic leak/stricture. Awareness of this variability permits the surgeon to adapt the surgical technique to deal with anomalies identified preoperatively or intraoperatively thereby preventing unnecessary surgical morbidity and mortality. The objective of our study is to provide a comprehensive review of the anatomic arterial anomalies and discuss surgical strategies that will equip the surgeon to deal with all anomalies that may be encountered a priori or en passant during the course of a Whipple procedure.

  16. Transcatheter embolization therapy of the gastrointestinal hemorrhage

    International Nuclear Information System (INIS)

    Sim, Jae In; Park, Auh Whan; Ryeom, Hun Kyu; Kim, Yong Joo

    1994-01-01

    To evaluate the effectiveness of transcatheter embolization for the treatment of massive gastrointestinal arterial bleeding. The study was based on retrospective analysis of twelve cases(8 men, 4 woman) including two patients with hemobilia in which transcatheter embolization was attempted for the control of massive gastrointestinal bleeding from March 1987 to October 1993. Clinical diagnoses of these patients were peptic ulcer(5), pseudoaneurysm formation(3) following percutaneous transhepatic biliary drainage or traffic accident, stomach cancer(1), typhoid fever(1), duodenal leiomyoma(1) and Osler-Weber-Rendu disease (1). Embolized vessels are as follows: gastroduodenal artery(6), left gastric artery(2), ileocolic artery(2), and hepatic artery(2). Embolization was effective in immediate control of bleeding in all patients. Although five of the six patients who had undergone embolization of the gastroduodenal artery developed rebleeding within 24 hour, only 2 required surgery and none showed serious complication. Embolization therapy is safe and effective initial treatment of choice for life-threatening massive gastrointestinal bleeding

  17. Transcatheter embolization therapy of the gastrointestinal hemorrhage

    Energy Technology Data Exchange (ETDEWEB)

    Sim, Jae In; Park, Auh Whan; Ryeom, Hun Kyu; Kim, Yong Joo [Kyungpook National University Hospital, Daegu (Korea, Republic of)

    1994-05-15

    To evaluate the effectiveness of transcatheter embolization for the treatment of massive gastrointestinal arterial bleeding. The study was based on retrospective analysis of twelve cases(8 men, 4 woman) including two patients with hemobilia in which transcatheter embolization was attempted for the control of massive gastrointestinal bleeding from March 1987 to October 1993. Clinical diagnoses of these patients were peptic ulcer(5), pseudoaneurysm formation(3) following percutaneous transhepatic biliary drainage or traffic accident, stomach cancer(1), typhoid fever(1), duodenal leiomyoma(1) and Osler-Weber-Rendu disease (1). Embolized vessels are as follows: gastroduodenal artery(6), left gastric artery(2), ileocolic artery(2), and hepatic artery(2). Embolization was effective in immediate control of bleeding in all patients. Although five of the six patients who had undergone embolization of the gastroduodenal artery developed rebleeding within 24 hour, only 2 required surgery and none showed serious complication. Embolization therapy is safe and effective initial treatment of choice for life-threatening massive gastrointestinal bleeding.

  18. Hepatic arterial pseudoaneurysm: a rare complication of blunt abdominal trauma in children

    Energy Technology Data Exchange (ETDEWEB)

    Basile, K.E.; Sivit, C.J.; Sachs, P.B. [Department of Radiology, Rainbow Babies and Children`s Hospital of the University Hospitals of Cleveland, OH (United States); Stallion, A. [Department of Surgery, Rainbow Babies` and Children`s Hospital of the University Hospitals of Cleveland, OH (United States)

    1999-05-01

    We report a child who developed a hepatic artery pseudoaneurysm following blunt hepatic injury. This is a rare complication of hepatic trauma in children. The imaging evaluation and clinical management of hepatic artery pseudoaneurysms are presented. (orig.) With 3 figs., 8 refs.

  19. Anatomical variations of hepatic arterial system, coeliac trunk and renal arteries: an analysis with multidetector CT angiography.

    Science.gov (United States)

    Ugurel, M S; Battal, B; Bozlar, U; Nural, M S; Tasar, M; Ors, F; Saglam, M; Karademir, I

    2010-08-01

    The purpose of our investigation was to determine the anatomical variations in the coeliac trunk-hepatic arterial system and the renal arteries in patients who underwent multidetector CT (MDCT) angiography of the abdominal aorta for various reasons. A total of 100 patients were analysed retrospectively. The coeliac trunk, hepatic arterial system and renal arteries were analysed individually and anatomical variations were recorded. Statistical analysis of the relationship between hepatocoeliac variations and renal artery variations was performed using a chi(2) test. There was a coeliac trunk trifurcation in 89% and bifurcation in 8% of the cases. Coeliac trunk was absent in 1%, a hepatosplenomesenteric trunk was seen in 1% and a splenomesenteric trunk was present in 1%. Hepatic artery variation was present in 48% of patients. Coeliac trunk and/or hepatic arterial variation was present in 23 (39.7%) of the 58 patients with normal renal arteries, and in 27 (64.3%) of the 42 patients with accessory renal arteries. There was a statistically significant correlation between renal artery variations and coeliac trunk-hepatic arterial system variations (p = 0.015). MDCT angiography permits a correct and detailed evaluation of hepatic and renal vascular anatomy. The prevalence of variations in the coeliac trunk and/or hepatic arteries is increased in people with accessory renal arteries. For that reason, when undertaking angiographic examinations directed towards any single organ, the possibility of variations in the vascular structure of other organs should be kept in mind.

  20. Hepatic arterial embolization in the management of blunt hepatic trauma: indications and complications.

    Science.gov (United States)

    Letoublon, Christian; Morra, Irene; Chen, Yao; Monnin, Valerie; Voirin, David; Arvieux, Catherine

    2011-05-01

    The objective was to clarify the role of hepatic arterial embolization (AE) in the management of blunt hepatic trauma. Retrospective observational study of 183 patients with blunt hepatic trauma admitted to a trauma referral center over a 9-year period. The charts of 29 patients (16%) who underwent hepatic angiography were reviewed for demographics, injury specific data, management strategy, angiographic indication, efficacy and complications of embolization, and outcome. AE was performed in 23 (79%) of the patients requiring angiography. Thirteen patients managed conservatively underwent emergency embolization after preliminary computed tomography scan. Six had postoperative embolization after damage control laparotomy and four had delayed embolization. Arterial bleeding was controlled in all the cases. Sixteen patients (70%) had one or more liver-related complications; temporary biliary leak (n=11), intra-abdominal hypertension (n=14), inflammatory peritonitis (n=3), hepatic necrosis (n=3), gallbladder infarction (n=2), and compressive subcapsular hematoma (n=1). Unrecognized hepatic necrosis could have contributed to the late posttraumatic death of one patient. AE is a key element in modern management of high-grade liver injuries. Two principal indications exist in the acute postinjury phase: primary hemostatic control in hemodynamically stable or stabilized patients with radiologic computed tomography evidence of active arterial bleeding and adjunctive hemostatic control in patients with uncontrolled suspected arterial bleeding despite emergency laparotomy. Successful management of injuries of grade III upward often entails a combined angiographic and surgical approach. Awareness of the ischemic complications due to angioembolization is important.

  1. Stentgraft Implantation for the Treatment of Postoperative Hepatic Artery Pseudoaneurysm

    Energy Technology Data Exchange (ETDEWEB)

    Pedersoli, F., E-mail: fpedersoli@ukaachen.de; Isfort, P.; Keil, S.; Goerg, F.; Zimmermann, M.; Liebl, M.; Schulze-Hagen, M. [RWTH Aachen University Hospital, Department of Diagnostic and Interventional Radiology (Germany); Schmeding, M. [RWTH Aachen University Hospital, Clinic for General, Visceral and Transplant Surgery (Germany); Kuhl, C. K.; Bruners, P. [RWTH Aachen University Hospital, Department of Diagnostic and Interventional Radiology (Germany)

    2016-04-15

    PurposeHepatic artery pseudoaneurysms are a rare but potentially life-threatening complication of major pancreaticobiliary surgery. We evaluated the safety and efficacy of endovascular stentgraft implantation for the management of such vascular lesions.Materials and MethodsBetween May 2013 and October 2015, ten patients with postoperative hepatic artery pseudoaneurysm, of which eight presented with active hemorrhage, were treated with endovascular stentgraft implantation. All patients had undergone major pancreatic or hepatic surgery before (pylorus-preserving pancreaticoduodenectomy, pancreatectomy, hemihepatectomy, extended hemihepatectomy). The pseudoaneurysms were diagnosed 13–202 days after surgery and were associated with postsurgical complications (e.g., leakage of pancreaticojejunal anastomosis).ResultsIn 9/10 patients, the pseudoaneurysm was completely excluded via stentgraft implantation. In 1/10 patient, the pseudoaneurysm ruptured during the procedure and was successfully treated by immediate open surgery. In 1/10 patient, a second intervention was performed after 6 days because of rebleeding; this was successfully treated by implantation of a second overlapping stentgraft. Mean follow-up time is 51 days. None of the patients died due to stentgraft- or aneurysm-related complications. Further episodes of hemorrhage were not observed. In one patient, clinically asymptomatic complete occlusion of the stentgraft was discovered at follow-up imaging.ConclusionStentgraft implantation is a safe and effective technique to treat hepatic artery pseudoaneurysms related to major pancreatic or hepatic surgery, especially in the setting of acute hemorrhage.

  2. Stentgraft Implantation for the Treatment of Postoperative Hepatic Artery Pseudoaneurysm

    International Nuclear Information System (INIS)

    Pedersoli, F.; Isfort, P.; Keil, S.; Goerg, F.; Zimmermann, M.; Liebl, M.; Schulze-Hagen, M.; Schmeding, M.; Kuhl, C. K.; Bruners, P.

    2016-01-01

    PurposeHepatic artery pseudoaneurysms are a rare but potentially life-threatening complication of major pancreaticobiliary surgery. We evaluated the safety and efficacy of endovascular stentgraft implantation for the management of such vascular lesions.Materials and MethodsBetween May 2013 and October 2015, ten patients with postoperative hepatic artery pseudoaneurysm, of which eight presented with active hemorrhage, were treated with endovascular stentgraft implantation. All patients had undergone major pancreatic or hepatic surgery before (pylorus-preserving pancreaticoduodenectomy, pancreatectomy, hemihepatectomy, extended hemihepatectomy). The pseudoaneurysms were diagnosed 13–202 days after surgery and were associated with postsurgical complications (e.g., leakage of pancreaticojejunal anastomosis).ResultsIn 9/10 patients, the pseudoaneurysm was completely excluded via stentgraft implantation. In 1/10 patient, the pseudoaneurysm ruptured during the procedure and was successfully treated by immediate open surgery. In 1/10 patient, a second intervention was performed after 6 days because of rebleeding; this was successfully treated by implantation of a second overlapping stentgraft. Mean follow-up time is 51 days. None of the patients died due to stentgraft- or aneurysm-related complications. Further episodes of hemorrhage were not observed. In one patient, clinically asymptomatic complete occlusion of the stentgraft was discovered at follow-up imaging.ConclusionStentgraft implantation is a safe and effective technique to treat hepatic artery pseudoaneurysms related to major pancreatic or hepatic surgery, especially in the setting of acute hemorrhage.

  3. Treatment of Small Hepatocellular Carcinoma (≤2 cm) in the Caudate Lobe with Sequential Transcatheter Arterial Chemoembolization and Radiofrequency Ablation

    International Nuclear Information System (INIS)

    Hyun, Dongho; Cho, Sung Ki; Shin, Sung Wook; Rhim, Hyunchul; Koh, Kwang Cheol; Paik, Seung Woon

    2016-01-01

    PurposeTo evaluate technical feasibility and treatment results of sequential transcatheter arterial chemoembolization (TACE) and cone-beam computed tomography-guided percutaneous radiofrequency ablation (CBCT-RFA) for small hepatocellular carcinoma (HCC) in the caudate lobe.Materials and MethodsInstitutional review board approved this retrospective study. Radiologic database was searched for the patients referred to perform TACE and CBCT-RFA for small caudate HCCs (≤2 cm) between February 2009 and February 2014. A total of 14 patients (12 men and 2 women, mean age; 61.3 years) were included. Percutaneous ultrasonography-guided RFA (pUS-RFA) and surgery were infeasible due to poor conspicuity, inconspicuity or no safe electrode pathway, and poor hepatic reserve. Procedural success (completion of both TACE and CBCT-RFA), technique efficacy (absence of tumor enhancement at 1 month after treatment), and complication were evaluated. Treatment results including local tumor progression (LTP), intrahepatic distant recurrence (IDR), overall survival (OS), and progression-free survival (PFS) were analyzed.ResultsProcedural success and technique efficacy rates were 78.6 % (11/14) and 90.9 % (10/11), respectively. Average follow-up period was 45.3 months (range, 13.4–64.6 months). The 1-, 3-, and 5-year LTP probabilities were 0, 12.5, and 12.5 %, respectively. IDR occurred in seven patients (63.6 %, 7/11). The 1-, 3-, and 5-year PFS probabilities were 81.8, 51.9, and 26 %, respectively. The 1-, 3-, and 5-year OS probabilities were 100, 80.8, and 80.8 %, respectively.ConclusionCombination of TACE and CBCT-RFA seems feasible for small HCC in the caudate lobe not amenable to pUS-RFA and effective in local tumor control.

  4. Treatment of Small Hepatocellular Carcinoma (≤2 cm) in the Caudate Lobe with Sequential Transcatheter Arterial Chemoembolization and Radiofrequency Ablation

    Energy Technology Data Exchange (ETDEWEB)

    Hyun, Dongho; Cho, Sung Ki, E-mail: sungkismc.cho@samsung.com; Shin, Sung Wook; Rhim, Hyunchul [Sungkyunkwan University School of Medicine, Department of Radiology, Samsung Medical Center (Korea, Republic of); Koh, Kwang Cheol; Paik, Seung Woon [Sungkyunkwan University School of Medicine, Department of Medicine, Samsung Medical Center (Korea, Republic of)

    2016-07-15

    PurposeTo evaluate technical feasibility and treatment results of sequential transcatheter arterial chemoembolization (TACE) and cone-beam computed tomography-guided percutaneous radiofrequency ablation (CBCT-RFA) for small hepatocellular carcinoma (HCC) in the caudate lobe.Materials and MethodsInstitutional review board approved this retrospective study. Radiologic database was searched for the patients referred to perform TACE and CBCT-RFA for small caudate HCCs (≤2 cm) between February 2009 and February 2014. A total of 14 patients (12 men and 2 women, mean age; 61.3 years) were included. Percutaneous ultrasonography-guided RFA (pUS-RFA) and surgery were infeasible due to poor conspicuity, inconspicuity or no safe electrode pathway, and poor hepatic reserve. Procedural success (completion of both TACE and CBCT-RFA), technique efficacy (absence of tumor enhancement at 1 month after treatment), and complication were evaluated. Treatment results including local tumor progression (LTP), intrahepatic distant recurrence (IDR), overall survival (OS), and progression-free survival (PFS) were analyzed.ResultsProcedural success and technique efficacy rates were 78.6 % (11/14) and 90.9 % (10/11), respectively. Average follow-up period was 45.3 months (range, 13.4–64.6 months). The 1-, 3-, and 5-year LTP probabilities were 0, 12.5, and 12.5 %, respectively. IDR occurred in seven patients (63.6 %, 7/11). The 1-, 3-, and 5-year PFS probabilities were 81.8, 51.9, and 26 %, respectively. The 1-, 3-, and 5-year OS probabilities were 100, 80.8, and 80.8 %, respectively.ConclusionCombination of TACE and CBCT-RFA seems feasible for small HCC in the caudate lobe not amenable to pUS-RFA and effective in local tumor control.

  5. Left bronchial artery arising from a replaced left hepatic artery in a patient with massive hemoptysis

    Energy Technology Data Exchange (ETDEWEB)

    Khil, Eun Kyung; Lee, Jae Myung [Dept. of Radiology, Soonchunhyang University College of Medicine, Bucheon Hospital, Bucheon (Korea, Republic of)

    2015-09-15

    A 70-year-old man with a 3-year history of bronchiectasis presented with massive hemoptysis that had lasted for 3 days. In our attempt to perform bronchial artery embolization, upper abdominal angiography was required to locate the left bronchial artery, which in this case was of anomalous origin, arising from a replaced left hepatic artery, which arose from the left gastric artery-a very unusual anatomical variant. We performed embolization with polyvinyl alcohol particles, and the patient's symptoms resolved completely, with no additional complications after conservative treatment.

  6. A preliminary discussion of angiographic anatomy and variations of rabbit hepatic vessels and catheterization methods of hepatic artery

    International Nuclear Information System (INIS)

    Wang Diaodong; Yang Renjie; Zhang Hongzhi; Sun Hongliang

    2006-01-01

    Objective: To study the normal angiographic anatomy and variations of rabbit hepatic vessels, and explore the optimal method for hepatic artery catheterization. Methods: 30 rabbits were divided into two groups randomly. Modified surgical method and interventional method were used to catheterize hepatic artery respectively, and followed by angiography to demonstrate the normal anatomy and variations of rabbit celiac artery, hepatic artery and portal vein. Results: The route and distribution of rabbit celiac artery and hepatic artery were very different from human's. The commonly seen variation showed the differences in branching bifurcation of hepatic-gastric artery, with the incidence of 13.3%. The rates of successfully hepatic artery catheterization with surgical and interventional methods were 86.6%(13/15) and 80%(12/15) respectively (P>0.05). The surgical method will not be successful, whenever there's variation. Conclusion: The normal anatomy and variation of rabbit celiac artery and hepatic artery are quite different from human's. Both surgical and interventional catheterizations could be rather successful but possessing advantages and disadvantages of each its own. (authors)

  7. Hepatic Falciform Ligament Artery in Patients with Chronic Liver Diseases: Detection on Computed Tomography Hepatic Arteriography

    International Nuclear Information System (INIS)

    Tajima, T.; Yoshimitsu, K.; Irie, H.; Nishie, A.; Hirakawa, M.; Ishigami, K.; Ushijima, Y.; Okamoto, D.; Honda, H.

    2009-01-01

    Background: The detection rate of hepatic falciform ligament artery (FLA) has been reported as ranging from 2-25%. The rate of FLA on laparotomy, however, is reported to be higher, at 68%. Purpose: To compare the detection rate of FLA on computed tomography hepatic arteriography (CTHA) with that on angiography and dynamic CT, and to clarify the clinical significance of FLA in patients with chronic liver disease. Material and Methods: 126 consecutive patients underwent CTHA angiography and dynamic CT to evaluate suspected liver tumors. Liver function was classified as follows: normal, n=5; Child-Pugh class A, n=94; B, n=21; and C, n=6. All CT images were obtained using multidetector (MDCT) scanners (Aquilion; Toshiba, Tokyo (JP)). For CTHA, CT images were obtained during contrast material injection through the left hepatic, proper, or common hepatic artery. On CT, FLAs were retrospectively identified within the hepatic falciform ligament and the hepatic round ligament by the paging method on a workstation (TWS-5000; Toshiba, Tokyo (JP)). The detection rates were compared among the three modalities (hepatic arterial phase of dynamic CT, CTHA, and angiography). The calibers of FLA were also correlated with the hepatic function of the patients. Results: The detection rates of FLA by angiography, dynamic CT, and CTHA were 37% (47/126), 10% (13/126), and 77% (97/126), respectively. The calibers of FLA increased as the hepatic function deteriorated (P=0.001). Conclusion: The detection rates of FLA with CTHA are far higher than those with angiography and dynamic CT. Careful interpretation with recognition of FLA on CTHA images is important, as inadvertent embolization or chemotherapeutic infusion of the FLA may result in supraumbilical skin rash

  8. Transcatheter closure of large patent ductus arteriosus with severe pulmonary arterial hypertension: Short and intermediate term results

    International Nuclear Information System (INIS)

    Bhalgat, Parag S; Pinto, Robin; Dalvi, Bharat V

    2012-01-01

    To assess the efficacy and safety of transcatheter closure (TCC) of patent ductus arteriosus (PDA) with severe pulmonary arterial hypertension (PHT). TCC of small and moderate-sized PDAs is well established. However, there is a paucity of data on TCC of large PDA with severe PHT. This is a retrospective observational study of 76 patients with large PDA and severe PHT who were referred for TCC. Multiple clinical and investigational parameters were evaluated to decide the reversibility of PHT. Following the TCC, patients were serially followed up to assess the efficacy and safety of closure and its impact on PHT. Of 76 patients, nine were found to have PDA with Eisenmenger's syndrome. Of remaining 67, two were thought to have irreversible PHT based on hemodynamic data obtained after balloon occlusion of the duct. Sixty five patients, who eventually underwent TCC of PDA, had a median age of 9.1 years (range 1 month to 40 years). The weight ranged between 2.5 to 62 kg (median 14 kg). The PDA size was 9.1 ± 4.6 mm. The mean systolic pulmonary artery pressure was 66.9 ± 15.3 mm Hg. Duct occluder was used in 63 and muscular ventricular septal defect closure device in 2. The follow up was available in 56 (86%) with a mean follow up period of 65 ± 34 months. All the patients had complete closure of the PDA at 6 months follow up. Mild obstruction of left pulmonary artery (n=3) and aortic isthmus flow (n=6) was noted at the time of discharge. During the follow up, partial or complete resolution of PHT was observed in all the patients in whom Doppler-derived right ventricular systolic pressure was recorded (available in 40 of 56 patients). TCC of large PDA with severe PHT and significant left to right shunt was found to be effective and safe in the short and intermediate term

  9. Transcatheter closure of large patent ductus arteriosus with severe pulmonary arterial hypertension: Short and intermediate term results.

    Science.gov (United States)

    Bhalgat, Parag S; Pinto, Robin; Dalvi, Bharat V

    2012-07-01

    To assess the efficacy and safety of transcatheter closure (TCC) of patent ductus arteriosus (PDA) with severe pulmonary arterial hypertension (PHT). TCC of small and moderate-sized PDAs is well established. However, there is a paucity of data on TCC of large PDA with severe PHT. This is a retrospective observational study of 76 patients with large PDA and severe PHT who were referred for TCC. Multiple clinical and investigational parameters were evaluated to decide the reversibility of PHT. Following the TCC, patients were serially followed up to assess the efficacy and safety of closure and its impact on PHT. Of 76 patients, nine were found to have PDA with Eisenmenger's syndrome. Of remaining 67, two were thought to have irreversible PHT based on hemodynamic data obtained after balloon occlusion of the duct. Sixty five patients, who eventually underwent TCC of PDA, had a median age of 9.1 years (range 1 month to 40 years). The weight ranged between 2.5 to 62 kg (median 14 kg). The PDA size was 9.1 ± 4.6 mm. The mean systolic pulmonary artery pressure was 66.9 ± 15.3 mm Hg. Duct occluder was used in 63 and muscular ventricular septal defect closure device in 2. The follow up was available in 56 (86%) with a mean follow up period of 65 ± 34 months. All the patients had complete closure of the PDA at 6 months follow up. Mild obstruction of left pulmonary artery (n=3) and aortic isthmus flow (n=6) was noted at the time of discharge. During the follow up, partial or complete resolution of PHT was observed in all the patients in whom Doppler-derived right ventricular systolic pressure was recorded (available in 40 of 56 patients). TCC of large PDA with severe PHT and significant left to right shunt was found to be effective and safe in the short and intermediate term.

  10. Transcatheter closure of large patent ductus arteriosus with severe pulmonary arterial hypertension: Short and intermediate term results

    Energy Technology Data Exchange (ETDEWEB)

    Bhalgat, Parag S [Department of Cardiology, King Edward VII Memorial Hospital, Mumbai, Maharashtra (India); Pinto, Robin; Dalvi, Bharat V, E-mail: bharatdalvi@hotmail.com [Glenmark Cardiac Center, 10 Nandadeep, 209 Dr. Ambedkar Road, Matunga (East), Mumbai, Maharashtra (India)

    2012-01-01

    To assess the efficacy and safety of transcatheter closure (TCC) of patent ductus arteriosus (PDA) with severe pulmonary arterial hypertension (PHT). TCC of small and moderate-sized PDAs is well established. However, there is a paucity of data on TCC of large PDA with severe PHT. This is a retrospective observational study of 76 patients with large PDA and severe PHT who were referred for TCC. Multiple clinical and investigational parameters were evaluated to decide the reversibility of PHT. Following the TCC, patients were serially followed up to assess the efficacy and safety of closure and its impact on PHT. Of 76 patients, nine were found to have PDA with Eisenmenger's syndrome. Of remaining 67, two were thought to have irreversible PHT based on hemodynamic data obtained after balloon occlusion of the duct. Sixty five patients, who eventually underwent TCC of PDA, had a median age of 9.1 years (range 1 month to 40 years). The weight ranged between 2.5 to 62 kg (median 14 kg). The PDA size was 9.1 ± 4.6 mm. The mean systolic pulmonary artery pressure was 66.9 ± 15.3 mm Hg. Duct occluder was used in 63 and muscular ventricular septal defect closure device in 2. The follow up was available in 56 (86%) with a mean follow up period of 65 ± 34 months. All the patients had complete closure of the PDA at 6 months follow up. Mild obstruction of left pulmonary artery (n=3) and aortic isthmus flow (n=6) was noted at the time of discharge. During the follow up, partial or complete resolution of PHT was observed in all the patients in whom Doppler-derived right ventricular systolic pressure was recorded (available in 40 of 56 patients). TCC of large PDA with severe PHT and significant left to right shunt was found to be effective and safe in the short and intermediate term.

  11. Transcatheter aortic valve implantation and off-pump coronary artery bypass surgery: an effective hybrid procedure in selected patients.

    Science.gov (United States)

    Mayr, Benedikt; Firschke, Christian; Erlebach, Magdalena; Bleiziffer, Sabine; Krane, Markus; Joner, Michael; Herold, Ulf; Nöbauer, Christian; Lange, Rüdiger; Deutsch, Marcus-André

    2018-02-26

    Simultaneous surgical off-pump coronary revascularization and transcatheter aortic valve implantation (TAVI) as a hybrid procedure may be a therapeutic option for patients with a TAVI indication who are not suitable for percutaneous coronary intervention and for patients who have an indication for combined surgical aortic valve implantation and coronary artery bypass grafting but present with a porcelain aorta. Early outcomes of these patients are analysed in this study. From February 2011 to April 2017, hybrid TAVI/off-pump coronary artery bypass (OPCAB) was performed in 12 (60%) patients, hybrid TAVI/minimally invasive direct coronary artery bypass in 6 (30%) patients and staged TAVI/OPCAB in 2 (10%) patients. Endpoints of this study were 30-day mortality, device success and postoperative adverse events as defined by the updated Valve Academic Research Consortium (VARC-2). The median age at the time of surgery was 77 years [interquartile range (IQR), 70-81] with a median logistic EuroSCORE and Society of Thoracic Surgeons' Predicted Risk score of 16.1% (IQR, 9.3-28.1) and 3.9% (IQR, 2.2-5.6), respectively. The median Synergy between PCI with Taxus and Cardiac Surgery score was 16.5 (IQR, 9.8-22.8). TAVI implantation routes were transaortic in 9 (45%) patients, transapical and transfemoral in 5 (25%) patients each and transsubclavian in 1 (5%) patient. Complete myocardial revascularization was achieved in 75% of patients. Device success rate was 100%. Paravalvular aortic regurgitation did not exceed mild in any patient. Stroke/transient ischaemic attack, vascular complications and myocardial infarction were not observed. Re-exploration for bleeding was required in 1 (5%) patient. Thirty-day mortality was 0%. Hybrid OPCAB/MIDCAB and TAVI prove to be a safe and effective alternative treatment option in selected higher risk patients.

  12. Segmental hepatic artery at hepatic hilar area. Analysis by 3 dimensional integrated image of artery, portal vein and bile duct

    Energy Technology Data Exchange (ETDEWEB)

    Sakai, Hisamune; Okuda, Kouji; Yoshida, Jun; Kinoshita, Hisafumi; Aoyagi, Shigeaki [Kurume Univ., School of Medicine, Kurume, Fukuoka (Japan)

    2006-11-15

    Multiple individual variations in running and bifurcation of the hepatic artery, biliary duct and portal vein are known in hepatic hilar area. This paper describes the examination of such arterial variations by integrating the 3D images of those vessels obtained by multidetector-row CT (MDCT). Subjects are findings from 64 patients with cholangiocarcinoma, hepatocarcinoma or cholelithiasis. MDCT dynamic scanning, and percutaneous transhepatic biliary drainage-CT and/or drip infusion cholangiography-CT with the intravenous iopamidol and/or iotroxate megulumin, were done with GE LightSpeed Ultra 16 slice type equipment to compose the 3D images. Arterial variants of the bifurcation in the right and left lobe were found to be 18 cases/62 (29%) and 13/64 (20%), respectively. The left artery running at right side of portal venous umbilical region was seen in 9/64 (14%) and right artery running ''northward'', in 9/62 (14%). Previous realization of such individual 3D arterial variations as above is necessary for the precise microsurgery of the hilar area to preserve the essential vessel. (T.I.)

  13. Segmental hepatic artery at hepatic hilar area. Analysis by 3 dimensional integrated image of artery, portal vein and bile duct

    International Nuclear Information System (INIS)

    Sakai, Hisamune; Okuda, Kouji; Yoshida, Jun; Kinoshita, Hisafumi; Aoyagi, Shigeaki

    2006-01-01

    Multiple individual variations in running and bifurcation of the hepatic artery, biliary duct and portal vein are known in hepatic hilar area. This paper describes the examination of such arterial variations by integrating the 3D images of those vessels obtained by multidetector-row CT (MDCT). Subjects are findings from 64 patients with cholangiocarcinoma, hepatocarcinoma or cholelithiasis. MDCT dynamic scanning, and percutaneous transhepatic biliary drainage-CT and/or drip infusion cholangiography-CT with the intravenous iopamidol and/or iotroxate megulumin, were done with GE LightSpeed Ultra 16 slice type equipment to compose the 3D images. Arterial variants of the bifurcation in the right and left lobe were found to be 18 cases/62 (29%) and 13/64 (20%), respectively. The left artery running at right side of portal venous umbilical region was seen in 9/64 (14%) and right artery running ''northward'', in 9/62 (14%). Previous realization of such individual 3D arterial variations as above is necessary for the precise microsurgery of the hilar area to preserve the essential vessel. (T.I.)

  14. Transcatheter arterial chemoembolization in combination with radiotherapy for unresectable hepatocellular carcinoma: A systematic review and meta-analysis

    International Nuclear Information System (INIS)

    Meng Maobin; Cui Yaoli; Lu You; She Bin; Chen Yan; Guan Yongsong; Zhang Ruiming

    2009-01-01

    Background and Purpose: To evaluate the efficacy and safety of transcatheter arterial chemoembolization (TACE) plus radiotherapy (RT) for unresectable hepatocellular carcinoma (UHCC) using meta-analysis of data from the literature involving available randomized controlled trials of TACE in combination with RT compared with that of TACE alone (Therapy I versus II) in treating UHCC. Material and Methods: We searched the Cochrane Library, MEDLINE, CENTRAL, EMBASE, CBMdisc, and CNKI as well as employing manual searches. Meta-analysis was performed on the results of homogeneous studies. Analyses subdivided by study design were also performed. Results: We found 17 trials involving 1476 patients. 5 of total were Randomized Controlled Trials (RCTs) and 12 were Non-randomized Controlled Clinical Trials (CCTs). In terms of quality, 5 RCTs were graded B, and 12 CCTs were graded C. Our results showed that Therapy I, compared with Therapy II, significantly improved the survival and the tumor response of patients, and was thus more therapeutically beneficial. Serious adverse events were not increased exception for total bilirubin (TB) level. Conclusions: Therapy I was more therapeutically beneficial. However, considering the strength of the evidence, additional randomized controlled trials are needed before Therapy I can be recommended routinely.

  15. Initial Experience with Balloon-Occluded Trans-catheter Arterial Chemoembolization (B-TACE) for Hepatocellular Carcinoma

    Energy Technology Data Exchange (ETDEWEB)

    Maruyama, Mitsunari, E-mail: mitunari@med-shimane.u.ac.jp; Yoshizako, Takeshi, E-mail: yosizako@med.shimane-u.ac.jp; Nakamura, Tomonori, E-mail: t-naka@med.shimane-u.ac.jp; Nakamura, Megumi, E-mail: megumi@med.shimane-u.ac.jp; Yoshida, Rika, E-mail: yoshidar@med.shimane-u.ac.jp; Kitagaki, Hajime, E-mail: kitagaki@med.shimane-u.ac.jp [Shimane University Faculty of Medicine, Department of Radiology (Japan)

    2016-03-15

    PurposeThis study was performed to evaluate the accumulation of lipiodol emulsion (LE) and adverse events during our initial experience of balloon-occluded trans-catheter arterial chemoembolization (B-TACE) for hepatocellular carcinoma (HCC) compared with conventional TACE (C-TACE).MethodsB-TACE group (50 cases) was compared with C-TACE group (50 cases). The ratio of the LE concentration in the tumor to that in the surrounding embolized liver parenchyma (LE ratio) was calculated after each treatment. Adverse events were evaluated according to the Common Terminology Criteria for Adverse Effects (CTCAE) version 4.0.ResultsThe LE ratio at the level of subsegmental showed a statistically significant difference between the groups (t test: P < 0.05). Only elevation of alanine aminotransferase was more frequent in the B-TACE group, showing a statistically significant difference (Mann–Whitney test: P < 0.05). While B-TACE caused severe adverse events (liver abscess and infarction) in patients with bile duct dilatation, there was no statistically significant difference in incidence between the groups. Multivariate logistic regression analysis suggested that the significant risk factor for liver abscess/infarction was bile duct dilatation (P < 0.05).ConclusionThe LE ratio at the level of subsegmental showed a statistically significant difference between the groups (t test: P < 0.05). B-TACE caused severe adverse events (liver abscess and infarction) in patients with bile duct dilatation.

  16. Severe primary postpartum hemorrhage due to genital tract laceration after operative vaginal delivery: successful treatment with transcatheter arterial embolization

    Energy Technology Data Exchange (ETDEWEB)

    Fargeaudou, Yann; Soyer, Philippe; Sirol, Marc; Dref, Olivier le; Boudiaf, Mourad; Dahan, Henri; Rymer, Roland [Hopital Lariboisiere-APHP-GHU Nord et Universite Diderot-Paris 7, Department of Abdominal and Interventional Imaging, Paris (France); Morel, Olivier [Hopital Lariboisiere-APHP-GHU Nord et Universite Diderot-Paris 7, Department of Obstetrics, Paris (France)

    2009-09-15

    The purpose of this study was to report our experience in the management of severe primary postpartum hemorrhage due to genital tract laceration following operative vaginal delivery with forceps using pelvic transcatheter arterial embolization (TAE). Ten women (mean age, 31.9 years) with severe primary postpartum hemorrhage due to genital tract laceration after operative delivery with forceps were treated with TAE. TAE was indicated because of intractable bleeding that could not be controlled with uterotonic drugs, blood transfusion, attempted suturing and packing in all patients. Postdelivery perineal examination showed cervical or vaginal tears in all women and associated paravaginal hematoma in four. Angiography revealed extravasation of contrast material in six patients. TAE performed with gelatin sponge allowed to control the bleeding in all patients. Cervical and vaginal suturing was made possible and successfully achieved in the six women who had failed suturing attempts before TAE. Paravaginal hematoma was successfully evacuated in four patients in whom it was present after TAE. No complications related to TAE were noted. We conclude that in women with severe primary postpartum hemorrhage due to genital tract laceration after operative delivery with forceps, TAE is effective and safe for stopping the bleeding and helps genital tract suturing and evacuation of hematoma. (orig.)

  17. Intractable Postpartum Bleeding: A Comparison of the Retrospective Analysis of Angiographic Findings and Transcatheter Arterial Embolization According to Delivery Pattern

    Energy Technology Data Exchange (ETDEWEB)

    Ahn, Eun Jung; Kim, Young Hwan; Kim, Si Hyung; Choi, Jin Soo; Park, Jun Cheol; Kwon, Sang Hun; Jo, Chi Heum; Cha, Soon Do [Keimyung University College of Medicine, Daegu (Korea, Republic of)

    2008-12-15

    We evaluated the technical aspect and efficacy of transcatheter arterial embolization (TAE) in cases of intractable postpartum bleeding by comparing the angiographic findings women patients according to their delivery pattern. Between July of 2003 and March of 2008, 55 female patients were enrolled in this study. Of the 55 patients, 36 underwent a vaginal delivery (group 1), whereas 19 underwent a cesarean section delivery (group 2). We retrospectively evaluated the angiographic findings and the embolization technique between groups, using a Pearson Chi-Square test. Medical records and telephone interview findings were also reviewed to evaluate the efficacy of TAE and the outcome of fertility. Significantly greater positive angiographic findings were found in group 2 (63.2%) relative to group 1 (30.6%). For positive angiographic findings, except for AVM, the embolization was performed using coil or glue with gelfoam. For the negative angiographic findings or AVM, the gelfoam was the only embolic agent used. In all patients except for one, bleeding stopped after embolization. Major complications occurred in 2 patients only, and included uterine synechia and perforation. All patients except for one recovered after menstruation. In total, four patients became pregnant and one patient delivered a healthy infant. Positive angiographic findings requiring embolization with coil or glue, as well as gelfoam, were more commonly encountered in group 2 than in group 1. Based on the outcome of the study group, TAE is a safe and effective treatment for intractable postpartum bleeding and is also useful for preserving fertility.

  18. Severe primary postpartum hemorrhage due to genital tract laceration after operative vaginal delivery: successful treatment with transcatheter arterial embolization

    International Nuclear Information System (INIS)

    Fargeaudou, Yann; Soyer, Philippe; Sirol, Marc; Dref, Olivier le; Boudiaf, Mourad; Dahan, Henri; Rymer, Roland; Morel, Olivier

    2009-01-01

    The purpose of this study was to report our experience in the management of severe primary postpartum hemorrhage due to genital tract laceration following operative vaginal delivery with forceps using pelvic transcatheter arterial embolization (TAE). Ten women (mean age, 31.9 years) with severe primary postpartum hemorrhage due to genital tract laceration after operative delivery with forceps were treated with TAE. TAE was indicated because of intractable bleeding that could not be controlled with uterotonic drugs, blood transfusion, attempted suturing and packing in all patients. Postdelivery perineal examination showed cervical or vaginal tears in all women and associated paravaginal hematoma in four. Angiography revealed extravasation of contrast material in six patients. TAE performed with gelatin sponge allowed to control the bleeding in all patients. Cervical and vaginal suturing was made possible and successfully achieved in the six women who had failed suturing attempts before TAE. Paravaginal hematoma was successfully evacuated in four patients in whom it was present after TAE. No complications related to TAE were noted. We conclude that in women with severe primary postpartum hemorrhage due to genital tract laceration after operative delivery with forceps, TAE is effective and safe for stopping the bleeding and helps genital tract suturing and evacuation of hematoma. (orig.)

  19. Intractable Postpartum Bleeding: A Comparison of the Retrospective Analysis of Angiographic Findings and Transcatheter Arterial Embolization According to Delivery Pattern

    International Nuclear Information System (INIS)

    Ahn, Eun Jung; Kim, Young Hwan; Kim, Si Hyung; Choi, Jin Soo; Park, Jun Cheol; Kwon, Sang Hun; Jo, Chi Heum; Cha, Soon Do

    2008-01-01

    We evaluated the technical aspect and efficacy of transcatheter arterial embolization (TAE) in cases of intractable postpartum bleeding by comparing the angiographic findings women patients according to their delivery pattern. Between July of 2003 and March of 2008, 55 female patients were enrolled in this study. Of the 55 patients, 36 underwent a vaginal delivery (group 1), whereas 19 underwent a cesarean section delivery (group 2). We retrospectively evaluated the angiographic findings and the embolization technique between groups, using a Pearson Chi-Square test. Medical records and telephone interview findings were also reviewed to evaluate the efficacy of TAE and the outcome of fertility. Significantly greater positive angiographic findings were found in group 2 (63.2%) relative to group 1 (30.6%). For positive angiographic findings, except for AVM, the embolization was performed using coil or glue with gelfoam. For the negative angiographic findings or AVM, the gelfoam was the only embolic agent used. In all patients except for one, bleeding stopped after embolization. Major complications occurred in 2 patients only, and included uterine synechia and perforation. All patients except for one recovered after menstruation. In total, four patients became pregnant and one patient delivered a healthy infant. Positive angiographic findings requiring embolization with coil or glue, as well as gelfoam, were more commonly encountered in group 2 than in group 1. Based on the outcome of the study group, TAE is a safe and effective treatment for intractable postpartum bleeding and is also useful for preserving fertility

  20. Parametric response mapping of dynamic CT for predicting intrahepatic recurrence of hepatocellular carcinoma after conventional transcatheter arterial chemoembolization

    Energy Technology Data Exchange (ETDEWEB)

    Choi, Seung Joon; Kim, Hyung Sik [Gachon University Gil Hospital, Department of Radiology, Incheon (Korea, Republic of); Kim, Jonghoon [Sungkyunkwan University, Department of Electronic Electrical and Computer Engineering, Suwon (Korea, Republic of); Seo, Jongbum [Yonsei University, Department of Biomedical Engineering, Wonju (Korea, Republic of); Lee, Jong-min [Hanyang University, Department of Biomedical Engineering, Seoul (Korea, Republic of); Park, Hyunjin [Sungkyunwkan University, School of Electronic and Electrical Engineering, Suwon (Korea, Republic of)

    2016-01-15

    The aim of our study was to determine the diagnostic value of a novel image analysis method called parametric response mapping (PRM) for prediction of intrahepatic recurrence of hepatocellular carcinoma (HCC) treated with conventional transcatheter arterial chemoembolization (TACE). This retrospective study was approved by the IRB. We recruited 55 HCC patients who achieved complete remission (CR) after TACE and received longitudinal multiphasic liver computed tomography (CT). The patients fell into two groups: the recurrent tumour group (n = 29) and the non-recurrent tumour group (n = 26). We applied the PRM analysis to see if this technique could distinguish between the two groups. The results of the PRM analysis were incorporated into a prediction algorithm. We retrospectively removed data from the last time point and attempted to predict the response to therapy of the removed data. The PRM analysis was able to distinguish between the non-recurrent and recurrent groups successfully. The prediction algorithm detected response to therapy with an area under the curve (AUC) of 0.76, while the manual approach had AUC 0.64. Adopting PRM analysis can potentially distinguish between recurrent and non-recurrent HCCs and allow for prediction of response to therapy after TACE. (orig.)

  1. Establishing an individual dosing system for patients undergoing interventional transcatheter arterial embolization: Radiochromic film and Monte Carlo simulation

    International Nuclear Information System (INIS)

    Tsai, Hui-Yu; Lai, Pei-Ling; Li, Yang-Ying; Tyan, Yeu-Sheng

    2011-01-01

    Less invasive imaging-guided vascular interventions with fluoroscopy and digital subtraction angiography have recently become widespread and have been successfully used for treating various diseases. However, interventional fluoroscopy procedures may present deterministic and stochastic radiation risks. The International Commission on Radiological Protection (ICRP) and the Food and Drug Administration have requested identifying procedures that may involve patient doses greater than the recommended thresholds. In this study, radiochromic dosimetric media, known as self-developing films, and measurement-based Monte Carlo simulations were used to establish an interventional radiology dosing system for individual patients undergoing interventional transcatheter arterial embolization. The peak skin dose, evaluated from the entrance surface dose distribution, was 21% less than the cumulated dose reported from the console. A 3D dose map incorporated into CT images was established. The organ doses and effective doses for individual patients were evaluated using this dosing system. This system could be applied very well to other fluoroscopic or interventional procedures for patient dose management.

  2. Implication of the presence of a variant hepatic artery during the Whipple procedure

    Directory of Open Access Journals (Sweden)

    Mercedes Rubio-Manzanares-Dorado

    2015-07-01

    Full Text Available Introduction: The anatomical variants of the hepatic artery may have important implications for pancreatic cancer surgery. The aim of our study is to compare the outcome following a pancreatoduodenectomy (PD in patients with or without a variant hepatic artery arising from superior mesenteric artery. Material and methods: We reviewed 151 patients with periampullary tumoral pathology. All patients underwent oncological PD between January 2005 and February 2012. Our series was divided into two groups: Group A: Patients with a hepatic artery arising from superior mesenteric artery; and Group B: Patients without a hepatic artery arising from superior mesenteric artery. We expressed the results as mean ± standard deviation for continuous variables and percentages for qualitative variables. Statistical tests were considered significant if p < 0.05. Results: We identified 11 patients with a hepatic artery arising from superior mesenteric artery (7.3%. The most frequent variant was an aberrant right hepatic artery (n = 7, following by the accessory right hepatic artery (n = 2 and the common hepatic artery trunk arising from the superior mesenteric artery (n = 2. In 73% of cases the diagnosis of the variant was intraoperative. R0 resection was performed in all patients with a hepatic artery arising from superior mesenteric artery. There were no significant differences in the tumor resection margins and the incidence of postoperative complications. Conclusion: Oncological PD is feasible by the presence of a hepatic artery arising from superior mesenteric artery. The complexity of having it does not seem to influence in tumor resection margins, complications and survival.

  3. MR imaging of the liver before and after transcatheter hepatic chemo-embolization for hepatocellular carcinoma

    International Nuclear Information System (INIS)

    Yoshioka, H.; Nakagawa, K.; Shindou, H.; Ono, Y.; Kawakami, A.; Mabuchi, N.; Arita, S.; Fujii, K.; Hamada, T.; Ishida, O.; Miyakoshi, K.; Uto, T.; Kinki Univ., Osaka

    1990-01-01

    Transcatheter chemo-embolization (TCE) in hepatocellular carcinoma (HCC) was performed in 38 patients. The patients were examined by MR imaging before TCE as well as one week and 4 to 5 weeks after TCE. The tumor signal intensity in T2 weighted images increased in 13 cases and decreased in 19 cases after TCE. Increased intensity seemed to reflect intra-tumoral hemorrhage or liquefaction accompanying tumor necrosis. Decreased intensity seemed to reflect coagulation necrosis. In 9 of 18 cases followed over a 2-month period the signal intensity had decreased in both T1 and T2 weighted images. In these patients the tumor showed no recurrence at angiography and the decreased signal seemed to reflect the completion of coagulation necrosis. A hyper- and/or hypointense rim around the tumor appeared in 22 cases. These changes were thought to be perifocal edema or granulation tissue around the tumor. MR imaging was useful in evaluating the necrotic process of the tumor after TCE. (orig.)

  4. Mirizzi syndrome associated with hepatic artery pseudoaneurysm: a case report

    Directory of Open Access Journals (Sweden)

    Anderson Oliver

    2008-11-01

    Full Text Available Abstract Introduction This is the first case report of Mirizzi syndrome associated with hepatic artery pseudoaneurysm. Case presentation A 54-year-old man presented with painful obstructive jaundice and weight loss. Computed tomography showed a hilar mass in the liver. Following an episode of haemobilia, angiography demonstrated a pseudoaneurysm of a branch of the right hepatic artery that was embolised. At surgery, a gallstone causing Mirizzi type II syndrome was found to be responsible for the biliary obstruction and a necrotic inflammatory mass and haematoma were found to be extending into the liver. The mass was debrided and drained, the obstructing stones removed and the bile duct drained with a t-tube. The patient made a full recovery. Conclusion This case highlights another situation where there may be difficulty in differentiating Mirizzi syndrome from biliary tract cancer.

  5. Progression of Treated versus Untreated Liver Imaging Reporting and Data System Category 4 Masses after Transcatheter Arterial Embolization Therapy.

    Science.gov (United States)

    Ronald, James; Gupta, Rajan T; Marin, Daniele; Wang, Qi; Durocher, Nicholas S; Suhocki, Paul V; Kim, Charles Y

    2018-05-01

    To compare outcomes of treated vs untreated Liver Imaging Reporting and Data System category 4 (LR-4) masses after transcatheter arterial embolization. In 167 patients undergoing embolization for HCC from January 2005 to December 2012, LR-4 masses were retrospectively identified on CT and MR imaging examinations performed before embolization. In 149 patients undergoing embolization from January 2013 to December 2016, masses prospectively classified as LR-4 were identified. In total, there were 81 LR-4 masses in 62 patients (16 women; mean age 62 y; range 29-83 y). Procedures were reviewed to determine whether LR-4 masses were within or outside the liver volume that received embolization during treatment of dominant masses. Time to progression to LR-5 and by modified Response Evaluation Criteria in Solid Tumors (mRECIST) was estimated for treated vs untreated LR-4 masses using the Kaplan-Meier method and compared using the log rank test. LR-4 masses averaged 1.8 cm; 88%, 60%, 14%, and 14% demonstrated arterial phase hyperenhancement, washout, a capsule, and growth. Of LR-4 masses, 62 were within the liver volume that received embolization and considered treated, and 19 were outside and considered untreated. Response rates according to mRECIST were 37% vs 21% for treated vs untreated masses (P = .27). The 6- and 12-month rates of progression to LR-5 were 7% and 26% for treated masses vs 27% and 75% for untreated masses (P = .001). According to mRECIST, 7% and 27% of treated masses progressed vs 30% and 65% of untreated masses (P = .001). LR-4 masses that receive embolization in the setting of dominant masses elsewhere show lower rates of progression compared with untreated masses. Copyright © 2017 SIR. Published by Elsevier Inc. All rights reserved.

  6. The role of CT in pelvic fracture. CT finding of retro-peritoneal hematoma and indication of transcatheter arterial embolization

    International Nuclear Information System (INIS)

    Igarashi, Tsuneo; Hoshikawa, Yoshikazu; Saeki, Mitsuaki; Nakajima, Yasuo

    1998-01-01

    Although retro-peritoneal hematoma accompanying a pelvic fracture has been treated by arterial ligation formerly, it is associated with a high mortality rate and a transcatheter arterial embolization has now become the first choice of treatment. Meanwhile, the usefulness of computed tomography (CT) in traumatized patient has been reported frequently. Our hospital also employs CT positively as an examination following plain radiography in the cases with pelvic fracture. However, while indication of angiography is seen in several reports, the amount of retro-peritoneal hematoma as an index has not been reported. In the present study, we examined 112 patients given CT at the time of examination at the emergency center of our hospital between April 1, 1988, and June 30, 1997, and classified the amount of retro-peritoneal hematoma on CT into 5 groups to discuss indication of angiography. In the cases with moderate or massive amount of retro-peritoneal hematomas, cases with shock state exceeded 60% and the amount of hematoma was considered to reflect the circulation profile to a certain extent. As the amount of retro-peritoneal hematoma increased, the number of cases given embolization also increased; embolization was performed in 29 cases (61.7%) among those which had moderate or massive amount of hematoma. From the above findings, it was predicted that the amount of retro-peritoneal hematoma could be one of the deciding factors for indication of angiography. However, as there are cases falling into a shock state due to gradual increase of hematoma or associated with injuries in other organs, careful observation is needed for the cases judged out of indication. (author)

  7. Pulsatile versus steady infusions for hepatic artery chemotherapy

    International Nuclear Information System (INIS)

    Kim, E.E.; Haynie, T.P.; Wright, K.C.; Chaynsangavej, C.; Gianturco, C.; Lamki, L.; Wallace, S.

    1984-01-01

    Hepatic artery chemotherapy for unresectable liver tumors requires an even distribution of the drugs in the tumor or vascular bed. This cannot be determined angiographically because the drugs are infused at a much lower rate than the contrast media. It is easy, however, to determine the quality of the perfusion by injecting a small volume of Tc-99m MAA in one of the side ports while chemotherapeutic agent is being infused at the same rate. Usually this shows a uniform, satisfactory distribution of isotope. Occasionally, however, some areas fail to receive Tc-99m in spite of what appears to be a good position of the catheter tip. Since ''streaming'' of the infused drugs has been blamed for their uneven distribution, the authors decided to compare the usual steady flow infusions with infusions made pulsatile by the addition of a pulsing device (Gianturco Pump) attached to the infusion tubing. Eighty-three patients were studied with steady as well as pulsatile infusions. In 16 of these patients the perfusion pattern was definitely changed by the pulsatile infusion. In one patient the pulsatile mode resulted in an unwanted gastric perfusion. In 5 patients the distribution was improved in one hepatic lobe and in 10 patients it was improved in both lobes. These results show that hepatic artery perfusions can occasionally be improved by pulsing the infusate. However, pulsing can produce the unwanted perfusion of extra-hepatic areas

  8. Effects of hepatic arterial yttrium 90 glass microspheres in dogs.

    Science.gov (United States)

    Wollner, I; Knutsen, C; Smith, P; Prieskorn, D; Chrisp, C; Andrews, J; Juni, J; Warber, S; Klevering, J; Crudup, J

    1988-04-01

    A 22-micron glass microsphere called TheraSphere (Theragenics Corp., Atlanta, GA) has been developed in which yttrium 89 oxide is incorporated into the glass matrix and is activated by neutron bombardment to form the beta-emitting isotope yttrium 90 (Y 90) before using the spheres as radiotherapeutic vehicles. The injection of up to 12 times (on a liver weight basis) the anticipated human dose of nonradioactive TheraSphere into the hepatic arteries of dogs was well tolerated and produced clinically silent alterations within centrolobular areas. The hepatic arterial (HA) injection of radioactive TheraSphere also produced portal changes similar to those observed in humans after external beam therapy. While the extent of damage increased with the delivered dose, radiation exposures in excess of 30,000 cGy did not cause total hepatic necrosis and were compatible with survival. No microspheres distributed to the bone marrow and absolutely no myelosuppression was encountered in any animal. Proposed hepatic exposures to humans of 5000 to 10,000 cGy by means of these microspheres, therefore, would appear to be feasible and tolerable. Radiotherapeutic microsphere administration preceded by regional infusion of a radiosensitizing agent and/or immediately following the redistribution of blood flow toward intrahepatic tumor by vasoactive agents can potentially yield a synergistic, highly selective attack on tumors confined to the liver.

  9. Transcatheter Embolization of Pulmonary Artery False Aneurysm Associated with Primary Pulmonary Hypertension

    International Nuclear Information System (INIS)

    Hiraki, T.; Kanazawa, S.; Mimura, H.; Yasui, K.; Okumura, Y.; Dendo, S.; Yoshimura, K.; Takahara, M.; Hiraki, Y.

    2004-01-01

    A 29-year-old woman with primary pulmonary hypertension presented with recurrent hemoptysis. Contrast-enhanced CT of the chest demonstrated the enhanced mass surrounded by consolidation related to parenchymal hemorrhage. Pulmonary angiography suggested that the mass was a pulmonary artery false aneurysm. After a microcatheter was superselectively inserted into the parent artery of the falseaneurysm, the false aneurysm was successfully treated by transcatheterembolization with coils. Her hemoptysis has never recurred

  10. Hepaticocystic duct and a rare extra-hepatic "cruciate" arterial anastomosis: a case report

    Directory of Open Access Journals (Sweden)

    Abeysuriya Vasitha

    2008-02-01

    Full Text Available Abstract Introduction The variations in the morphological characteristics of the extra-hepatic biliary system are interesting. Case presentation During the dissection of cadavers to study the morphological characteristics of the extra-hepatic biliary system, a 46-year-old male cadaver was found to have drainage of the common hepatic duct drains directly into the gall bladder neck. The right and left hepatic ducts were not seen extra-hepatically. Further drainage of the bile away from the gallbladder and into the duodenum was provided by the cystic duct. Formation of the common bile duct by the union of the common hepatic duct and cystic duct was absent. Further more the right hepatic artery was found to be communicating with the left hepatic artery by a "bridging artery" after giving rise to the cystic artery. An accessory hepatic artery originated from the "bridging artery" forming a "cruciate" hepatic arterial anastomosis. Conclusion Combination of a Hepaticocystic duct and an aberrant variation in the extra-hepatic arterial system is extremely rare.

  11. Transcatheter Treatment of “Pulmonary Artery Hypertension” due to Patent Ductus Arteriosus and Pulmonary Artery Stenosis

    OpenAIRE

    Gaio, Gianpiero; Santoro, Giuseppe; D'Alto, Michele; Palladino, Maria Teresa; Russo, Maria Giovanna; Caianiello, Giuseppe; Calabrò, Raffaele

    2006-01-01

    The association between large, left-sided patent ductus arteriosus and severe, peripheral, right pulmonary artery stenosis with no other cardiac malformation is an unreported condition that might be misdiagnosed as pulmonary hypertension due to long-standing ductal shunt. A 57-year-old man with supposed hypertensive patent ductus arteriosus underwent confirmatory cardiac catheterization. At angiography, a severe pre-hilar right pulmonary artery stenosis (peak pressure gradient, 65 mmHg) was f...

  12. Transcatheter arterial chemoembolization plus {sup 131}I-labelled metuximab versus transcatheter arterial chemoembolization alone in intermediate/advanced stage hepatocellular carcinoma: A systematic review and meta-analysis

    Energy Technology Data Exchange (ETDEWEB)

    Zhu, Ze Xin; Liao, Ming Heng; Huang, Ji Wei [Dept. of Liver Surgery, Liver Transplantation Division, West China Hospital, Sichuan University, Chengdu (China); Wang, Xiao Xue [Dept. of Dermatovenereology, West China Hospital, Sichuan University, Chengdu (China)

    2016-11-15

    The aim of the study was to compare transcatheter arterial chemoembolization (TACE) plus 131I-labelled metuximab with TACE alone for hepatocellular carcinoma (HCC). A comprehensive search was conducted in PubMed, Embase, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and Chinese BioMedical Literature Database with published date from the earliest to February 29th, 2016. No language restrictions were applied, but only prospective randomized controlled trials (RCTs) or non-RCTs were eligible for a full-text review. The primary outcome was the overall survival (OS) and effective rate (the rate of partial atrophy or complete clearance of the tumor lesion). The odds ratios (ORs) were combined using either the fixed-effects model or random-effects model. Eight trials (3 RCTs and 5 non-RCTs) were included, involving a total of 1121 patients. Patients receiving combined therapy of TACE plus {sup 131}I-labelled metuximab showed significant improvement in effective rate [OR = 4.00, (95% confidence interval [CI]: 2.40-6.66], p < 0.001), 1-year OS (OR = 2.03 [95% CI: 1.55-2.67], p < 0.001) and 2-year OS (OR = 2.57 [95% CI: 1.41-4.66], p = 0.002]. TACE plus {sup 131}I-labelled metuximab is more beneficial for treating advanced HCCs than TACE alone in terms of tumor response and OS. Large, multi-center, and blinded randomized trials are required to confirm these findings.

  13. Hepatic perfusion during hepatic artery infusion chemotherapy: Evaluation with perfusion CT and perfusion scintigraphy

    International Nuclear Information System (INIS)

    Miller, D.L.; Carrasquillo, J.A.; Lutz, R.J.; Chang, A.E.

    1989-01-01

    The standard method for the evaluation of hepatic perfusion during hepatic artery infusion (HAI) chemotherapy is planar hepatic artery perfusion scintigraphy (HAPS). Planar HAPS was performed with 2 mCi of [99mTc] macroaggregated albumin infused at 1 ml/min and compared with single photon emission CT (SPECT) HAPS and with a new study, CT performed during the slow injection of contrast material through the HAI catheter (HAI-CT). Thirteen patients underwent 16 HAI-CT studies, 14 planar HAPS studies, and 9 SPECT HAPS studies. In 13 of 14 studies (93%) HAI-CT and planar HAPS were in complete agreement as to the perfusion pattern of intrahepatic metastases and normal liver. In nine studies where all modalities were performed, the findings identified by HAI-CT and planar HAPS agreed in all cases, whereas the results of two SPECT scans disagreed with the other studies. With respect to perfusion of individual metastases, 14 of 14 HAI-CT studies, 12 of 13 planar HAPS studies, and 9 of 9 SPECT HAPS studies correctly demonstrated the perfusion status of individual lesions as indicated by the pattern of changes in tumor size determined on CT obtained before and after the perfusion studies. Hepatic artery infusion CT was superior for delineation of individual metastases, particularly small lesions, and for the evaluation of nonperfused portions of the liver. Planar HAPS detected extrahepatic perfusion in four patients, and this was not detected by HAI-CT. We conclude that HAI-CT and scintigraphy are complementary techniques. Hepatic artery infusion CT has advantages for the evaluation of intrahepatic perfusion, and planar HAPS is superior to HAI-CT for the detection of extrahepatic perfusion

  14. Transcatheter closure of large patent ductus arteriosus with severe pulmonary arterial hypertension in adults: immediate and two-year follow-up results.

    Science.gov (United States)

    Zhang, Cao-Jin; Huang, Yi-Gao; Huang, Xin-Sheng; Huang, Tao; Huang, Wen-Hui; Xia, Chun-Li; Mo, Yu-Jing

    2012-11-01

    Transcatheter closure of patent ductus arteriosus (PDA) is a well established procedure and an accepted treatment modality for small to moderate-sized PDA. This study aimed to evaluate the immediate and follow-up results of transcatheter closure of large PDAs with severe pulmonary arterial hypertension (PAH) in adults. After a complete hemodynamic evaluation differentiating from the reversibility of severe PAH, transcatheter closure of PDA was performed. Patients were followed up clinically and echocardiographically at 24 hours, 1 month, 3 months, 6 months, 12 months and 24 months after occlusion. Twenty-nine patients had successful occlusion, pulmonary artery pressure (PAP), left ventricular ejection fraction (LVEF) and fractional shortening (FS) significantly decreased immediately after occlusion ((106 ± 25) mmHg vs. (50 ± 14) mmHg, P closure, the signs and symptoms improved markedly in all 29 patients, and PDAs were completely closed and remained closed during the follow-up. Eighteen patients having different degrees of dyspnea were treated with angiotensin converting enzyme inhibitor (ACEI) and/or digoxin after occlusion. Nine patients whose pulmonary vascular resistence (PVR) > 6 Wood units accepted targeted PAH therapy. After 1 to 3 months of peroral drug therapy, their exercise tolerance improved from New York Heart Association (NYHA) class III-IV to NYHA class I. During follow-up, no latent arrhythmias were found, the left atrial diameter (LAD), left ventricular end-diastolic diameter (LVEDD), left ventricular end-systolic diameter (LVESD), left ventricular mass index (LVMI) and pulmonary artery systolic pressure (PASP) decreased significantly (P closure of large PDA with severe PAH is feasible, effective, and safe in adults. Significant left ventricular systolic changes may occur after closure of large PDA, and left ventricular function usually recovers within a few months.

  15. Transcatheter Closure of a Chronic Iatrogenic Arteriovenous Fistula Between the Carotid Artery and the Brachiocephalic Vein with an Amplatzer Duct Occluder in Combination with a Carotid Stent

    International Nuclear Information System (INIS)

    Stasek, Josef; Lojik, Miroslav; Bis, Josef; Horak, David; Dusek, Jaroslav; Brtko, Miroslav; Polansky, Pavel; Babu, Anush; Vojacek, Jan

    2009-01-01

    We report an original method of transcatheter closure of an arteriovenous fistula using the combination of an Amplatzer PDA occluder and a carotid stent. The fistula was between the left carotid artery and the brachiocephalic vein. The patient had significant left-to-right shunt and was highly symptomatic. Due to the large orifice and pseudoaneurysmatic enlargement of the fistula, we had to use a large Amplatzer PDA occluder and the protruding part of the PDA device disk had to be covered with a carotid stent. The fistula was completely closed. The patient stopped having symptoms and, 2 years after the procedure, the effect persists.

  16. Gelatin sponge particle used as an embolic agent in transcatheter arterial chemoembolization treatment for primary hepatocellular carcinoma: its current situation in research

    International Nuclear Information System (INIS)

    Ao Jin; Zhang Yuewei; Xu Ke

    2011-01-01

    Transcatheter arterial chemoembolization (TACE) is one of the most commonly used therapeutic procedures for primary hepatocellular carcinoma (HCC). As an important and easily-available embolic agent, gelatin sponge (Gelfoam) particles have been constantly and widely employed in clinical practice. Various types of embolic agents have been continuously developed and effectively used in TACE for liver cancers. For recent years, great progress has been made in the clinical use of gelatin sponge particles, as the most traditional embolic agent, in the interventional therapeutic field for HCC. This article aims to make a comprehensive review about gelatin sponge. (authors)

  17. Coil Embolization of an Arteriobiliary Fistula Caused by Hepatic Intra-Arterial Chemotherapy

    International Nuclear Information System (INIS)

    Takao, Hidemasa; Doi, Ippei; Makita, Kohzoh; Watanabe, Toshiaki

    2005-01-01

    Arteriobiliary fistula is a rare complication of hepatic intra-arterial chemotherapy. We report successful coil embolization of an arteriobiliary fistula. An 80-year-old woman underwent percutaneous placement of an indwelling catheter into the replaced right hepatic artery for intra-arterial chemotherapy of liver metastases. Coil embolization of the left hepatic artery was not performed. The patient complained of abdominal pain during intra-arterial chemotherapy. Angiography revealed a fistula between the replaced right hepatic artery and the common bile duct. The fistula was successfully treated by coil embolization via the indwelling catheter, and the indwelling catheter was removed. Although such complications usually herald the termination of intra-arterial chemotherapy, the patient underwent percutaneous implantation of a new catheter-port system, and intra-arterial chemotherapy was restarted

  18. Combination of transcatheter arterial chemoembolization and interrupted dosing sorafenib improves patient survival in early–intermediate stage hepatocellular carcinoma

    Science.gov (United States)

    Lee, Teng-Yu; Lin, Chen-Chun; Chen, Chiung-Yu; Wang, Tsang-En; Lo, Gin-Ho; Chang, Chi-Sen; Chao, Yee

    2017-01-01

    Abstract Background/Objective: The survival benefit of treatment for unresectable hepatocellular carcinoma (HCC) with transcatheter arterial chemoembolization (TACE) combined with sorafenib remains uncertain. We compared the survival of patients treated with TACE and sorafenib with that of patients treated with TACE alone. Methods: This was a post hoc analysis of the Study in Asia of the Combination of TACE with Sorafenib in Patients with HCC (START) trial. All patients who received TACE and interrupted dosing of sorafenib for early or intermediate-stage HCC in Taiwan from 2009 to 2010 were recruited into the TACE and sorafenib group. They were randomly matched 1:1 by age, sex, Child–Pugh score, tumor size, tumor number, and tumor stage with patients from Taichung Veterans General Hospital in Taiwan who received TACE alone and who fulfilled the selection criteria of the START trial during the same time period (control group). Patient survival [cumulative incidence and hazard ratio (HR)] of the 2 groups were analyzed and compared. Results: The baseline characteristics of the 36 patients in each group were similar. Tumor response rates were significantly better in the TACE and sorafenib group (P < .04). Overall survival of the TACE and sorafenib group was also significantly better than that of the control (TACE alone) group over the 2 years [78%, 95% confidence interval (95% CI) 64–91 vs 49, 95% CI 32–66; P = .012]. In the multivariate regression analysis, TACE and sorafenib was found to be independently associated with a decreased risk of mortality (HR 0.33, 95% CI 0.12–0.89; P = .015). Multivariate stratified analyses verified this association in each patient subgroup (all HR < 1.0). Conclusion: With a high patient tolerance to an interrupted sorafenib dosing schedule, the combination of TACE with sorafenib was associated with improved overall survival in early–intermediate stage HCC when compared with treatment with TACE alone. PMID

  19. Risk factors for the leakage of chemotherapeutic agents into systemic circulation after transcatheter arterial chemoembolization of hepatocellular carcinoma

    Directory of Open Access Journals (Sweden)

    Ming-Yen Hsieh

    2011-10-01

    Full Text Available This prospective study was to investigate the possible risk factors for the leakage of chemotherapeutic agent into the systemic circulation after transcatheter arterial chemoembolization (TACE of hepatocellular carcinoma (HCC. Peripheral plasma concentrations of chemotherapeutic agents were determined at 1 hour and 72 hours after TACE by high-performance liquid chromatography in 53 patients. HCC were divided into three types namely single nodule (<5 cm, multiple nodules (all <5 cm, and main nodule measuring 5 cm or more. Forty-four patients (83% showed detectable chemotherapeutic concentrations within 72 hours after TACE. Patients with single nodular-type HCC had lower incidence of detectable plasma chemotherapeutic agents after TACE than the other two groups (all p<0.05. The injected doses of lipiodol, epirubicin, and mitomycin C were lower in patients without detection than in patients with detectable chemotherapeutic agents (all p<0.05. Multivariate logistic regression showed that tumor type and injected dose of lipiodol were two independent risk factors for the leakage of mitomycin C at 1 hour after TACE (all p<0.05, and the injected dose of mitomycin C was the risk factor for the leakage of epirubicin at 1 hour after TACE (p<0.05. In conclusion, multiple nodular type and large nodule measuring 5 cm or more have a risk of leakage of mitomycin C after TACE. Injected dose of lipiodol and mitomycin C as risk factor for the leakage of mitomycin C and epirubicin respectively may be because of competition of their injected volume within the limited space of target.

  20. Clinical effect of systemic chemotherapy combined with transcatheter arterial chemoembolization in treatment of breast cancer with liver metastases

    Directory of Open Access Journals (Sweden)

    LI Liye

    2016-01-01

    Full Text Available ObjectiveTo investigate the clinical effect of systemic chemotherapy combined with transcatheter arterial chemoembolization (TACE in the treatment of breast cancer with liver metastases. MethodsA total of 86 female breast cancer patients with liver metastases who were treated in the Affiliated Hospital of Shandong Academy of Medical Sciences from December 2012 to December 2014 were selected and equally divided into experimental group and control group. The patients in the control group received systemic chemotherapy, and those in the experimental group received systemic chemotherapy combined with TACE. The clinical effect, changes in lesions, and patients′ quality of life (QOL scores after treatment were compared between two groups. The t-test was applied for comparison of continuous data between the two groups, and the chi-square test was applied for comparison of categorical data between the two groups. ResultsThe experimental group had a significantly higher overall response rate than the control group (90.70% vs 58.14%, χ2=13.07, P=0.001. Compared with the control group, the experimental group had significantly smaller diameters of tumors and lymph nodes after treatment (t=4.26 and 4.63, both P<0.001, as well as significantly higher QOL scores at 3 and 6 months after treatment (t=6.30 and 3.89, both P<0001. ConclusionSystemic chemotherapy combined with TACE has a significant therapeutic effect in breast cancer patients with liver metastases, and can improve patients′ symptoms, reduce adverse drug reactions, and improve QOL. As a safe and reliable therapeutic method, it is worthy of clinical application.

  1. Stabilization of a percutaneously implanted port catheter system for hepatic artery chemotherapy infusion

    International Nuclear Information System (INIS)

    Shindoh, Noboru; Ozaki, Yutaka; Kyogoku, Shinsuke; Yamana, Daigo; Sumi, Yukiharu; Katayama, Hitoshi

    1999-01-01

    A port catheter system for hepatic artery infusion chemotherapy was implanted percutaneously via the left subclavian artery in 41 patients for treatment of unresectable liver metastases. The catheter tip was inserted into the gastroduodenal artery (GDA), the end hole was occluded with a guidewire fragment, and a side-hole for infusion was positioned at the bifurcation of the proper hepatic artery and the GDA. The GDA was embolized with steel coils around the infusion catheter tip via a transfemoral catheter. This procedure is designed to reduce the incidence of hepatic artery occlusion and infusion catheter dislocation.

  2. Abnormal splenic artery diameter/hepatic artery diameter ratio in cirrhosis-induced portal hypertension

    Science.gov (United States)

    Zeng, Dao-Bing; Dai, Chuan-Zhou; Lu, Shi-Chun; He, Ning; Wang, Wei; Li, Hong-Jun

    2013-01-01

    AIM: To determine an optimal cutoff value for abnormal splenic artery diameter/proper hepatic artery diameter (S/P) ratio in cirrhosis-induced portal hypertension. METHODS: Patients with cirrhosis and portal hypertension (n = 770) and healthy volunteers (n = 31) underwent volumetric computed tomography three-dimensional vascular reconstruction to measure the internal diameters of the splenic artery and proper hepatic artery to calculate the S/P ratio. The cutoff value for abnormal S/P ratio was determined using receiver operating characteristic curve analysis, and the prevalence of abnormal S/P ratio and associations between abnormal S/P ratio and major complications of portal hypertension were studied using logistic regression. RESULTS: The receiver operating characteristic analysis showed that the cutoff points for abnormal splenic artery internal diameter and S/P ratio were > 5.19 mm and > 1.40, respectively. The sensitivity, specificity, positive predictive value, and negative predictive value were 74.2%, 45.2%, 97.1%, and 6.6%, respectively. The prevalence of an abnormal S/P ratio in the patients with cirrhosis and portal hypertension was 83.4%. Patients with a higher S/P ratio had a lower risk of developing ascites [odds ratio (OR) = 0.708, 95%CI: 0.508-0.986, P = 0.041] and a higher risk of developing esophageal and gastric varices (OR = 1.483, 95%CI: 1.010-2.175, P = 0.044) and forming collateral circulation (OR = 1.518, 95%CI: 1.033-2.230, P = 0.034). After splenectomy, the portal venous pressure and maximum and mean portal venous flow velocities were reduced, while the flow rate and maximum and minimum flow velocities of the hepatic artery were increased (P portal hypertension, and it can be used as an important marker of splanchnic hemodynamic disturbances. PMID:23483462

  3. N-butyl Cyanoacrylate Glue Embolization of Arterial Networks to Facilitate Hepatic Arterial Skeletonization before Radioembolization

    Energy Technology Data Exchange (ETDEWEB)

    Samuelson, Shaun D.; Louie, John D.; Sze, Daniel Y., E-mail: dansze@stanford.edu [Stanford University School of Medicine, Division of Interventional Radiology (United States)

    2013-06-15

    Purpose. Avoidance of nontarget microsphere deposition via hepatoenteric anastomoses is essential to the safety of yttrium-90 radioembolization (RE). The hepatic hilar arterial network may remain partially patent after coil embolization of major arteries, resulting in persistent risk. We retrospectively reviewed cases where n-butyl cyanoacrylate (n-BCA) glue embolization was used to facilitate endovascular hepatic arterial skeletonization before RE. Methods. A total of 543 RE procedures performed between June 2004 and March 2012 were reviewed, and 10 were identified where n-BCA was used to embolize hepatoenteric anastomoses. Arterial anatomy, prior coil embolization, and technical details were recorded. Outcomes were reviewed to identify subsequent complications of n-BCA embolization or nontarget RE. Results. The rate of complete technical success was 80 % and partial success 20 %, with one nontarget embolization complication resulting in a minor change in treatment plan. No evidence of gastrointestinal or biliary ischemia or infarction was identified, and no microsphere-related gastroduodenal ulcerations or other evidence of nontarget RE were seen. Median volume of n-BCA used was <0.1 ml. Conclusion. n-BCA glue embolization is useful to eliminate hepatoenteric networks that may result in nontarget RE, especially in those that persist after coil embolization of major vessels such as the gastroduodenal and right gastric arteries.

  4. Efficacy of transcatheter uterine artery embolization for treating emergency hemorrhage obstetrics and gynecology

    International Nuclear Information System (INIS)

    Li Hongwei

    2011-01-01

    Objective: To evaluate the efficacy of selective iliac artery embolization (TAE) or uterine artery embolization (UAE) for treatment of emergency hemorrhage in obstetrics and gynecology. Methods: Selective bilateral TAE or UAE were performed on 59 patients with acute cervical hemorrhage from postpartum hemorrhage (30), cervical cancer (16), endometrial cancer (8), and choriocarcinoma (5). Gelfoam particles were used in postpartum hemorrhage; chemotherapeutics and Iodipin suspension were used in malignancy. Results: Bleeding was stopped completely in all 59 patients with TAE or UAE procedure time of 30-50 minutes (mean: 42.17±4.78 minutes). There were no serious complications. Conclusion: TAE or UAE are effective for treating emergency hemorrhage in obstetrics and gynecology. (authors)

  5. Selective arterial chemoembolization for hepatic metastases from medullary thyroid carcinoma.

    Science.gov (United States)

    Lorenz, Kerstin; Brauckhoff, Michael; Behrmann, Curd; Sekulla, Carsten; Ukkat, Jörg; Brauckhoff, Katrin; Gimm, Oliver; Dralle, Henning

    2005-12-01

    Hepatic metastases from medullary thyroid carcinoma (MTC) may impair quality of life by hypercalcitonemia-associated diarrhea and pain. In this prospective study, the effect of selective arterial chemoembolization (SACE) was evaluated. Eleven patients with hepatic metastases from MTC received 1 to 9 courses of SACE using epirubicine. Symptomatic, biochemical, and morphologic responses on SACE were recorded. Symptomatic response was observed in all symptomatic patients. However, biochemical and radiologic response occurred only in 6 patients. Liver function was not affected by SACE. One patient with unexpected concurrent pheochromocytoma metastases died after the first course. Development of side effects in the course was observed in 8 patients but were only World Health Organization grade 1. Patients' satisfaction with SACE was excellent. Long-term follow-up found 7 patients alive (1-72 months). Three patients died with tumor 6, 12, and 24 months after SACE, respectively. SACE provided good symptom palliation for the majority of patients with hepatic metastases from MTC. However, transient remission or stabilization of hepatic metastases resulted in only 60%. Further studies using a randomized protocol are required.

  6. Tumor and liver drug uptake following hepatic artery and portal vein infusion

    International Nuclear Information System (INIS)

    Sigurdson, E.R.; Ridge, J.A.; Kemeny, N.; Daly, J.M.

    1987-01-01

    Anatomic dye injection studies of the blood supply of colorectal hepatic metastases suggest that tumors are supplied predominantly by the hepatic artery. Using 13 N amino acids with dynamic gamma camera imaging in patients with colorectal hepatic metastases, it has been shown that hepatic artery infusion results in a significantly greater nutrient delivery to tumor compared with portal vein infusion. However, direct measurements of drug levels in tumor following hepatic artery and portal vein infusion in humans have not previously been reported. Patients with metastatic colorectal cancer confined to the liver received fluorodeoxyuridine (FUdR) through the hepatic artery or through the portal vein. All patients had previously failed systemic chemotherapy. Five patients with hepatic artery catheters were matched (by age, serum lactic dehydrogenase levels, percent hepatic replacement, and tumor size) with five patients with portal vein catheters. At operation, 3 H-FUdR (1 microCi/kg) and /sup 99m/Tc-macroaggregated albumin (MAA) (6 mCi) were injected into the hepatic artery or portal vein. Liver and tumor biopsies were obtained two and five minutes later. 3 H and /sup 99m/Tc were measured per gram tissue by scintillation and gamma counting. The mean liver levels following hepatic artery infusion (23.9 +/- 11.4 nmol/g) and portal vein infusion (18.4 +/- 14.5 nmol/g) did not differ. However, the mean tumor FUdR level following hepatic artery infusion was 12.4 +/- 12.2 nmol/g, compared with a mean tumor FUdR level following portal vein infusion of 0.8 +/- 0.7 nmol/g (P less than .01). This low level of tumor drug uptake after portal vein infusion of FUdR predicts minimal tumor response to treatment via this route. Thus, regional chemotherapy for established colorectal hepatic metastases should be administered through the hepatic artery

  7. Hepatic artery embolization for treatment of patients with hereditary hemorrhagic telangiectasia and symptomatic hepatic vascular malformations

    Energy Technology Data Exchange (ETDEWEB)

    Chavan, Ajay [Hannover Medical School, Department of Diagnostic Radiology, Hannover (Germany); Klinikum Oldenburg, Department of Radiology and Nuclear Medicine, Oldenburg (Germany); Caselitz, Martin; Wagner, Siegfried; Manns, Michael [Hannover Medical School, Department of Gastroenterology and Hepatology, Hannover (Germany); Gratz, Karl-Friedrich [Hannover Medical School, Department of Nuclear Medicine, Hannover (Germany); Lotz, Joachim; Kirchhoff, Timm; Galanski, Michael [Hannover Medical School, Department of Diagnostic Radiology, Hannover (Germany); Piso, Plinio [Hannover Medical School, Department of Abdominal and Transplantation Surgery, Hannover (Germany)

    2004-11-01

    At present there is no established therapy for treating patients with hereditary hemorrhagic telangiectasia (HHT) and symptomatic hepatic involvement. We present the results of a prospective study with 15 consecutive patients who were treated with staged hepatic artery embolization (HAE). Branches of the hepatic artery were selectively catheterized and embolized in stages using polyvinyl alcohol particles (PVA) and platinum microcoils or steel macrocoils. Prophylactic antibiotics, analgesics and anti-emetics were administered after every embolization. Clinical symptomatology and cardiac output were assessed before and after therapy as well as at the end of follow-up (median 28 months; range 10-136 months). Five patients had abdominal pain and four patients had symptoms of portal hypertension. The cardiac output was raised in all patients, with cardiac failure being present in 11 patients. After treatment, pain resolved in all five patients, and portal hypertension improved in two of the four patients. The mean cardiac output decreased significantly (P<0.001) from 12.57{+-}3.27 l/min pre-treatment to 8.36{+-}2.60 l/min at the end of follow-up. Symptoms arising from cardiac failure resolved or improved markedly in all but one patient. Cholangitis and/or cholecystitis occurred in three patients of whom two required a cholecystectomy. One patient with pre-existent hepatic cirrhosis died as a complication of the procedure. Staged HAE yields long-term relief of clinical symptoms in patients with HHT and hepatic involvement. Patients with pre-existing hepatic cirrhosis may be poor candidates for HAE. (orig.)

  8. Bleeding after dilatation and curettage: the efficacy of transcatheter uterine artery embolisation

    International Nuclear Information System (INIS)

    Song, Y.; Shin, J.H.; Yoon, H.-K.; Kim, J.W.; Ko, G.-Y.; Won, H.-S.

    2015-01-01

    Aim: To evaluate safety and clinical outcomes of uterine artery embolisation (UAE) for bleeding after dilatation and curettage (D&C) performed for abortion or termination. Materials and methods: The outcomes were analysed in 11 patients who underwent UAE for bleeding after D&C for missed abortions (n=8), caesarean scar pregnancies (n=2), or planned termination (n=1) between October 2001 and December 2013. Angiograms and medical records were retrospectively reviewed in order to obtain the patients' baseline characteristics, technical/clinical success rate, complications, and follow-up data regarding menstruation. Results: Technical success, defined as successful catheterisation of both uterine arteries with embolisation to haemostasis, was 100%, whereas clinical success, defined as cessation of bleeding after the initial session of UAE and without the need for additional UAE or surgery for the purpose of haemostasis, was 81.8% (nine of 11). In the two patients with clinical failure due to recurrent vaginal bleeding after UAE, one patient underwent repeat UAE and showed a successful outcome, whilst the other patient required hysterectomy with pathological results of placenta increta. Two other patients underwent hysterectomy for placenta percreta or hydatidiform mole-mimicking remnant placenta. None of the patients included in the present series had procedure-related complications. Menstruation resumed in all eight patients with an intact uterus during the mean follow-up period. Conclusion: UAE may be a safe and effective treatment for bleeding after D&C, especially for women who wish to preserve their fertility; however, hysterectomy may be indicated for patients with a placental abnormality. - Highlights: • We evaluate outcomes of uterine artery embolization for bleeding after D&C. • UAE may be a safe and effective treatment for bleeding after D&C. • Hysterectomy may be indicated for patients with a placental abnormality.

  9. The use of coronary stent in hepatic artery stenosis after orthotopic liver transplantation

    International Nuclear Information System (INIS)

    Huang Mingsheng; Shan Hong; Jiang Zaibo; Li Zhengran; Zhu Kangshun; Guan Shouhai; Qian Jiesheng; Chen Guihua; Lu Minqiang; Yang Yang

    2006-01-01

    Purpose: This retrospective study was undertaken to evaluate the effectiveness of coronary stent placement in hepatic artery stenosis after orthotopic liver transplantation (OLT). Materials and methods: Of 430 consecutive adult orthotopic liver transplant recipients between November 2003 and September 2005, 17 had hepatic artery stenosis (HAS). Fourteen of them underwent coronary stent placement in the HAS. The technical results, complications, hepatic artery patency and clinical outcome were reviewed. Results: Technical and immediate success was 100%. After a mean follow-up of 159.4 days (range, 9-375 days), all patients obtained patent hepatic arteries except 2 patients occurred hepatic artery restenoses at 26 and 45 days after stent placement, respectively. Kaplan-Meier curve of patency showed cumulated stent patency at 3, 6, and 12 months of 78%, 58% and 45%, respectively. During the follow-up, 8 patients survived, 5 died of septic multiple-organ failure, 1 received retransplantation because of refractory biliary infection. Hepatic artery dissection induced by a guiding catheter occurred in one patient and was successfully treated with a coronary stent. Conclusion: Hepatic artery stenosis after OLT can be successfully treated with coronary stent placement with low complication rate and an acceptable 1-year hepatic artery patency rate

  10. CT findings in ischaemic hepatic failure due to intra-arterial embolisation: A case report

    International Nuclear Information System (INIS)

    Catalano, O.

    1997-01-01

    Liver infarction is relatively uncommon. It may be secondary to several conditions such as sepsis, shock, sickle-cell anaemia, eclampsia, vasculitis, metastatic disease, bacterial endocarditis, rheumatic heart disease, trauma, portal venous occlusion or compression, oral contraception, anaesthesia, hepatic artery thrombosis, therapeutical or inadvertent hepatic artery ligation, intra-arterial chemotherapy or embolisation. A case of hepatic infraction, unusual for iatrogenic pathogenesis, submassive extension with acute hepatic failure, and CT findings of an internally branching pattern due to intravascular gas was observed. (orig./AJ)

  11. Hepatic artery stenosis in liver transplantation: Imaging and interventional treatment

    International Nuclear Information System (INIS)

    Rinaldi, Pierluigi; Inchingolo, Riccardo; Giuliani, Michela; Di Stasi, Carmine; De Gaetano, Anna Maria; Maresca, Giulia; Bonomo, Lorenzo

    2012-01-01

    Introduction: Main purpose of our study is to demonstrate the spectral and color Doppler ultrasonography (DUS) findings that would indicate hepatic artery stenosis (HAS) after liver transplantation and to report our single center results. Moreover we want to establish role and limits of the different imaging techniques in detecting HAS, proposing a non invasive diagnostic approach and to depict indications and feasibility of endovascular treatment in the single patient. Materials and methods: Our study consisted of 222 patients who underwent liver transplantation between January 1999 and December 2009. DUS findings were correlated with multidetector computed tomography angiography (MDCTA) and angiographic results. Results: HAS occurred in 21 cases (9.5%). In all cases diagnosis was performed by DUS. MDCTA quantified stenosis and showed an overall picture of splanchnic vascularization. Based on DUS and MDCTA data integration, in 9 cases we adopted the “wait and see” strategy. Moreover in 12 cases treatment was considered necessary. For hepatic artery stenosis, use of DUS criteria resulted in a sensitivity of 100% (20/20), a specificity of 99.5% (201/202), a positive predictive value (PPV) of 95% (20/21), and negative predictive value (NPV) of 100% (201/201), and an overall accuracy of 99.5% (221/222). Conclusion: Our study underline the role of DUS in early diagnosis of HAS: repeated evaluation of both direct and indirect signs increases NPV and sensitivity of DUS.

  12. Assessment of hepatic arterial variation using multidetector helical CT-angiography

    International Nuclear Information System (INIS)

    Lee, Dong Hoon; Lee, Jun Woo; Jun, Woong Bae; Lee, Suk Hong

    2001-01-01

    To evaluate the anatomy of the hepatic artery and normal variants using oblique thick-slab maximal intensity projection (MIP) 3-D CT angiography and multidetector helical CT technology. In 70 patients, axial three-phase CT together with multidetector helical CT and a nonionic contrast agent was used to evaluate liver disease. During the early arterial phase, the parameters were as follow: slice thickness, 2.5 mm; table speed, 15 mm/rotation, pitch, 6; contrast material, 4 ml/sec; total 120 ml. Using the MIP technique and an Advantage window voxtal 3.03 system (GE), the images obtained were reconstructed as 3D angiograms. In each case, the arterial anatomy and its variants were recorded. A typical anatomy was found in 53 cases (75.7%). Common variants were a left hepatic artery arising from the left gastric artery(8 cases, 11.4 %) and a right hepatic artery arising from the superior mesenteric artery(3 cases, 4.3%). Other variant cases were right hepatic artery arising from the gastroduodenal artery(2 cases, 2.9%), a proper hepatic artery arising from the left gastric artery (1 case, 1.4%), a hepatomesenteric trunk (1 case), a hepatogastric/splenomesenteric trunk(1 case), and a celiomesenteric trunk (1 case). 3-D hepatic angiography using multidetector helical CT technology is non-invasive and as accurate as conventional angiography for the evaluation of hepatic arterial anatomy. It is thus considered that 3-D CT angiography is very helpful for the evaluation of hepatic arterial anatomy prior to liver surgery such as transplantation or the treatment of hepatocellular carinoma

  13. Transcatheter arterial chemoembolization (TACE) combined with γ-knife compared to TACE or γ-knife alone for hepatocellular carcinoma.

    Science.gov (United States)

    Cai, Yeyu; Chang, Qian; Xiao, Enhua; Shang, Quan-Liang; Chen, Zhu

    2018-06-01

    To compare the clinical efficacies and adverse reactions between transcatheter arterial chemoembolization (TACE), γ-ray 3-dimensional fractionated stereotactic conformal radiotherapy (FSCR), and TACE combined with FSCR for primary hepatocellular carcinoma.The study was approved by the Institutional Review Board, and informed consent was waived due to the retrospective study design. About 121 patients met the inclusion criteria and were included in this study, from March 2008 to January 2010, in the Second Xiangya Hospital. Forty-six patients underwent TACE alone, 36 patients underwent γ-knife alone, and 39 were treated by γ-knife combined with TACE. Short-term effects, overall survival rates, adverse reactions, and survival times were compared between the 3 treatment groups.Short-term effects were observed in 41.3% of the TACE group, 33.3% of the γ-knife group, and 64.1% of the TACE combined γ-knife group (P = .020). Overall survival rates at 6,12, 18, and 24 months were 50%, 34.8%, 28.3%, and 21.7% for the TACE group, 36.1%, 30.6%, 16.7%, and 11.1% for γ-knife group, and 84.6%, 71.8%, 61.5%, and 30.8% for TACE combined γ-knife group, respectively. The differences in the overall survival rates at 6, 12, and 18 months between the 3 groups were statistically significant (P = 0), but the overall survival rates at 24 months in the 3 groups were not significantly different (P = .117). The median survival time was 7 months for the TACE group, 3 months for the γ-knife group, and 20 months for the TACE combined γ-knife group (P = 0). There were statistically significant differences (P = .010) of leukopenia between the 3 groups, and no statistically significant differences of (P > .05) thrombocytopenia, anemia, nausea, vomiting, and liver function lesions.TACE combined with γ-knife for primary hepatocellular carcinoma is superior to TACE or γ-knife alone in short-term and long-term effects. This procedure is a mild, safe, and effective

  14. Analysis of adverse reactions and complications of transcatheter uterine artery embolization (TUAE) for uterine fibroids

    International Nuclear Information System (INIS)

    Chen Xiaoming; Luo Pengfei; Du Juan; Zuo Yuewei; Hu Xiaoping; Hong Danhua; Lin Huahuan; Li Gaowen; Liu Suyun

    2002-01-01

    Objective: To investigate the adverse reactions and complications as well as their preventive and therapeutic measures of TUAE for uterine fibroids. Methods: One hundred and eighty-two patients with uterine fibroids were treated by TUAE. Bilateral uterine arteries were embolized using lipiodol-pingyangmycin emulsion (LPE), together with Gelfoam particles. All patients were hospitalized for 3 to 10 days after TUAE and were followed up for 1 to 24 months to observe the adverse reactions and complications. Results: Adverse reactions of TUAE included postembolization syndrome ( n 182); urinary irritation ( n = 24), and hyporrhea of vagina ( n = 25 ) . Complications of TUAE included expelling of necrotic fibroids per vagina ( n = 5 ); urinary retention ( n = 10); urinary tract infection ( n = 1 ); ulcer of labia minora ( n = 1 ); ecchymosis and ulceration on buttock ( n = 1), and secondary infection of chocolate cyst of ovary. ( n = 1 ). All the above-mentioned side effects of TUAE recovered to normal after expectant or especial treatment without any sequels left. Conclusion: The adverse reactions of TUAE are reversible and the complications of TUAE are preventable and curable

  15. Interventional therapy of hepatic arterial hemorrhage occurred after percutaneous transhepatic biliary drainage

    International Nuclear Information System (INIS)

    Liang Songnian; Feng Bo; Su Hongying; Xu Ke

    2011-01-01

    Objective: To analyze the causes and clinical manifestations of hepatic arterial hemorrhage which occurred after percutaneous transhepatic biliary drainage and to summarize the practical experience in its diagnosis and treatment in order to decrease its incidence and mortality. Methods: During the period from June 2007 to June 2010, percutaneous transhepatic biliary drainage was carried out in 622 cases, of which DSA-proved postoperative hepatic arterial hemorrhage occurred in 11, including bile duct hemorrhage (n=6), abdominal cavity bleeding (n=3) and combination of bile duct and abdominal cavity (n=2). Interventional embolization of the bleeding branches of hepatic artery with Gelfoam and coils was carried out in all 11 patients. The clinical data such as clinical manifestations and therapeutic results were retrospectively analyzed. Results: After interventional embolization therapy for postoperative hepatic arterial hemorrhage the bleeding stopped in ten patients, who were discharged from hospital when the clinical conditions were alleviated. The remaining one patient died of sustained deterioration in hepatic and renal functions although the bleeding was ceased. Conclusion: Though hepatic arterial hemorrhage occurred after percutaneous transhepatic biliary drainage is a rare complication, it is dangerous and fatal. Hepatic arterial angiography together with interventional embolization is a sate and effective therapy for hepatic arterial hemorrhage. (authors)

  16. Anatomical variation of celiac axis, superior mesenteric artery, and hepatic artery: Evaluation with multidetector computed tomography angiography

    Directory of Open Access Journals (Sweden)

    Maryam Farghadani

    2016-01-01

    Full Text Available Background: The celiac axis, superior mesenteric artery (SMA, and hepatic artery are the most important branches of abdominal aorta due to their vascularization field. The aim of our study was to evaluate the prevalence of different anatomical variation of celiac axis, SMA, hepatic artery, and its branches with multidetector computed tomography (MDCT angiography of upper abdomen arteries. Materials and Methods: MDCT of 607 kidney donor and traumatic patients that referred to MDCT unit at Al Zahra Hospital in Isfahan from 2012 to 2015 were retrospectively evaluated. We excluded patients with history of abdominal vascular surgery and hepatic or pancreatic surgery. Computed tomography images of the patient were obtained with 64-row MDCT scanner and anatomical variations were analyzed. Results: Three hundred and eighty-eight (63.9% of the 607 patients had classic arterial anatomy and 219 (36.1% patients had variant types. The most common type of variation was the origin of the right hepatic artery (RHA from SMA (9.6%, and the next common variation was the origin of the left hepatic artery (LHA from the left gastric artery (6.9%. Variations in the origin of the common hepatic artery (CHA were seen in 16 (2.6% patients. Buhler arc was identified in two patients. The RHA originated from the celiac axis in 11 (1.8% patients and from the aorta in 8 (1.3% patients. Trifurcation of CHA into gastroduodenal artery, RHA, and LHA was detected in 11 (1.8% patients. Conclusion: The results of the present study showed that anatomical variation occurs in a high percentage of patients. Detection of these variations can guide surgical and radiological interventional planning.

  17. Computed tomography angiography study of variations of the celiac trunk and hepatic artery in 100 patients

    Energy Technology Data Exchange (ETDEWEB)

    Brasil, Ivelise Regina Canito; Araujo, Igor Farias de; Lima, Adriana Augusta Lopes de Araujo; Melo, Ernesto Lima Araujo; Esmeraldo, Ronaldo de Matos, E-mail: igor_farias98@hotmail.com [Universidade Estadual do Ceará (UECE), Fortaleza, CE (Brazil). Escola de Medicina

    2018-01-15

    Objective: To describe the main anatomical variations of the celiac trunk and the hepatic artery at their origins. Materials and methods: This was a prospective analysis of 100 consecutive computed tomography angiography studies of the abdomen performed during a one-year period. The findings were stratified according to classification systems devised by Sureka et al. and Michels. Results: The celiac trunk was 'normal' (i.e., the hepatogastrosplenic trunk and superior mesenteric artery originating separately from the abdominal aorta) in 43 patients. In our sample, we identified four types of variations of the celiac trunk. Regarding the hepatic artery, a normal anatomical pattern (i.e., the proper hepatic artery being a continuation of the common hepatic artery and bifurcating into the right and left hepatic arteries) was seen in 82 patients. We observed six types of variations of the hepatic artery. Conclusion: We found rates of variations of the hepatic artery that are different from those reported in the literature. Our findings underscore the need for proper knowledge and awareness of these anatomical variations, which can facilitate their recognition and inform decisions regarding the planning of surgical procedures, in order to avoid iatrogenic intraoperative injuries, which could lead to complications. (author)

  18. Computed tomography angiography study of variations of the celiac trunk and hepatic artery in 100 patients

    Directory of Open Access Journals (Sweden)

    Ivelise Regina Canito Brasil

    Full Text Available Abstract Objective: To describe the main anatomical variations of the celiac trunk and the hepatic artery at their origins. Materials and Methods: This was a prospective analysis of 100 consecutive computed tomography angiography studies of the abdomen performed during a one-year period. The findings were stratified according to classification systems devised by Sureka et al. and Michels. Results: The celiac trunk was "normal" (i.e., the hepatogastrosplenic trunk and superior mesenteric artery originating separately from the abdominal aorta in 43 patients. In our sample, we identified four types of variations of the celiac trunk. Regarding the hepatic artery, a normal anatomical pattern (i.e., the proper hepatic artery being a continuation of the common hepatic artery and bifurcating into the right and left hepatic arteries was seen in 82 patients. We observed six types of variations of the hepatic artery. Conclusion: We found rates of variations of the hepatic artery that are different from those reported in the literature. Our findings underscore the need for proper knowledge and awareness of these anatomical variations, which can facilitate their recognition and inform decisions regarding the planning of surgical procedures, in order to avoid iatrogenic intraoperative injuries, which could lead to complications.

  19. Computed tomography angiography study of variations of the celiac trunk and hepatic artery in 100 patients

    International Nuclear Information System (INIS)

    Brasil, Ivelise Regina Canito; Araujo, Igor Farias de; Lima, Adriana Augusta Lopes de Araujo; Melo, Ernesto Lima Araujo; Esmeraldo, Ronaldo de Matos

    2018-01-01

    Objective: To describe the main anatomical variations of the celiac trunk and the hepatic artery at their origins. Materials and methods: This was a prospective analysis of 100 consecutive computed tomography angiography studies of the abdomen performed during a one-year period. The findings were stratified according to classification systems devised by Sureka et al. and Michels. Results: The celiac trunk was 'normal' (i.e., the hepatogastrosplenic trunk and superior mesenteric artery originating separately from the abdominal aorta) in 43 patients. In our sample, we identified four types of variations of the celiac trunk. Regarding the hepatic artery, a normal anatomical pattern (i.e., the proper hepatic artery being a continuation of the common hepatic artery and bifurcating into the right and left hepatic arteries) was seen in 82 patients. We observed six types of variations of the hepatic artery. Conclusion: We found rates of variations of the hepatic artery that are different from those reported in the literature. Our findings underscore the need for proper knowledge and awareness of these anatomical variations, which can facilitate their recognition and inform decisions regarding the planning of surgical procedures, in order to avoid iatrogenic intraoperative injuries, which could lead to complications. (author)

  20. Transcatheter arterial chemoembolization of colorectal liver metastases using degradable starch microspheres (Spherex registered). Own investigations and review to the literature

    International Nuclear Information System (INIS)

    Wasser, K.; Landwehr, P.

    2005-01-01

    Since two decades transarterial chemoembolization (TACE) of liver metastases has been investigated in numerous studies. However, no standardized therapeutic procedure exists so far. The present study retrospectively investigated survival, response and side effects after TACE of liver metastases in 21 patients with colorectal cancer and results are compared with previous literature. A total of 68 TACE procedures were performed. A suspension of degradable starch microspheres (DSM, Spherex registered ) and Mitomycin C was applied selectively into hepatic arteries via a transfemoral approach. DSM effect a temporary arterial occlusion. Follow-up studies were performed by contrast enhanced spiral computed tomography (CT). The median survival was 13.8 months. Therapeutic response (according to WHO) was observed only in three patients. The progression free interval was 5.8 months. Patients developed a postembolization-syndrome (abdominal pain, fever, nausea) and increased transaminases in 27-43% of all interventions. A gastric ulcer occurred after four, cholecystitis after two TACE. As already shown in most previous studies, regardless of the used agents, also this investigation underlines the moderate therapeutic effect of TACE on colorectal liver metastases. So far, no significant survival benefit has been shown in the literature and the response rates are rather limited. In general, complications of TACE seem to be rare, but should not to be underestimated. Compared to TACE with long or permanent arterial occlusion, postembolization syndrome seems to be less pronounced using DSM. As TACE is rather a palliative therapeutic approach, DSM therefore might be more suited. Further studies on TACE of liver metastases should focus on to the patients' quality of life. (orig.) [de

  1. Arteries of the falciform ligament on C-arm CT hepatic arteriography: The hepatic falciform artery and the Sappey's superior artery

    Energy Technology Data Exchange (ETDEWEB)

    Hur, Saebeom; Chung, Jin Wook; Lee, Jae Hwan; Cho, SooBeum; Kim, Minuk; Lee, Myungsu; Kim, Hyo-Cheol; Jae, Hwan Jun [Seoul National University Hospital, Department of Radiology, Seoul (Korea, Republic of); Zhou, Chun Gao [First Affiliated Hospital of Nanjing Medical University, Department of Interventional Radiology, Nanjing, Jangsu (China)

    2017-04-15

    To investigate the prevalence, anatomy and distribution of the hepatic falciform artery (HFA) and Sappey's superior artery (SSA) using C-arm CT hepatic arteriography (C-arm CTHA). From January 2011 to December 2012, 220 patients who underwent C-arm CTHA during initial transarterial treatment for hepatocellular carcinoma were included in this retrospective study. The HFAs and SSAs prevalence and origin were evaluated using axial images of C-arm CTHA. A 5-point scale for HFAs and a 4-point scale for SSAs were used to designate the radiologically conspicuous arteries. The prevalences of the total HFAs and SSAs were 95 % (n=209) and 22 % (n=49), while those of radiologically conspicuous HFAs and SSAs were 62 % (n=137) and 10 % (n=22), respectively. Thirty HFAs (22 % of radiologically conspicuous HFAs and 14 % of the total study population) were distributed in the subcutaneous layer of the anterior abdominal wall, while the majority of SSAs ran through the superior part of the falciform ligament in the left-anterior direction and anastomosed with left inferior phrenic artery. Our study using C-arm CTHA revealed that the prevalence of the HFA is higher than the existing knowledge and proved the existence of the SSA radiologically for the first time. (orig.)

  2. Arteries of the falciform ligament on C-arm CT hepatic arteriography: The hepatic falciform artery and the Sappey's superior artery

    International Nuclear Information System (INIS)

    Hur, Saebeom; Chung, Jin Wook; Lee, Jae Hwan; Cho, SooBeum; Kim, Minuk; Lee, Myungsu; Kim, Hyo-Cheol; Jae, Hwan Jun; Zhou, Chun Gao

    2017-01-01

    To investigate the prevalence, anatomy and distribution of the hepatic falciform artery (HFA) and Sappey's superior artery (SSA) using C-arm CT hepatic arteriography (C-arm CTHA). From January 2011 to December 2012, 220 patients who underwent C-arm CTHA during initial transarterial treatment for hepatocellular carcinoma were included in this retrospective study. The HFAs and SSAs prevalence and origin were evaluated using axial images of C-arm CTHA. A 5-point scale for HFAs and a 4-point scale for SSAs were used to designate the radiologically conspicuous arteries. The prevalences of the total HFAs and SSAs were 95 % (n=209) and 22 % (n=49), while those of radiologically conspicuous HFAs and SSAs were 62 % (n=137) and 10 % (n=22), respectively. Thirty HFAs (22 % of radiologically conspicuous HFAs and 14 % of the total study population) were distributed in the subcutaneous layer of the anterior abdominal wall, while the majority of SSAs ran through the superior part of the falciform ligament in the left-anterior direction and anastomosed with left inferior phrenic artery. Our study using C-arm CTHA revealed that the prevalence of the HFA is higher than the existing knowledge and proved the existence of the SSA radiologically for the first time. (orig.)

  3. CT arteriography via the right inferior phrenic artery developed parasitic perfusion into the liver

    International Nuclear Information System (INIS)

    Inaba, Yoshitaka; Arai, Yasuaki; Sueyoshi, Satoshi; Yamagami, Takuji; Aramaki, Takeshi; Yamaura, Hidekazu; Matsueda, Kiyoshi; Sasaki, Fumio; Takeuchi, Yoshihito.

    1998-01-01

    The distribution of arterial blood flow via the right inferior phrenic artery (rt-IPA) developing parasitic perfusion into the liver was evaluated by CT arteriography (CTA) in 50 cases with hepatic tumors. In all cases, CTA via rt-IPA showed hyperperfusion area including hepatic tumors in the posterior segment and the caudate lobe of the liver, and adding the left hepatic lobe in cases with hepatic arterial occlusion. In 82% of 33 cases obtained both CTA via rt-IPA and CTA via hepatic artery, the hyperperfusion area on CTA via rt-IPA exactly corresponded to perfusion defect area on CTA via hepatic artery. CTA was much useful for understanding hemodynamics in cases with parasitic perfusion into the liver and it could make transcatheter arterial therapy more effective. (author)

  4. CT arteriography via the right inferior phrenic artery developed parasitic perfusion into the liver

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    Inaba, Yoshitaka; Arai, Yasuaki; Sueyoshi, Satoshi; Yamagami, Takuji; Aramaki, Takeshi; Yamaura, Hidekazu; Matsueda, Kiyoshi; Sasaki, Fumio [Aichi Cancer Center, Nagoya (Japan); Takeuchi, Yoshihito

    1998-02-01

    The distribution of arterial blood flow via the right inferior phrenic artery (rt-IPA) developing parasitic perfusion into the liver was evaluated by CT arteriography (CTA) in 50 cases with hepatic tumors. In all cases, CTA via rt-IPA showed hyperperfusion area including hepatic tumors in the posterior segment and the caudate lobe of the liver, and adding the left hepatic lobe in cases with hepatic arterial occlusion. In 82% of 33 cases obtained both CTA via rt-IPA and CTA via hepatic artery, the hyperperfusion area on CTA via rt-IPA exactly corresponded to perfusion defect area on CTA via hepatic artery. CTA was much useful for understanding hemodynamics in cases with parasitic perfusion into the liver and it could make transcatheter arterial therapy more effective. (author)

  5. Radiologic management of hepatic arterial stenosis or thrombosis following liver transplantation

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    Shin, Byung Suck; Sung, Kyu Bo; Lim, Soo Mee; Yoon, Hyun Ki; Song, Ho Young [Asan Medical Center, Ulsan Univ. College of Medicine, Seoul (Korea, Republic of)

    2001-06-01

    To assess the results and usefulness of interventional procedures for hepatic arterial stenosis or thrombosis following liver transplantation. During the past five years, eight patients aged 1-59 (mean, 39) years among 187 liver transplant recipients showed elevated of liver enzyme levels (AST/ALT) and decreased arterial flow at Doppler ultrasound. Hepatic arteriography revealed luminal stenosis or occlusion at the proper hepatic artery, and six patients, one of whom required thrombolysis before the procedure, underwent percutaneous transluminal angioplasty (PTA) using a balloon. In two with thrombosis, thrombolysis without PTA was performed. In order to increase hepatic arterial flow, four patients underwent additional coil embolization of the gastroduodenal or splenic artery. Hepatic arterial flow recovered in all six patients after PTA. Three required repeat PTA for restenosis and one of these needed stent placement after repeated PTA. At follow-up, 6-17 months later, the three had good hepatic function. Within four days, the other three expired due to graft failure, hepatorenal syndrome and sepsis. One of the patients who underwent thrombolysis without PTA expired and the other required retransplantation. In this case there were no procedure - related complications. Radiologic interventions are useful for treatment of hepatic arterial stensis or thrombosis in patients with liver transplantations.

  6. Functional assessment of the hepatic arterial blood flow by pharmacoradiography

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    Stellamor, K; Hruby, W; Peschl, L

    1981-12-01

    By means of celiacography it was possible to demonstrate that parenteral medication with parathormone creates a selective dilatation of the liver vessels in man, provided that they are dilatable. This hemodynamic hormone effect could not be traced in the other mesenteric vessels. The increase of portal hypertension resulting from cirrhosis leads to a loss of the dilating ability of liver vessels. This regressive reaction is well demonstrated on the parathormone-celiacogram. Thus a functional assessment of the hepatic blood flow is possible. The extent of the dilatability of the liver artery seems to be of great importance for the prognosis and indication of the porto-systemic shunt-operation. Moreover we could show that an increase in the liver perfusion demonstrates pathologic liver processes in a better way.

  7. Isolated Common Hepatic Artery Branch Thrombosis: Results and Risk Factors

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    Abdoulhossein Davoodabadi

    2016-10-01

    Full Text Available Isolated common hepatic artery branch thrombosis with severe gastric ischemia and duodenojejunal infarction is a rare condition; it usually presents with acute abdomen and may be associated with underlying thrombotic risk factors. We present a 35-year-old man admitted to our hospital with five days history of sudden abdominal pain and deteriorating epigastric pain. He was a driver and had no any past medical history. Explorative laparotomy showed: distal 2/3 gastric, duodenojejunal and papilla vater was sloughed. The stomach subtotal and sloughed duodenum and first 20 cm of jejunum were resected, continuity of the gastrointestinal was preserved with anastomosis of the proximal part of jejunum to gastric stump, pancreatic duct, and CBD repaired to the lateral side of jejunum on the guide of two 18 French feeding tube as an external drain. The patient had a good immediate postoperative recovery. Coagulation checkup after operation revealed isolated Hyperhomocysteinemia.

  8. Role of regional radiofrequency hyperthermia after hepatic artery block in the normal pit liver

    International Nuclear Information System (INIS)

    Luo Jingwei; Xu Guozhen; Xiong Jinghong; Liu Xiaoyun; Wang Weihu; Li Yexiong

    2003-01-01

    Objective: To study the temperature difference, tolerated high temperature, pathological changes between normal and blocked hepatic artery in radiofrequency hyperthermia for pig liver. Methods: Mature pig was used with iodine blocked right hepatic artery. Heat of the whole liver was given for 1 hour by SR-1000 radiofrequency hyperthermia with four thermocouple probes to measure the temperature of the right hepatic artery, right and left normal liver and rectum. Results: Temperature of blocked right liver increased by 10.2 degree C from 39.1 degree C to 49.3 degree C as compared with the left liver of which the temperature rose by 6.8 degree C from 39.7 degree C to 46.5 degree C but the temperature of right hepatic artery and rectum rose only by 3.3 degree C, 3.2 degree C respectively. After sacrificing the pig one week later, on lobe exploration, severe necrosis was observed in the right lobe but the left lobe was normal with a clear demarcation between the two lobes. Conclusions: Hepatic arterial iodine embolization potentiates radiofrequency hyperthermia in the liver. Liver with blocked artery showed conspicuous necrosis but liver with normal un-blocked artery was able to tolerate 46.5 degree C. This provides some evidence for the combination of regional hyperthermia and hepatic artery block in the treatment of advanced liver cancer

  9. Experimental research on treating hepatic carcinoma by arterial injection of liposome mediated p53 genes

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    Guangyu, Zhu; Qin, Lu; Gaojun, Teng; Jinhe, Guo; Hui, Yu; Gang, Deng; Shicheng, He; Wen, Fang; Guozhao, Li; Xiaoying, Wei [Zhongda Hospital, Southeast Univ., Nanjing (China)

    2007-02-15

    Objective: To investigate the transfection and expression of p53 genes mediated by liposome and its feasibility in treatment of liver cancer by transcatheter arterial injection on rabbit VX2 hepatocarcinoma model. Methods: pCMV-myc-p53 plasmids, LipofectAMINE and p53-LipofectAMINE complex were infused into tumor's feeding artery of rabbit VX2 hepatocarcinoma model, respectively, and then protein of cancer tissue was extracted, followed by measuring gene transfection and expression by western blot and immunohistochemistry, p53-LipofectAMlNE complex in different doses were infused into tumor's feeding artery of rabbit VX2 hepatocarcinoma model with the gene transfection and expression detected by the same way. Results: Liposome-mediated p53 gene injected through catheter could be successfully transfected and expressed in the cancer tissue of rabbit VX2 hepatocarcinoma model, with transfection efficiency higher than the gene delivery alone. The efficiency and the gene dose has dose-effect relationship. Conclusions: Treatment of liver cancer by transcatheter arterial injection of p53 genes mediated by liposome is a feasible and effective method, with wide prospect of application. (authors)

  10. Experimental research on treating hepatic carcinoma by arterial injection of liposome mediated p53 genes

    International Nuclear Information System (INIS)

    Zhu Guangyu; Lu Qin; Teng Gaojun; Guo Jinhe; Yu Hui; Deng Gang; He Shicheng; Fang Wen; Li Guozhao; Wei Xiaoying

    2007-01-01

    Objective: To investigate the transfection and expression of p53 genes mediated by liposome and its feasibility in treatment of liver cancer by transcatheter arterial injection on rabbit VX2 hepatocarcinoma model. Methods: pCMV-myc-p53 plasmids, LipofectAMINE and p53-LipofectAMINE complex were infused into tumor's feeding artery of rabbit VX2 hepatocarcinoma model, respectively, and then protein of cancer tissue was extracted, followed by measuring gene transfection and expression by western blot and immunohistochemistry, p53-LipofectAMlNE complex in different doses were infused into tumor's feeding artery of rabbit VX2 hepatocarcinoma model with the gene transfection and expression detected by the same way. Results: Liposome-mediated p53 gene injected through catheter could be successfully transfected and expressed in the cancer tissue of rabbit VX2 hepatocarcinoma model, with transfection efficiency higher than the gene delivery alone. The efficiency and the gene dose has dose-effect relationship. Conclusions: Treatment of liver cancer by transcatheter arterial injection of p53 genes mediated by liposome is a feasible and effective method, with wide prospect of application. (authors)

  11. Analysis of prognostic factors in patients with hepatocellular carcinoma after transcatheter hepatic arterial chemoembolization(TAE)

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    Kim, Tae Gwon; Byun, Kyung Hwan; Oh, Hyun Han; Ryeom, Hun Kyu; Kim, Yong Joo [Kyungpook National Univ. Hospital, Taegu (Korea, Republic of)

    1996-07-01

    To evaluate long-term survival rates and prognostic factors of patients with hepatocellular carcinoma after TAE. 225 patients with hepatocellular carcinoma treated with TAE between January 1988 and December 1994 were studied. Hepatocellular carcinoma was diagnosed either histologically(n=13) or clinically on the basis of findings characteristic for hepatocellular carcinoma obtained using such as diagnostic imaging methods such as ultrasonography, CT, MRI, and angiography as well as on the basis of high serum alpha-fetoprotein level(n=212). TAE was carried out between one and six times(mean, 1.4 time) using a mixture of lipiodol and Adriamycin, together with Gelfoam. Cumulative survival rates from the day of the first TAE were obtained by the Kaplan-Meier method. Parameters likely to influence the prognosis were subjected to univariate analysis using the log-rank test Cumulative survival rates at the end of the first, second, third, fourth, and fifth year were 55.9%, 32.6%, 21.9%, 17.9%, and 15.0%, respectively. The mean survival time was 727{+-}76 days. Several factors, including Child-Pugh classification, Okuda's stage, tumor size, presence of portal vein invasion by tumor, of arterio-portal shunt, and of extrahepatic metastases, catheter selection level, and number of TAE showed significant correlation with the outcome. Degrees of Lipiodol accumulation in a tumor on follow up CT were also correlated with survival rates. TAE is an effective measure for prolonging the patient's life expectancy and evaluation of prognostic factor is helpful for prognosis and in deciding on the optimal therapeutic modality.

  12. Trans-catheter arterial chemoembolization as first-line treatment for hepatic metastases from endocrine tumors

    International Nuclear Information System (INIS)

    Roche, Alain; Girish, Baragur V.; de Baere, Thierry; Baudin, Eric; Schlumberger, Martin; Boige, Valerie; Ducreux, Michel; Elias, Dominique; Lasser, Philippe

    2003-01-01

    Our objective was to report the outcome in patients with liver metastasis from endocrine tumors who underwent transarterial chemoembolization (TACE) as first-line non-surgical treatment. From January 1990 to December 2000, 14 patients with progressive unresectable liver metastases from digestive neuroendocrine tumor were treated with TACE (mean of 3.6 sessions) before any non-surgical treatment (somatostatin analogue, chemotherapy or interferon). Liver involvement was less than 50% in 11 patients. Size of the largest lesion ranged from 1.5 to 10 cm. Ten patients presented with carcinoid symptoms. The TACE was performed with Doxorubicin emulsified in Lipiodol and gelatin sponge particles. Symptomatic response upon flushes and/or diarrhea was complete in 7 of 10 cases and partial in 2 of 10 cases. An objective morphologic response was noted in 12 of 14 cases. The 5- and 10-year survival rate from diagnosis was 83 and 56%, respectively. Six patients were alive at the end of the study after 27-100 months from first TACE and 38-142 months from diagnosis. Three of them were successfully palliated for 55, 69, and 100 months with only TACE as treatment. Long-term palliation is possible in unresectable liver metastases from digestive neuroendocrine tumors with a few sessions of TACE as first-line and eventually exclusive treatment. (orig.)

  13. Resection-Reconstruction of Aberrant Right Hepatic Artery During Whipple Procedure (Pancreaticoduodenectomy).

    Science.gov (United States)

    Sayyed, Raza; Rehman, Iffat; Niazi, Imran Khalid; Yusuf, Muhammed Aasim; Syed, Aamir Ali; V, Faisal

    2016-06-01

    Aberrant hepatic arterial anatomy poses a challenge for the surgeon during Whipple procedure. Intraoperative injury to the aberrant vasculature results in hemorrhagic or ischemic complications involving the liver and biliary tree. We report a case of replaced right hepatic artery arising from the superior mesenteric artery in a patient with periampullary carcinoma of the pancreas, undergoing pancreaticoduodenectomy. The aberrant artery was found to be coursing through the pancreatic parenchyma. This is a rare vascular anomaly. Resection of the arterial segment and end-to-end anastomosis was fashioned. Intrapancreatic course of the replaced right hepatic artery is a rare anomaly and is best managed by preoperative identification on radiology and meticulous intra-operative dissection and preservation. However, for an intrapancreatic course, resection and reconstruction may occasionally be required.

  14. Carbon dioxide hepatic arterial DSA and CT angiography in swine model

    International Nuclear Information System (INIS)

    Tan Huaqiao; Hu Hongjie; Huang Wenxin; Zhang Shizheng; Dong Yonghua; Zhou Dachun

    2005-01-01

    Objective: To evaluate the imaging findings of carbon dioxide hepatic arterial DSA and CT angiography in normal swine. Methods: In general anaesthesia, hepatic arterial DSA was performed with 10 ml iodinated contrast medium (5 ml/s, 10 ml) in 5 normal swine, and then repeated hepatic arterial CO 2 -DSA was performed with a total of 30-50 ml CO 2 injected by manually operated syringe at the velocity of 5-8 ml/s, followed by CO 2 -CT angiography. All the swine were sacrificed after the procedure, the selective hepatic segments were removed, and pathological examination was carried out. The radiological features of hepatic arterial DSA with iodinated contrast medium and CO 2 and CT angiography with CO 2 were analyzed. The ability of showing the arterio-venous shunt was compared. Results: Hepatic arterio-portal shunt was found in the advanced arterial phase of CO 2 -DSA in three of five swine, which was furthermore demonstrated by CO 2 -CT angiography, but iodinated contrast medium DSA showed no arterio-portal shunt in all swine. The gaseous CO 2 in portal vein was absorbed within 1-3 minutes. No CO 2 shunted into the hepatic vein during CO 2 -DSA and CO 2 -CTA. Histology didn't reveal any abnormal changes caused by CO 2 shunt in the swine liver. Conclusion: (1) Hepatic arterial CO 2 -DSA and CO 2 -CTA can reveal arterio-portal shunt that isn't seen with iodinated contrast medium, the gaseous CO 2 in portal vein was absorbed within 1-3 minutes. (2) The gaseous CO 2 can't shunt into hepatic vein when the hepatic artery is perfused with CO 2 in normal swine. (authors)

  15. Efficacy of hepatic arterial infusion chemotherapy in advanced hepatocellular carcinoma

    Science.gov (United States)

    Baek, Yang Hyun; Kim, Kyoung Tae; Lee, Sung Wook; Jeong, Jin Sook; Park, Byeong Ho; Nam, Kyung Jin; Cho, Jin Han; Kim, Young Hoon; Roh, Young Hoon; Lee, Hyung Sik; Choi, Young Min; Han, Sang Young

    2012-01-01

    AIM: To investigate the efficacy of hepatic arterial infusion chemotherapy (HAIC) using floxuridine (FUDR) in patients with advanced hepatocellular carcinoma (HCC) confined to the liver. METHODS: Thirty-four patients who had advanced HCC with unresectability or unsuccessful previous therapy in the absence of extrahepatic metastasis were treated with intra-arterial FUDR chemotherapy at our hospital between March 2005 and May 2008. Among the 34 patients, 9 patients were classified as Child class C, and 18 patients had portal vein tumor thrombus (PVTT). One course of chemotherapy consisted of continuous infusion of FUDR (0.3 mg/kg during day 1-14) and dexamethasone (10 mg on day 1, 4, 7 and 11), and this treatment was repeated every 28 d. RESULTS: Two patients (5.9%) displayed a complete response, and 12 patients (35.3%) had a partial response. The tumor control rate was 61.8%. The median overall survival times were 15.3 mo, 12.4 mo and 4.3 mo for the patients who were classified as Child class A, Child class B and Child class C, respectively (P = 0.0392). The progression-free survival was 12.9 mo, 7.7 mo and 2.6 mo for the patients who were classified as Child class A, Child class B and Child class C, respectively (P = 0.0443). The cumulative survival differed significantly according to the Child-Pugh classification and the presence of PVTT. In addition to hepatic reserve capacity and PVTT, the extent of HCC was an independent factor in determining a poor prognosis. The most common adverse reactions to HAIC were mucositis, diarrhea and peptic ulcer disease, but most of these complications were improved by medical treatment and/or a delay of HAIC. CONCLUSION: The present study demonstrates that intra-arterial FUDR chemotherapy is a safe and effective treatment for advanced HCC that is recalcitrant to other therapeutic modalities, even in patients with advanced cirrhosis. PMID:22807613

  16. Miscellaneous Endovascular Treatment of Ruptured Hepatic Artery Pseudoaneurysms after Pylorus Preserving Pancreaticoduodenectomy

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    Kang, Ung Rae; Lee, Young Hwan [Dept. of Radiology, Daegu Catholic University Medical Center, Catholic of Daegu University School of Medicine, Daegu (Korea, Republic of); Ahn, Eun Joung; Kim, See Hyung; Kim, Young Hwan [Dept. of Radiology, Keimyung University Dongsan Medical Center, Keimyung University College of Medicine, Daegu (Korea, Republic of)

    2012-03-15

    To assess the feasibility and safety of the endovascular treatment of ruptured hepatic artery pseudoaneurysms after pylorus preserving pancreaticoduodenectomy (PPPD). Thirteen patients with hepatic artery pseudoaneurysm after PPPD were enrolled. Various endovascular techniques were used depending on the sites and morphologies of the pseudoaneurysms. Five cases were treated by coil embolization, five with stent-graft, one by thrombin injection and coil embolization, one with stent-graft and coil embolization, and one with N-butyl cyanoacrylate (NBCA) injection. Computed tomography scans and liver function test were performed after the procedures. Pseudoaneurysm exclusion and bleeding cessation was achieved in all patients. In four patients that underwent coil or NBCA embolization of the hepatic artery, aspartate transaminase (AST) and alanine transaminase (ALT) were markedly elevated. Two of these four patients with narrowing of the portal vein due to surrounding hematoma died of hepatic infarction or hepatic abscess. In other nine patients, AST and ALT were unchanged. In the 11 surviving patients, normal hepatic function and complete pseudoaneurysm disappearance were achieved during follow-up. Endovascular treatment of ruptured hepatic artery pseudoaneurysms can be considered as a feasible and safe method. However, complete occlusion of the hepatic artery with coils should be avoided in patients with inadequate portal flow.

  17. Evaluation of variants in hepatic artery anatomy on conventional angiography in patients undergoing transarterial chemoembolization (tace): experience at siut

    International Nuclear Information System (INIS)

    Faiq, S.M.; Jesrani, A.; Jamal, M.; Lalwani, A.

    2017-01-01

    Objective: The purpose of this research is to evaluate common and uncommon variant of hepatic arterial anatomy that usually come across during Hepatic Angiographies. Study Design: Cross sectional study. Methods: This study included 50 patients having history of Hepatocellular Carcinoma from May to October 2015. Hepatic Angiography (Transarterial chemoembolization for management of Hepatoma and identification of classical and variant anatomy of hepatic artery) was evaluated in angiography unit. All procedures were performed on Digital Subtraction Angiography (DSA) machine (Toshiba KXO100 G). Selective DSA of the superior mesenteric artery and celiac trunk is performed initially to evaluate the frequency of normal and variant arterial anatomy and secondly to determine origin and course of tumor-feeding vessels. Evaluation of common and uncommon variants of hepatic arteries was done by using Michel’s classification as reference standard. Results: Age of the patient range from 40 – 80 years, 35 of whom were males. Fifty patients underwent angiographic procedure of viscera. Normal anatomy of hepatic artery was found in twenty eight (56%) cases. In six (12%) cases we found the replaced form of right hepatic artery (RHA) originating from visceral superior mesenteric artery. In five (10%) cases we found the replaced form of left hepatic artery (LHA) originating from left gastric artery (LGA), the combination of both these anomalies in one (2%) patient. Four (8%) cases had the left gastric artery giving rise to accessory left hepatic artery in conjunction with the common hepatic artery of celiac axis giving rise to typical right or left hepatic artery. In another four (8%) cases anatomic variation was noted in form of a dual arterial supply noted as common hepatic artery of celiac axis giving rise to typical left or right hepatic artery in conjunction with superior mesenteric artery giving rise to accessory right hepatic artery. In two (4%) cases superior mesenteric

  18. Stent grafting of acute hepatic artery bleeding following pancreatic head resection

    International Nuclear Information System (INIS)

    Stoupis, Christoforos; Ludwig, Karin; Triller, Juergen; Inderbitzin, Daniel; Do, Dai-Do

    2007-01-01

    The purpose of this study was to report the potential of hepatic artery stent grafting in cases of acute hemorrhage of the gastroduodenal artery stump following pancreatic head resection. Five consecutive male patients were treated because of acute, life-threatening massive bleeding. Instead of re-operation, emergency angiography, with the potential of endovascular treatment, was performed. Because of bleeding from the hepatic artery, a stent graft (with the over-the-wire or monorail technique) was implanted to control the hemmorhage by preserving patency of the artery. The outcome was evaluated. In all cases, the hepatic artery stent grafting was successfully performed, and the bleeding was immediately stopped. Clinically, immediately after the procedure, there was an obvious improvement in the general patient condition. There were no immediate procedure-related complications. Completion angiography (n=5) demonstrated control of the hemorrhage and patency of the hepatic artery and the stent graft. Although all patients recovered hemodynamically, three individuals died 2 to 10 days after the procedure. The remaining two patients survived, without the need for re-operation. Transluminal stent graft placement in the hepatic artery is a safe and technically feasible solution to control life-threatening bleeding of the gastroduodenal artery stump. (orig.)

  19. Liver Abscess Associated with Hepatic Artery Pseudoaneurysm with Arteriovenous Fistula: Imaging and Interventional Management

    International Nuclear Information System (INIS)

    Kang, M.; Bapuraj, J.R.; Khandelwal, N.; Kochhar, R.; Kalra, N.; Verma, G. R.

    2006-01-01

    Hepatic artery pseudoaneurysm is an infrequently encountered entity that is usually seen secondary to trauma or surgical procedures. The clinical presentation is often due to complications such as massive intrahepatic or intraperitoneal bleeding as a result of rupture of the pseudoaneurysm into the biliary tree or peritoneal cavity, respectively. Hepatic artery pseudoaneurysm, associated with a liver abscess, has very rarely been described in the literature. We present the imaging features of a case of liver abscess associated with a hepatic artery pseudoaneurysm and complicated by rupture and formation of an arteriovenous fistula. The case was successfully managed by percutaneous endovascular embolization. The association between a hepatic artery pseudoaneurysm and a liver abscess must not be overlooked, bearing in mind the potentially fatal associated complications which can be averted or treated by timely intervention

  20. Liver Abscess Associated with Hepatic Artery Pseudoaneurysm with Arteriovenous Fistula: Imaging and Interventional Management

    Energy Technology Data Exchange (ETDEWEB)

    Kang, M.; Bapuraj, J.R.; Khandelwal, N.; Kochhar, R.; Kalra, N.; Verma, G. R. [Postgraduate Inst. of Medical Education and Research, Chandigarh (India). Depts. of Radiodiagnosis and General Surgery

    2006-03-15

    Hepatic artery pseudoaneurysm is an infrequently encountered entity that is usually seen secondary to trauma or surgical procedures. The clinical presentation is often due to complications such as massive intrahepatic or intraperitoneal bleeding as a result of rupture of the pseudoaneurysm into the biliary tree or peritoneal cavity, respectively. Hepatic artery pseudoaneurysm, associated with a liver abscess, has very rarely been described in the literature. We present the imaging features of a case of liver abscess associated with a hepatic artery pseudoaneurysm and complicated by rupture and formation of an arteriovenous fistula. The case was successfully managed by percutaneous endovascular embolization. The association between a hepatic artery pseudoaneurysm and a liver abscess must not be overlooked, bearing in mind the potentially fatal associated complications which can be averted or treated by timely intervention.

  1. Modified sleeve anastomosis for reconstruction of the hepatic artery in rat liver transplantation.

    Science.gov (United States)

    Li, Jun; Dahmen, Uta; Dirsch, Olaf; Shen, Kai; Gu, Yanli; Broelsch, Christoph Erich

    2002-01-01

    End-to-end sleeve anastomosis between a donor common hepatic artery and a recipient proper hepatic artery was proven to be the most physiological and simple method for hepatic rearterialization in rat liver transplantation. Current technical variants of the sleeve technique, however, are hampered by the high rate of bleeding from the anastomotic site. This report deals with a technical modification which inhibits postoperative bleeding efficiently. The procedure consisted of a guiding suture, as previously described in other technical variants, and a modified fixing suture. Instead of using a single stitch to fix the feeding vessel with the receiving vessel, a running suture between the edge of the donor common hepatic artery and the adventitia of the recipient proper hepatic artery was performed to avoid a possible backflow. The patency rate of 91% was as high as reported by others using a sleeve technique, which was also reflected in the histomorphological picture, being indistinguishable from normal liver histology. This technical modification simplified the procedure of reconstructing the hepatic artery and could contribute to a wider use of the arterialized liver transplantation model in rats. Copyright 2002 Wiley-Liss, Inc.

  2. A case of gastrointestinal bleeding due to right hepatic artery pseudoaneurysm following total remnant pancreatectomy: A case report

    Directory of Open Access Journals (Sweden)

    Atsushi Fujio

    Full Text Available Introduction: Pseudoaneurysm is a serious complication after pancreatic surgery, which mainly depends on the presence of a preceding pancreatic fistula. Postpancreatectomy hemorrhage following total pancreatectomy is a rare complication due to the absence of a pancreatic fistula. Here we report an unusual case of massive gastrointestinal bleeding due to right hepatic artery (RHA pseudoaneurysm following total remnant pancreatectomy. Presentation of case: A 75-year-old man was diagnosed with intraductal papillary mucinous carcinoma recurrence following distal pancreatectomy and underwent total remnant pancreatectomy. After discharge, he was readmitted to our hospital with melena because of the diagnosis of gastrointestinal bleeding. Gastrointestinal endoscopy was performed to detect the origin of bleeding, but an obvious bleeding point could not be detected. Abdominal computed tomography demonstrated an expansive growth, which indicated RHA pseudoaneurysm. Emergency angiography revealed gastrointestinal bleeding into the jejunum from the ruptured RHA pseudoaneurysm. Transcatheter arterial embolization was performed; subsequently, bleeding was successfully stopped for a short duration. Because of improvements in his general condition, the patient was discharged. Discussion: To date, very few cases have described postpancreatectomy hemorrhage following total remnant pancreatectomy. We suspect that the aneurysm ruptured into the jejunum, possibly because of the scarring and inflammation associated with his two complex surgeries. Conclusion: Pseudoaneurysm should be considered when the fragility of blood vessels is suspected, despite no history of anastomotic leak and intra-abdominal abscess. Our case also highlighted that detecting gastrointestinal bleeding is necessary to recognize sentinel bleeding if the origin of bleeding is undetectable. Abbreviations: PPH, RHA, CT, IPMC, RCCs, POD, LHA, GIE, TAE, Keywords: Case report, Pseudoaneurysm, Total

  3. Prehepatocholedochal proper hepatic artery. Rare anatomical variant. Surgical considerations. Case report.

    Science.gov (United States)

    Ardeleanu, V; Chicoş, S; Tutunaru, D; Georgescu, C

    2014-01-01

    In classical anatomic variants, the proper hepatic artery (PHA)continues the common hepatic artery (CHA) after the gastroduodenal artery (GDA) detaches itself and divides into the right hepatic artery (RHA) and left hepatic artery (LHA), the proper hepatic artery being located to the left of the hepatocholedochal duct (HCD). This paper presents an abnormal positioning of the PHA placed before the HCD with an increased diameter of about 5-7 mm, which could be confused with the HCD. We present the case of a 57 year-old woman diagnosed with acute lithiasic cholecystitis, associated with hypersplenism and hypertension. The literature mentions manifold anatomical variants of arterial liver vascularization,including PHA. For this reason, this paper presents an overview of similar cases that can be found in medical literature. The aforementioned case is a rare topographic anatomy for the PHA that can easily pass for HCD especially during celioscopy, therefore it is crucial for this to be acknowledged by all surgeons. Celsius.

  4. Impact of Multislice CT Angiography on Planning of Radiological Catheter Placement for Hepatic Arterial Infusion Chemotherapy

    International Nuclear Information System (INIS)

    Sone, Miyuki; Kato, Kenichi; Hirose, Atsuo; Nakasato, Tatsuhiko; Tomabechi, Makiko; Ehara, Shigeru; Hanari, Takao

    2008-01-01

    The objective of this study was to assess prospectively the role of multislice CT angiography (MSCTA) on planning of radiological catheter placement for hepatic arterial infusion chemotherapy (HAIC). Forty-six patients with malignant liver tumors planned for HAIC were included. In each patient, both MSCTA and intra-arterial digital subtraction angiography (DSA) were performed, except one patient who did not undergo DSA. Comparison of MSCTA and DSA images was performed for the remaining 45 patients. Detectability of anatomical variants of the hepatic artery, course of the celiac trunk, visualization scores of arterial branches and interobserver agreement, presence of arterial stenosis, and technical outcome were evaluated. Anatomical variations of the hepatic artery were detected in 19 of 45 patients (42%) on both modalities. The course of the celiac trunk was different in 12 patients. The visualization scores of celiac arterial branches on MSCTA/DSA were 3.0 ± 0/2.9 ± 0.2 in the celiac trunk, 3.0 ± 0/2.9 ± 0.3 in the common hepatic artery, 2.9 ± 0.2/2.9 ± 0.3 in the proper hepatic artery, 2.9 ± 0.3/2.9 ± 0.4 in the right hepatic artery, 2.8 ± 0.4/2.9 ± 0.4 in the left hepatic artery, 2.9 ± 0.2/2.9 ± 0.3 in the gastroduodenal artery, 2.1 ± 0.8/2.2 ± 0.9 in the right gastric artery, and 2.7 ± 0.8/2.6 ± 0.8 in the left gastric artery. No statistically significant differences exist between the two modalities. Interobserver agreement for MSCTA was equivalent to that for DSA. Two patients showed stenosis of the celiac trunk on both modalities. Based on these imaging findings, technical success was accomplished in all patients. In conclusion, MSCTA is accurate in assessing arterial anatomy and abnormalities. MSCTA can provide adequate information for planning of radiological catheter placement for HAIC

  5. Radioembolization of hepatic tumors. Flow redistribution after the occlusion of intrahepatic arteries

    International Nuclear Information System (INIS)

    Lauenstein, T.C.; Heusner, T.A.; Antoch, G.; Hamami, M.; Bockisch, A.; Ertle, J.; Schlaak, J.F.; Gerken, G.

    2011-01-01

    Radioembolization using 90yttrium is an emerging therapy option for unresectable liver malignancies. In order to reduce the number of yttrium injections, endovascular occlusion of a segmental hepatic artery has been proposed. The aim of this study was to assess whether sufficient vascular redistribution of the occluded liver segments through intrahepatic collaterals can be observed. 27 patients with hepatocellular carcinoma (n = 16) or hepatic metastases (n = 11) were studied. Hepatic angiography was performed on average 16 days prior to radioembolization. The segment II/III artery (n = 9) or the segment IV artery (n = 18) was occluded using coils. Technectium-99m-labeled macroaggregated albumin (99mTc-MAA) was injected into the right and the remaining part of the left hepatic artery in order to identify any hepatic volume not included in the perfused area. Patients underwent a SPECT/CT on average 1 h after the 99mTc-MAA injection. Two radiologists evaluated the SPECT/CT scans regarding the presence of non-perfused hepatic segments. Furthermore, hepatic perfusion was assessed by digital subtraction angiography (DSA) on the day of radioembolization. In 16 / 27 patients (59 %) a perfusion of the occluded liver segment was visible on the SPECT/CT scan. In 8 / 11 patients without flow redistribution at the time of the SPECT/CT, perfusion of the occluded segment through hepatic collaterals was observed during angiography prior to radioembolization. Hence, flow redistribution was eventually found in 24 / 27 patients (89 %). Flow redistribution after the occlusion of intrahepatic arteries prior to radioembolization can be successfully induced in the majority of patients with anatomical variants of the hepatic arteries. (orig.)

  6. The establishment of implanted VX2 liver tumor model in rabbits and discussion on superselective left hepatic arterial catheterization with micro-catheter technique via femoral artery

    International Nuclear Information System (INIS)

    Jiang Xiongying; Luo Rongguang; Huang Jinhua; Miao Bijian; Wang Yan

    2011-01-01

    Objective: To establish the implanted VX2 liver tumor model in rabbits and to discuss the feasibility and technical features of superselective left hepatic arterial catheterization by using micro-catheter through the femoral artery catheter sheath. Methods: Forty New Zealand white rabbits were inoculated with fragments of VX2 tumor into the medial left lobe of liver by using a 16G lumbar puncture needle through laparotomy route. Two weeks later, all the rabbits were proved to be successfully inoculated with liver neoplasm on CT scanning. Then, the catheter sheath was inserted into one of the femoral arteries, which was followed by celiac artery angiography and left hepatic artery catheterization with a micro-catheter under DSA guidance in order to evaluate the main branches of celiac artery and the imaging manifestations of VX2 liver tumor. After that, some scheduled interventional experiments were carried out. Results: Imaging examination and histopathologic study showed that the successful rate of implanted rabbit VX2 liver tumor was 100% (40/40). And the successful rate of the catheter sheath inserted to femoral artery was 97.5% (39/40). The successful rate of celiac artery, gastro-hepatic artery, common hepatic artery, proper hepatic artery and left hepatic artery catheterizations was 100% (39/39), 100% (39/39), 100% (39/39), 94.9% (37/39) and 71.2% (28/39) respectively. Conclusion: To implant tumor tissue mass through laparotomy is a stable and reliable method to establish rabbit VX2 liver tumor model. The insertion of micro-catheter through rabbit femoral catheter sheath approach is a convenient and simple technique to be carried out for the left hepatic artery catheterization and it can efficiently solve the technical difficulties when performing the interventional treatment of the rabbit VX2 hepatic tumor via left hepatic artery approach. (authors)

  7. Evaluation of Superselective Transcatheter Arterial Embolization with n-Butyl Cyanoacrylate in Treating Lower Gastrointestinal Bleeding: A Retrospective Study on Seven Cases

    Directory of Open Access Journals (Sweden)

    Yuan Zhao

    2016-01-01

    Full Text Available Background. To investigate the safety and efficacy of superselective transcatheter arterial embolization (TAE with n-butyl cyanoacrylate (NBCA in treating lower gastrointestinal bleeding caused by angiodysplasia. Methods. A retrospective study was performed to evaluate the clinical data of the patients with lower gastrointestinal bleeding caused by angiodysplasia. The patients were treated with superselective TAE with NBCA between September 2013 and March 2015. Angiography was performed after the embolization. The clinical signs including melena, anemia, and blood transfusion treatment were evaluated. The complications including abdominal pain and intestinal ischemia necrosis were recorded. The patients were followed up to evaluate the efficacy in the long run. Results. Seven cases (2 males, 5 females; age of 69.55±2.25 were evaluated in the study. The embolization was successfully performed in all cases. About 0.2–0.8 mL (mean 0.48±0.19 mL NCBA was used. Immediate angiography after the embolization operation showed that the abnormal symptoms disappeared. The patients were followed up for a range of 2–19 months and six patients did not reoccur. No serious complications, such as femoral artery puncture point anomaly, vascular injury, and intestinal necrosis perforation were observed. Conclusion. For the patients with refractory and repeated lower gastrointestinal hemorrhage due to angiodysplasia, superselective TAE with NBCA seem to be a safe and effective alternative therapy when endoscopy examination and treatment do not work.

  8. Microcatheter with a ball tip for hepatic embolization and intra-arterial chemotherapy

    International Nuclear Information System (INIS)

    Hori, S.; Matsushita, M.; Narumi, Y.; Fujita, M.; Tomoda, K.; Marukawa, T.; Kuroda, C.; Kozuka, T.

    1989-01-01

    A microcatheter used mainly for cranial arterial embolization and chemotherapy was employed for hepatic arterial embolization. The tip of the microcatheter is inflated like a small balloon which then acts as a calibrated-leak balloon. A coaxial system employing a conventional catheter for abdominal angiography combined with a propulsion chamber was used. Successful chemotherapy and embolization by Lipiodol and Spongel was carried out even in cases in whom it had been considered impossible to insert a catheter into the desired arteries. (orig.)

  9. Resolution of Hepatic Encephalopathy Following Hepatic Artery Embolization in a Patient with Well-Differentiated Neuroendocrine Tumor Metastatic to the Liver

    International Nuclear Information System (INIS)

    Erinjeri, Joseph P.; Deodhar, Ajita; Thornton, Raymond H.; Allen, Peter J.; Getrajdman, George I.; Brown, Karen T.; Sofocleous, Constantinos T.; Reidy, Diane L.

    2010-01-01

    Hepatic encephalopathy is considered a contraindication to hepatic artery embolization. We describe a patient with a well-differentiated neuroendocrine tumor metastatic to the liver with refractory hepatic encephalopathy and normal liver function tests. The encephalopathy was refractory to standard medical therapy with lactulose. The patient's mental status returned to baseline after three hepatic artery embolization procedures. Arteriography and ultrasound imaging before and after embolization suggest that the encephalopathy was due to arterioportal shunting causing hepatofugal portal venous flow and portosystemic shunting. In patients with a primary or metastatic well-differentiated neuroendocrine tumor whose refractory hepatic encephalopathy is due to portosystemic shunting (rather than global hepatic dysfunction secondary to tumor burden), hepatic artery embolization can be performed safely and effectively.

  10. Endovascular treatment of acute arterial complications after living-donor liver transplantation

    Energy Technology Data Exchange (ETDEWEB)

    Jeon, G.S. [Department of Diagnostic Radiology, Ajou University Hospital, School of Medicine, San 5, Wonchun-dong, Youngtong-gu, Suwon, Gyeonggido 443-721 (Korea, Republic of); Won, J.H. [Department of Diagnostic Radiology, Ajou University Hospital, School of Medicine, San 5, Wonchun-dong, Youngtong-gu, Suwon, Gyeonggido 443-721 (Korea, Republic of)], E-mail: wonkwak@ajou.ac.kr; Wang, H.J.; Kim, B.W. [Department of Surgery, Ajou University Hospital, School of Medicine, San 5, Wonchun-dong, Youngtong-gu, Suwon, Gyeonggido 443-721 (Korea, Republic of); Lee, B.M. [Department of Surgery, Aerospace medical center, Ssangsu-ri, Cheongwon-gun, Chungcheongbuk-do 363-849 (Korea, Republic of)

    2008-10-15

    Aim: The aim of this study was to evaluate the efficacy of endovascular treatment for acute arterial complications following living-donor liver transplantation (LDLT). Materials and methods: Of 79 LDLT patients, 17 (mean age 48 {+-} 8 years, range 33-66 years) who had acute arterial complications and underwent endovascular treatment were evaluated. Transcatheter arterial embolization was performed to control peritoneal bleeding. Catheter-directed thrombolysis using urokinase was performed in hepatic artery thromboses. The locations of complications and materials used were evaluated. The technical and clinical success rates were calculated. Results: Twenty-three acute arterial complications, including four hepatic artery thromboses and 19 cases of peritoneal haemorrhages were identified in 22 angiographic sessions in 17 patients. The mean duration between LDLT and first angiography was 3.2 {+-} 3.5 days (range 1-13 days). Hepatic artery recanalization with catheter-directed thrombolysis using urokinase was achieved in two patients. Transcatheter arterial embolization for peritoneal bleeding was successfully performed in 16 cases. The most common bleeding focus was the right inferior phrenic artery. Additional surgical management was needed in five patients to control bleeding or hepatic artery recanalization. Technical and clinical success rates of transcatheter arterial embolization were 84.2 and 63.1%, respectively. Overall technical success was achieved in 18 of 23 arterial complications (78.2%), and clinical success was achieved in 14 of 23 arterial complications (60.8%). Conclusion: Endovascular treatment for the acute arterial complications of haemorrhage or thrombosis in LDLT patients is safe and effective. Therefore, it should be considered as the first line of treatment in selective cases.

  11. Hepatic arterial supply in 1297 CT-angiographies; Die arterielle Leberversorgung in 1297 CT-Angiografien

    Energy Technology Data Exchange (ETDEWEB)

    Loeschner, C.; Kausche, S.; Teichgraeber, U. [Jena University Hospital, Jena (Germany). Dept. of Radiology; Nagel, S.N. [Charite Universitaetsmedizin Berlin (Germany). Dept. of Radiology

    2015-04-15

    Analysis, evaluation and classification of hepatic arterial supply variants and determination of their frequency distribution in CT-angiographies. CT-angiographies of 1,568 patients were evaluated retrospectively for the period between January 1, 2010 and August 30, 2012. The hepatic arterial anatomy was assessed and categorized according to Michels's classification. So far unclassified variants were considered separately. Results: CT-angiographies of 1297 patients were included in the study. Type I according to Michels was seen in 937 cases (72.2%), followed by type V in 114 patients (8.8%) and type III in 83 patients (6.4%). Type X could not be found in any of the patients. Not yet classified variants were discovered in 26 patients. The most frequent variant in this connection was a right hepatic artery originating from the superior mesenteric artery with the left hepatic artery originating from the left gastric artery (n=10). Michels's classification could be largely confirmed on the basis of a radiologically examined patient population. Not yet classified variants were categorized into subgroups of the existing classification.

  12. Microballoon Occlusion Test to Predict Colonic Ischemia After Transcatheter Embolization of a Ruptured Aneurysm of the Middle Colic Artery

    International Nuclear Information System (INIS)

    Tajima, Tsuyoshi; Yoshimitsu, Kengo; Inokuchi, Hiroyuki; Irie, Hiroyuki; Nishie, Akihiro; Hirakawa, Masakazu; Ishigami, Kousei; Ushijima, Yasuhiro; Okamoto, Daisuke; Honda, Hiroshi; Itoh, Hiroyuki; Morita, Masaru; Kakeji, Yoshihiro

    2008-01-01

    A 76-year-old woman presented with sudden massive melena, and superior mesenteric arteriography showed an aneurysm in the middle colic artery (MCA). Because she had a history of right hemicolectomy and ligation of the inferior mesenteric artery (IMA) during open abdominal aortic aneurysm repair, embolization of the MCA aneurysm was considered to pose a risk comparable to that of colonic ischemia. A microballoon occlusion test during occlusion of the MCA confirmed retrograde visualization of the IMA branches through the collateral arteries by way of the left internal iliac artery, and embolization was successfully performed using microcoils. No colonic ischemia or aneurysm rupture occurred after embolization.

  13. [Clinical application of combined hepatic artery resection and reconstruction in surgical treatment for hilar cholangiocarcinoma].

    Science.gov (United States)

    Dai, H S; Bie, P; Wang, S G; He, Y; Li, D J; Tian, F; Zhao, X; Chen, Z Y

    2018-01-01

    Objective: To clarify whether the surgical treatment for hilar cholangiocarcinoma combined with artery reconstruction is optimistic to the patients with hilar cholangiocarcinoma with hepatic artery invasion. Methods: There were 384 patients who received treatment in the First Affiliated Hospital to Army Medical University from January 2008 to January 2016 analyzed retrospectively. There were 27 patients underwent palliative operation, 245 patients underwent radical operation, radical resection account for 63.8%. Patients were divided into four groups according to different operation method: routine radical resection group( n =174), portal vein reconstruction group ( n =47), hepatic artery reconstruction group ( n =24), palliative group( n =27). General information of patients who underwent radical operation treatment was analyzed by chi-square test and analysis of variance. The period of operation time, blood loss, the length of hospital stay and hospitalization expenses of the radical operation patients were analyzed by one-way ANOVA. Comparison among groups was analyzed by LSD- t test. Results: The follow-up ended up in June first, 2016. Each of patients followed for 6 to 60 months, the median follow-up period was 24 months. 1-, 3-, and 5-year survival rates were 81.3%, 44.9% and 13.5% of routine radical operation group, and were 83.0%, 44.7% and 15.1% of portal vein reconstruction group, and were 70.8%, 27.7% and 6.9% of hepatic artery reconstruction group, respectively. And 1-, 3-, and 5-year survival rates of hepatic artery reconstruction group was lower than routine radical group and portal vein reconstruction group significantly ( P 0.05). The data shows that the ratio of lymphatic metastasis in hepatic artery reconstruction group (70.8%) is much higher than them in routine radical operation group (20.1%) and portal vein reconstruction group (19.1%) significantly ( P hilar cholangiocarcinoma. Cox regression analysis indicate that hepatic artery resection and

  14. Nursing care of patients receiving interventional therapy for hepatic artery stenosis after liver transplantation

    International Nuclear Information System (INIS)

    Wei Lin; Liu Shiguang

    2009-01-01

    Objective: To discuss the perioperative nursing care of patients who is going to receive interventional therapy for hepatic artery stenosis after liver transplantation and to provide useful reference for reducing surgery-related complication and for improving the prognosis of patients. Methods: Based on the patient's condition and operative requirement,we provided effective nursing care for 20 patients who were admitted to receive the interventional therapy for hepatic artery stenosis after liver transplantation. The nursing care included preoperative preparation,postoperative nursing and medical guidance at the time of discharge. Results: Interventional therapy was successfully performed in all 20 cases, and no hemorrhagic tendency or acute thrombosis occurred. Marked symptomatic improvement was obtained in all patients. Conclusion: The interventional therapy is an effective treatment for hepatic artery stenosis after liver transplantation. Intensive perioperative nursing care can well prevent the occurrence of surgery-related complications and can surely improve the therapeutic results. (authors)

  15. Effect of surgical resection combined with transcatheter arterial chemoembolization on postoperative serum tumor marker levels and stem cell characteristics during tumor recurrence

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    Sen Yang

    2017-05-01

    Full Text Available Objective: To study the effect of surgical resection combined with transcatheter arterial chemoembolization (TACE on postoperative serum tumor marker levels and stem cell characteristics during tumor recurrence. Methods: A total of 98 patients with liver cancer who received radical resection in our hospital between May 2013 and July 2015 were reviewed and divided into TACE group and control group according to whether they received TACE within two months after surgical resection. Serum levels of tumor markers were detected 4 weeks after operation; the tumor recurrence was followed up within 3 years after operation, and the expression of stem cell marker molecules and cell proliferation molecules in recurrent lesions were detected. Results: 4 weeks after radical hepatectomy, serum AFP, AFP-L3, GP73 and GPC3 levels in TACE group were significantly lower than those in control group; Nanog, CD133, EpCAM, PICK1, CyclinD1, C-myc and Survivin expression in surgically removed lesions of TACE group were not different from those of control group while Nanog, CD133, EpCAM, PICK1, CyclinD1, C-myc and Survivin expression in recurrent lesions were significantly lower than those of control group. Conclusion: Surgical resection combined with TACE can more effectively remove liver cancer lesions, reduce the tumor marker levels and inhibit the tumor stem cell characteristics and cell proliferation activity in recurrent lesions.

  16. Influence of sequential 125I particle chain implantation and transcatheter arterial chemoembolization on tumor cell killing effect in patients with liver cancer

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    Wei Dai

    2017-07-01

    Full Text Available Objective: To study the influence of sequential 125I particle chain implantation and transcatheter arterial chemoembolization (TACE on tumor cell killing effect in patients with liver cancer. Methods: A total of 82 cases of patients with advanced liver cancer who were treated in our hospital between September 2014 and December 2016 were collected, reviewed and then divided into the control group (n=45 who received TACE alone and the observation group (n=37 who received sequential 125I particle chain implantation and TACE. Serum levels of tumor markers, angiogenesis indexes and apoptosis molecules before and after treatments were compared between two groups of patients. Results: Before treatment, differences in serum levels of tumor markers, angiogenesis indexes and apoptosis molecules were not statistically significant between two groups of patients. After treatment, serum tumor markers AFP, CA199, CA153 and Ferritin levels in observation group were lower than those in control group; serum angiogenesis indexes VEGF, PEDF, ES and bFGF contents were lower than those in control group; serum apoptosis molecules p53 and Fas contents were higher than those in control group. Conclusion: Sequential 125I particle chain implantation and TACE treatment of advanced liver cancer can effectively reduce tumor malignancy and promote tumor apoptosis.

  17. Transcatheter arterial embolization of abnormal vessels as a treatment for lateral epicondylitis refractory to conservative treatment: a pilot study with a 2-year follow-up.

    Science.gov (United States)

    Iwamoto, Wataru; Okuno, Yuji; Matsumura, Noboru; Kaneko, Takao; Ikegami, Hiroyasu

    2017-08-01

    Abnormal vessels and accompanying nerves are possible sources of pain with lateral epicondylitis. The purpose of this study was to describe the safety and efficacy of transcatheter arterial embolization (TAE) for lateral epicondylitis resistant to conservative treatment. This prospective study was conducted in 24 patients with lateral epicondylitis resistant to conservative treatments for more than 3 months, with a symptom duration longer than 6 months, and with moderate to severe pain who were treated with TAE between March 2013 and October 2014. Two patients were lost to follow-up, and the remaining 22 patients were followed up for 2 years after TAE. Abnormal vessels were identified in all of the patients. No major adverse events were observed. The Quick Disabilities of the Arm, Shoulder and Hand scores at baseline significantly decreased at 1, 3, 6, and 24 months after treatment (50.8 vs 23.4, 8.3, 5.3, and 2.7, respectively; all P lateral epicondylitis that fails to improve with conservative treatments. Copyright © 2017 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

  18. Efficacy and safety of radiofrequency ablation combined with transcatheter arterial chemoembolization for hepatocellular carcinomas compared with radiofrequency ablation alone: A time to event meta-analysis

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    Wang, Xin; Hu, Yanan; Ren, Mudan; Lu, Xin Lan; Lu, Gui Fang; He, Shui Xiang [Dept. of Gastroenterology, First Affiliated Hospital of Xi' an Jiaotong University, Xi' an (China)

    2016-02-15

    To compare the efficacy and safety of combined radiofrequency ablation (RFA) and transcatheter arterial chemoembolization (TACE) with RFA alone for hepatocellular carcinomas (HCC). Randomized controlled trial (RCT) studies that compared the clinical or oncologic outcomes of combination therapy of TACE and RFA versus RFA for the treatment of HCC were identified through literature searches of electronic databases (Pubmed, Embase, Cochrane Library, China Biology Medicine disc, China National Knowledge Infrastructure, and Google Scholar). Hazard ratios (HRs) or odds ratios (ORs) with their corresponding 95% confidence interval (CI) were combined as the effective value to assess the summary effects. The strength of evidence was rated by the Grading of Recommendations Assessment, Development, and Evaluation system. Six RCTs with 534 patients were eligible for inclusion in this meta-analysis. The meta-analysis showed that the combination of TACE and RFA is associated with a significantly longer overall survival (HR = 0.62, 95% CI: 0.49-0.78, p < 0.001) and recurrence-free survival (HR = 0.55, 95% CI: 0.40-0.76, p < 0.001) in contrast with RFA monotherapy. The seemingly higher incidence of major complications in the combination group compared with RFA group did not reach statistical significance (OR = 1.17, 95% CI: 0.39-3.55, p = 0.78). In patients with HCC, the combination of TACE and RFA is associated with significantly higher overall survival and recurrence-free survival, as compared with RFA monotherapy, without significant difference in major complications.

  19. Evaluation of residual hepatocellular carcinoma after transcatheter arterial chemoembolization: Comparison between contrast-enhanced helical CT and contrast-enhanced power doppler ultrasonography

    International Nuclear Information System (INIS)

    Kim, Seung Hoon; Lim, Hyo Keun; Lee, Won Jae

    2001-01-01

    To evaluate the effectiveness of contrast-enhanced helical CT and contrast-enhanced power doppler ultrasonography (PDUS) in assessing the therapeutic effect of transcatheter arterial chemoembolization (TACE) in hepatocellular carcinomas (HCCs). The follow-up contrast-enhanced helical CT and contrast-enhanced PDUS were performed for twenty-nine nodular HCCs from twelve patients previously treated with TACE. We defined the residual HCCs as intratumoral enhancing area on contrast-enhanced helical CT and color signal on contrast-enhanced PDUS. The interval between two examinations was less than 2 weeks (mean, 9 days). Two radiologists evaluated two examinations by consensus, and the results of these two examination were compared with the findings of other examinations including CT, angiography, and/or pathology to calculate the sensitivity, specificity and accuracy of two examinations. Of the 29 HCCs, 20 had residual HCCs whereas no residual HCCs in 9 HCCs on pathologic examination and/or follow-up radiologic study. The sensitivity, sensitivity and accuracy of contrast-enhanced helical CT were 65 (13/20), 89 (8/9), and 72% (21/29) while those of contrast-enhanced PDUS were 100 (20/20), 89 (8/9) and 97% (28/29), respectively. A microbubble contrast-enhanced PDUS was more effective in the detection of residual tumor in HCCs following TACE than contrast-enhanced helical CT.

  20. Efficacy and safety of radiofrequency ablation combined with transcatheter arterial chemoembolization for hepatocellular carcinomas compared with radiofrequency ablation alone: A time to event meta-analysis

    International Nuclear Information System (INIS)

    Wang, Xin; Hu, Yanan; Ren, Mudan; Lu, Xin Lan; Lu, Gui Fang; He, Shui Xiang

    2016-01-01

    To compare the efficacy and safety of combined radiofrequency ablation (RFA) and transcatheter arterial chemoembolization (TACE) with RFA alone for hepatocellular carcinomas (HCC). Randomized controlled trial (RCT) studies that compared the clinical or oncologic outcomes of combination therapy of TACE and RFA versus RFA for the treatment of HCC were identified through literature searches of electronic databases (Pubmed, Embase, Cochrane Library, China Biology Medicine disc, China National Knowledge Infrastructure, and Google Scholar). Hazard ratios (HRs) or odds ratios (ORs) with their corresponding 95% confidence interval (CI) were combined as the effective value to assess the summary effects. The strength of evidence was rated by the Grading of Recommendations Assessment, Development, and Evaluation system. Six RCTs with 534 patients were eligible for inclusion in this meta-analysis. The meta-analysis showed that the combination of TACE and RFA is associated with a significantly longer overall survival (HR = 0.62, 95% CI: 0.49-0.78, p < 0.001) and recurrence-free survival (HR = 0.55, 95% CI: 0.40-0.76, p < 0.001) in contrast with RFA monotherapy. The seemingly higher incidence of major complications in the combination group compared with RFA group did not reach statistical significance (OR = 1.17, 95% CI: 0.39-3.55, p = 0.78). In patients with HCC, the combination of TACE and RFA is associated with significantly higher overall survival and recurrence-free survival, as compared with RFA monotherapy, without significant difference in major complications

  1. Volume-rendered hemorrhage-responsible arteriogram created by 64 multidetector-row CT during aortography: utility for catheterization in transcatheter arterial embolization for acute arterial bleeding.

    Science.gov (United States)

    Minamiguchi, Hiroki; Kawai, Nobuyuki; Sato, Morio; Ikoma, Akira; Sanda, Hiroki; Nakata, Kouhei; Tanaka, Fumihiro; Nakai, Motoki; Sonomura, Tetsuo; Murotani, Kazuhiro; Hosokawa, Seiki; Nishioku, Tadayoshi

    2014-01-01

    Aortography for detecting hemorrhage is limited when determining the catheter treatment strategy because the artery responsible for hemorrhage commonly overlaps organs and non-responsible arteries. Selective catheterization of untargeted arteries would result in repeated arteriography, large volumes of contrast medium, and extended time. A volume-rendered hemorrhage-responsible arteriogram created with 64 multidetector-row CT (64MDCT) during aortography (MDCTAo) can be used both for hemorrhage mapping and catheter navigation. The MDCTAo depicted hemorrhage in 61 of 71 cases of suspected acute arterial bleeding treated at our institute in the last 3 years. Complete hemostasis by embolization was achieved in all cases. The hemorrhage-responsible arteriogram was used for navigation during catheterization, thus assisting successful embolization. Hemorrhage was not visualized in the remaining 10 patients, of whom 6 had a pseudoaneurysm in a visceral artery; 1 with urinary bladder bleeding and 1 with chest wall hemorrhage had gaze tamponade; and 1 with urinary bladder hemorrhage and 1 with uterine hemorrhage had spastic arteries. Six patients with pseudoaneurysm underwent preventive embolization and the other 4 patients were managed by watchful observation. MDCTAo has the advantage of depicting the arteries responsible for hemoptysis, whether from the bronchial arteries or other systemic arteries, in a single scan. MDCTAo is particularly useful for identifying the source of acute arterial bleeding in the pancreatic arcade area, which is supplied by both the celiac and superior mesenteric arteries. In a case of pelvic hemorrhage, MDCTAo identified the responsible artery from among numerous overlapping visceral arteries that branched from the internal iliac arteries. In conclusion, a hemorrhage-responsible arteriogram created by 64MDCT immediately before catheterization is useful for deciding the catheter treatment strategy for acute arterial bleeding.

  2. Hepatic artery stent-grafts for the emergency treatment of acute bleeding

    Energy Technology Data Exchange (ETDEWEB)

    Bellemann, Nadine, E-mail: nadine.bellemann@med.uni-heidelberg.de [Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, INF 110, 69120 Heidelberg (Germany); Sommer, Christof-Matthias; Mokry, Theresa; Kortes, Nikolas; Gnutzmann, Daniel; Gockner, Theresa; Schmitz, Anne [Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, INF 110, 69120 Heidelberg (Germany); Weitz, Jürgen [Department of Surgery, University Hospital Heidelberg, INF 110, 69120 Heidelberg (Germany); Department for Visceral, Thoracic and Vascular Surgery at the University Hospital, Technical University Dresden (Germany); Kauczor, Hans-Ulrich; Radeleff, Boris; Stampfl, Ulrike [Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, INF 110, 69120 Heidelberg (Germany)

    2014-10-15

    Highlights: • We report our experiences with stent-grafts for the treatment of acute hemorrhage from the hepatic artery or the stump of the gastroduodenal artery. • The technical success of stent-graft implantation was 88%. • The bleeding ceased immediately after stent-graft implantation in 88%. • The complication rate was 21%. - Abstract: Purpose: We evaluated the technical success and clinical efficacy of stent-graft implantation for the emergency management of acute hepatic artery bleeding. Methods: Between January 2010 and July 2013, 24 patients with hemorrhage from the hepatic artery were scheduled for emergency implantation of balloon expandable stent-grafts. The primary study endpoints were technical and clinical success, which were defined as successful stent-graft implantation with sealing of the bleeding site at the end of the procedure, and cessation of clinical signs of hemorrhage. The secondary study endpoints were complications during the procedure or at follow-up and 30-day mortality rate. Results: In 23 patients, hemorrhage occurred after surgery, and in one patient hemorrhage occurred after trauma. Eight patients had sentinel bleeding. In most patients (n = 16), one stent-graft was implanted. In six patients, two overlapping stent-grafts were implanted. The stent-grafts had a target diameter between 4 mm and 7 mm. Overall technical success was 88%. The bleeding ceased after stent-graft implantation in 21 patients (88%). The mean follow-up was 137 ± 383 days. In two patients, re-bleeding from the hepatic artery occurred during follow-up after 4 and 29 days, respectively, which could be successfully treated by endovascular therapy. The complication rate was 21% (minor complication rate 4%, major complication rate 17%). The 30-day mortality rate was 21%. Conclusions: Implantation of stent-grafts in the hepatic artery is an effective emergency therapy and has a good technical success rate for patients with acute arterial hemorrhage.

  3. Use of a Stent Graft for Bleeding Hepatic Artery Pseudoaneurysm Following Pancreaticoduodenectomy

    Directory of Open Access Journals (Sweden)

    Leoncio L. Kaw, Jr

    2006-10-01

    Full Text Available Although uncommon, bleeding following pancreaticoduodenectomy is associated with high mortality. Management generally includes surgical reexploration or, alternatively, transarterial embolization. We report the case of a 62-year-old man who presented with massive upper gastrointestinal bleeding 3 weeks after pancreaticoduodenectomy. Selective coeliac angiography revealed a large pseudoaneurysm involving the proper hepatic artery. This was treated successfully with a stent graft. There was no recurrence of bleeding at the 6-month follow-up. To our knowledge, this is the first report of stent graft repair of bleeding hepatic artery pseudoaneurysm following pancreaticoduodenectomy.

  4. Dual Energy Computed Tomography to Evaluate Hepatocellular Carcinoma Treated with Transcatheter Arterial Chemo-Embolization: Comparison between the Linear Blending and Nonlinear Moidal Blending Methods

    International Nuclear Information System (INIS)

    Shin, Sang Soo; Kim, Hyeong Wook; Lee, Daun; Kang, Heoung Keun; Kim, Jin Woong; Heo, Suk Hee; Jeong, Yong Yeon; Seon, Hyun Ju

    2012-01-01

    To compare the linear blending image with the nonlinear moidal blending image using dual energy CT for the evaluation of the viable portion of hepatocellular carcinoma (HCC) after transcatheter arterial chemoembolization (TACE). One-hundred and twenty three HCC patients incompletely treated after TACE were enrolled in this study. The dual energy mode (80 kVp and Sn140 kVp) was only applied in the late arterial phase scanning. A paired t-test was used to compare the lesion-to-liver contrast-to-noise ratio (CNR) and the image noise between the two blending images. Lesion conspicuity, image sharpness, image noise and the overall image quality between the two blending images were compared using the Wilcoxon matched-pair signed-ranks test. The lesion-to-liver CNR was significantly higher on the moidal blending image (5.6 ± 3.2) than on the linear blending image (2.7 ± 1.6) (p < 0.001). The image noise was significantly lower on the moidal blending image (10.9 ± 3.5) than on the linear blending image (17.5 ± 5.5) (p < 0.001). The lesion conspicuity and overall image quality were significantly better on the moidal blending image for both reviewers (p < 0.001). However, with respect to image sharpness, the linear blending image was significantly better for both reviewers (p < 0.01). The nonlinear moidal blending image of dual energy CT showed an increased lesion-to-liver CNR, decreased noise and improved overall image quality for the evaluation of the viable portion of HCC after TACE.

  5. Clinical observation on coil embolization in treatment of hepatic arterial pseudoaneurysm

    International Nuclear Information System (INIS)

    Chen Yaoting; Xu Linfeng; Jiang Rongjian; Zhou Jingxing; Luo Jianghong; Tang Qiyun; Hu Renmei

    2007-01-01

    Objective: To discuss the method, mid-long term clinical therapeutic effect and safety of coil embolization in treating patients with hepatic arterial pseudoaneurysm (HAPA). Methods: Seven patients with repeatedly massive hemorrhage of gastrointestinal tract were undertaken DSA of celiac arteries and hepatic arteries and embolization of the feeding artery by coils or microcoils after correct diagnosis. All cases underwent follow-up from 6 to 60 months(mean 38). Results: The blood loss before angiography was ranged from 1200 to 4 000 (mean 2 385) ml. There were 3 cases with normal hepatic function and 4 with hepatic dysfunction including ALT increase in 2 and obstructive jaundice in another. Digital substraction angiography (DSA) clearly showed the location, shape and feeding arteries of HAPA. There were 2 types of HAPA namely intrahepatic (n=3)and extrahepatic (n=4), adding one case with arteriovenous fistula (AVF). Embolization was successful in all cases by coils (n=13) or microcoils (n=12). No recurrence and any definite clinical complication occurred during follow-up. Conclusion: Coil embolization in treating HAPA is safe and effective with mid-long term positive clinical therapeutic efficiency without severe complications. (authors)

  6. [POL-PAVTI--Polish report on transcatheter pulmonary artery valve implantation of Melody-Medtronic prosthesis in the first 14 patients in Poland].

    Science.gov (United States)

    Ruzyłło, Witold; Demkow, Marcin; Włodarska, Elzbieta K; Kowalski, Mirosław; Spiewak, Mateusz; Siudalska, Hanna; Wolski, Piotr; Miśko, Jolanta; Hoffman, Piotr; Kusa, Jacek; Szkutnik, Małgorzata; Białkowski, Jacek; Fiszer, Roland; Urbańska, Ewa; Sondergaard, Lars

    2009-10-01

    To assess the early results of the pulmonary artery valve transcatheter implantation (PAVTI) in pts included into POL-PAVTI registry. Detailed medical and economic analyses were performed. Pulmonary artery valve implantation was performed in 14 pts (9 men), aged 16-31 (mean 24.6 +/- 4.8) years, with pulmonary homograft dysfunction after total repair of tetralogy of Fallot (4 pts), pulmonary atresia (2 pts), pulmonary stenosis (1 pt), common arterial trunk type I (1 pt), Ross procedure (3 pts) and TGA - Rastelli operation (3 pts). Eleven pts underwent in the past 2-5 surgical or/and catheter interventions. Indication for PAVTI was based on clinical evaluation and echocardiographic studies. Assessment of morphological and functional features of the right ventricle (RV) and homograft with the use of cardiac magnetic resonance (CMR) was performed in 10 cases. Pulmonary stenosis (max. pulmonary gradient 32-119, mean 72 +/- 28 mmHg) was observed in 13 pts and/or significant pulmonary regurgitation in 10 pts. The procedure was performed in general anesthesia. The deployment of a valved stent in the pulmonary valve position was preceded by a metal stent implantation. Results were evaluated by echocardiography two days after the procedure and one month later. Four patients were evaluated 6 months after procedure. Time of the procedure varied 60-190 (mean 127 +/- 35) min, time of fluoroscopy ranged 12-31 (mean 21 +/- 11) min. PAVTI was successfully performed in all pts without serious complications. Patients were discharged from the hospital 48-293 (mean 120 +/- 71) h after procedure. Significant reduction of pulmonary gradient after the procedure assessed by echocardiography was observed on the second day (20-60, mean 38 +/- 12 mmHg, p < 0.0001) and one month (19-52, mean 34 +/- 9 mmHg, p < 0.0001). Mild pulmonary regurgitation was observed in 2 pts. In 5 pts evaluated 6 months after procedure haemodynamic parameters were unchanged; no late complications were observed

  7. Liver microcirculation after hepatic artery embolization with degradable starch microspheres in vivo

    Institute of Scientific and Technical Information of China (English)

    Jian Wang; Satoru Murata; Tatsuo Kumazaki

    2006-01-01

    AIM: To observe the dynamic changes of liver microcirculation in vivo after arterial embolization with degradable starch microspheres (DSM).METHODS: DSM were injected into the proper hepatic artery through a silastic tube inserted retrogradely in gastroduodenal artery (GDA) of SD rats. Fluorescent microscopy was used to evaluate the dynamic changes of blood flow through the terminal portal venules (TPVs), sinusoids and terminal hepatic venules (THVs).The movements of DSM debris were also recorded. Six hours after injection of DSM, percentages of THVs with completely stagnant blood flow were recorded.RESULTS: Two phases of blood flow change were recorded. In phase one: after intra-arterial injection of DSM, slow or stagnant blood flow was immediately recorded in TPVs, sinusoids and THVs. This change was reversible, and blood flow resumed completely. In phase two: after phase one, blood flow in TPVs changed again and three patterns of blood flow were recorded. Six hours after DSM injection, 36.9% ± 9.2% of THVs were found with completely stagnant blood flow.CONCLUSION: DSM can stop the microcirculatory blood flow in some areas of liver parenchyma. Liver parenchyma supplied by arteries with larger A-P shunt is considered at a higher risk of total microcirculatory blood stagnation after injection of DSM through hepatic artery.

  8. The biodistribution and effect on hepatic parenchyma with intraarterial injected I-131 lipiodol into hepatic artery

    International Nuclear Information System (INIS)

    Kim, Dong Ik; Suh, Jung Ho; Yoo, Hyung Sik; Lee, Jong Tae; Kim, Ki Whang; Park, Chan Il; Kim, Byung Ro

    1989-01-01

    Iodized oil has been used as a contrast agent in lymphangiography. One of the commercially available compounds is Lipidol Ultra-fluid(LUF) which contains 38% iodine by weight. Nakakuma et al(1979) reported that LUF was selectively retained in the hypervascular hepatocellular carcinoma when injected directly into the ligated hepatic artery. Since that time, it has been widely utilized in the detection as well as the therapeutic attempts of hepatocellular carcinoma, where it has been mixed with chemotherapeutic agents or labeled with radioactive I-131. Like all significant advances, the mechanism of lipid retention within the hepatocellular carcinoma is not clearly understood, and also there is a lack of information about the biodistribution and kinetics of I-131 Lipiodol. The apparent safety of this technique require confirmation. The present study was aimed to assess the biodistribution and kinetics of intraarterially injected I-131 Lipiodol and the histologic changes in canine livers. It was also to verify the safety of this technique in clinical applications. Radioactive iodized oil was obtained by simple exchange method . 518 ± 19 MBq(14 mCi, about 1 mCi/kg body weight) of I-131 Lipiodol was injected intraarterially in 12 dogs as a experimental group. Serial count rates over the livers under gamma camera were measured, and then it was compared with quantitative analysis of radioactivities distributed in liver, lung, spleen, kidney, thyroid, bile and circulating blood using dose calibrator after sacrifice at various time intervals. Cumulative radiation doses were calculated by Quimby method. The effect of I-131 lipiodol on hepatic function were analysed by serial liver function tests after intrahepatic injection of I-131 Lipiodol and compared with preinjection values. Liver tissue obtained after sacrifice were stained with hematoxylin-eosin, Oil red-O, and also election microscopic examinations were performed. The results were summarized as follows; 1

  9. Changes in distribution of hepatic blood flow induced by intra-arterial infusion of angiotensin II in human hepatic cancer

    International Nuclear Information System (INIS)

    Sasaki, Y.; Imaoka, S.; Hasegawa, Y.

    1985-01-01

    Changes in the distribution of the hepatic blood flow induced by intra-arterial infusion of angiotensin II (AT-II) were studied in human hepatic cancers using extremely short-lived radioisotope (RI) (krypton 81 m [/sup 81m/Kr]; half-life, 13 seconds). After the start of continuous infusion of AT-II, the radioactivity of the tumor showed about a two-fold increase, whereas that of the nontumor region decreased to about one half as much as the level before the infusion. Consequently, the mean ratio of the arterial blood flow in the tumor region to that in the nontumor region (T/N ratio) increased to 3.30 (P less than 0.001). The T/N ratio showed a peak before the peripheral blood pressure reached the maximum, and thereafter tended to decrease. Intra-arterial infusion of AT-II raised the T/N ratio more obviously than did intravenous infusion of the drug, with less rise in the peripheral blood pressure. It is believed that intra-arterial infusion chemotherapy with local use of AT-II enables better accessibility of chemotherapeutic drugs to tumors

  10. Impact of femoral artery puncture using digital subtraction angiography and road mapping on vascular and bleeding complications after transfemoral transcatheter aortic valve implantation.

    Science.gov (United States)

    El-Mawardy, Mohamed; Schwarz, Bettina; Landt, Martin; Sulimov, Dmitriy; Kebernik, Julia; Allali, Abdelhakim; Becker, Bjoern; Toelg, Ralph; Richardt, Gert; Abdel-Wahab, Mohamed

    2017-01-20

    The use of large-diameter sheaths carries the risk of significant vascular and bleeding complications after transfemoral transcatheter aortic valve implantation (TAVI). In this analysis, we sought to assess the impact of a modified femoral artery puncture technique using digital subtraction angiography (DSA) and road mapping during transfemoral TAVI on periprocedural vascular and bleeding events. This is a retrospective analysis of transfemoral TAVI patients included in a prospective institutional database. The modified femoral artery puncture technique using DSA-derived road mapping guidance was introduced in October 2012. Before the introduction of this technique, vascular puncture was acquired based on an integration of angiographic data, the bony iliofemoral landmarks and a radiopaque object. Consecutive patients who underwent TAVI with the road mapping technique (RM group, n=160) were compared with consecutive patients who underwent TAVI without road mapping (control group, n=160) prior to its introduction. A standardised strategy of periprocedural anticoagulation was adopted in both groups as well as the use of a single suture-based closure device. All endpoints were defined according to the VARC-2 criteria for event definition. The mean age in the RM group was 80±7.7 years compared to 81±5.9 years in the control group (p=0.19), and females were equally distributed between both groups (63.1% vs. 58.1%, p=0.36). The baseline logistic EuroSCORE was 20.7±14.4% vs. 24.9±15.2% in the RM and control group, respectively (p=0.01). Notably, sheath size was significantly larger in the RM compared to the control group due to the more frequent use of the 20 Fr sheath (23.8% vs. 1.8%, proad map group but did not reach statistical significance (8.1% vs. 13.8%, p=0.1). Other forms of vascular and bleeding complications as well as all-cause mortality were comparable in both groups. A modified femoral artery puncture technique using DSA and road mapping was associated

  11. Successful Control of Liver Metastases From Pancreatic Solid-Pseudopapillary Neoplasm (SPN) Using Hepatic Arterial Embolization

    Energy Technology Data Exchange (ETDEWEB)

    Violari, Elena G., E-mail: eviolari@live.com; Brody, Lynn A.; Covey, Anne M.; Erinjeri, Joseph P.; Getrajdman, George I.; Sofocleous, Constantinos T. [Memorial Sloan-Kettering Cancer Center, Department of Radiology, Interventional Radiology Service (United States); Reidy, Diane L. [Memorial Sloan-Kettering Cancer Center, Department of Medicine, Gastrointestinal Oncology Service (United States); Jarnagin, William R. [Memorial Sloan-Kettering Cancer Center, Department of Surgery, Hepatopancreatobiliary Service (United States); Brown, Karen T. [Memorial Sloan-Kettering Cancer Center, Department of Radiology, Interventional Radiology Service (United States)

    2015-04-15

    No systemic agents that are known to be effective for the treatment of solid-pseudopapillary neoplasm (SPN) are available. We report the prolonged and sustained control of metastatic pancreatic SPN to the liver using hepatic arterial embolization (HAE), where a total of 13 HAE sessions were performed over a 6-year period.

  12. Hepatic artery aneurysm simulating a lesion in the head of the pancreas: a case report

    International Nuclear Information System (INIS)

    Pinto, Oswaldo Luiz; Camargo, Jose Gonzaga; Tornin, Olger de Souza; Botelho, Renato Assayag; Menezes, Marcelo Carneiro; Chagas, Jose Francisco Sales; Souza, Ricardo Pires de

    2005-01-01

    The aim of this study is to report a rare case of hepatic artery aneurysm simulating a lesion in the head of the pancreas. A precise evaluation using computed tomography and magnetic resonance imaging is important in the treatment planning, which will influence the prognosis. (author)

  13. Hepatic artery aneurysm in a patient with Behcet's disease and segmental pancreatitis developing after its embolization

    International Nuclear Information System (INIS)

    Oto, A.; Cekirge, S.; Guelsuen, M.; Balkanci, F.; Besim, A.

    2000-01-01

    Segmental pancreatitis is an unusual form of acute pancreatitis mostly seen in the head of pancreas. We present the CT findings of a segmental pancreatitis in the body and tail of the pancreas developed following endovascular embolization of a giant hepatic artery aneurysm and arterioportal fistula in a patient with Behcet's disease. (orig.)

  14. Combined resection of aberrant right hepatic artery without anastomosis in panceaticoduodenectomy for pancreatic head cancer: A case report.

    Science.gov (United States)

    Nanashima, Atsushi; Imamura, Naoya; Tsuchimochi, Yuki; Hiyoshi, Masahide; Fujii, Yoshiro

    2016-01-01

    This case report is intended to inform pancreas surgeons of our experience in operative management of aberrant pancreatic artery. A 63-year-old woman was admitted to our institute's Department of Surgery with obstructive jaundice, and the pancreas head tumor was found. To improve liver dysfunction, an endoscopic retrograde nasogastric biliary drainage tube was placed in the bile duct. Endoscopic fine-needle aspiration showed a pancreas head carcinoma invading the common bile duct, the aberrant right hepatic artery arising from the superior mesenteric artery, and the portal vein. Enhanced computed tomography showed the communicating artery between the right and left hepatic artery via the hepatic hilar plate. By way of imaging preoperative examination, a pancreaticoduodenectomy combined resection of the aberrant right hepatic artery and portal vein was conducted without arterial anastomosis. Hepatic arterial flow was confirmed by intraoperative Doppler ultrasonography, and R0 resection without tumor exposure at the dissected plane was achieved. The patient's postoperative course was uneventful. In this case report, perioperative detail examination by imaging diagnosis with respect to hepatic arterial communication to achieve curative resection in a pancreas head cancer was necessary. Non-anastomosis of hepatic artery was achieved, and the necessity of R0 resection was stressed by such management. By the preoperative and intraoperative imaging managements conducted, combined resection of the aberrant right hepatic artery without anastomosis was achieved by pancreaticoduodenectomy for pancreas head cancer. However, improvements in imaging diagnosis and careful management of R0 resection are important. Copyright © 2016 The Author(s). Published by Elsevier Ltd.. All rights reserved.

  15. CT detection of daughter nodules in hepatocellular carcinoma after lipiodol infusion via the hepatic artery

    Energy Technology Data Exchange (ETDEWEB)

    Ohishi, Hajime; Ohgami, Syoichi; Katsuragi, Masami

    1985-02-01

    The detectability of daughter nodules in 80 hepatocellular carcinomas was compared between CT assisted by Lipiodol Ultra Fluid (Lipiodol) infused via the hepatic artery and IHA (Infusion hepatic angiography). Lipiodol infused via the hepatic artery was selectively accumulated in the tumor vessels and the tumors and small daughter nodules appeared as markedly high density areas by CT. 18 cases in which the daughter nodules were detected were identified only by CT. Furthermore, in 38 cases CT demonstrated superior detectability of the daughthr nodules than IHA. In 15 cases the daughter nodules were newly detected in areas other than the invaded area where the primary tumor existed. This method is very effective in the diagnosis of daughter nodules of hepatocellular carcinoma. (author).

  16. The experimental studies of Chinese herbs as a vascular embolization agent for the hepatic arteries

    International Nuclear Information System (INIS)

    Chen Ziqian; Yang Xizhang; Shen Junjie; Wang Shudong; Zheng Xiaogang; Cao Jianmin

    2006-01-01

    Objective: To study the efficacy, safety and correlative characteristics of Chinese herb as a vascular embolization agent. Methods: Vascular embolization agent combined from several kinds of Chinese herb was manufactured and served as anticarcinogen and coagulant according to the chinese Pharmacopoeia. The characteristics of the combination embolization agent through embolizing the hepatic arteries in eight pigs were studied. Results: The combination agent was a non-homogenous suspension, easily to be injected through 5-F catheter with hyper attenuation under fluoroscopy; simultaneously with good histocompatibility and hemo-compatibility and without feverish response and toxicity. The combination agent mainly embolized the peripheral arteries with maintaining occlusion for 5 weeks and without formation of collateral circulation. Slight injuries of normal hepatic tissues with hepatic cytonecrosis and endochyloma focal necrosis were found through optical and electronic microscopy. Conclusions: The Chinese herb combination agent is safe and effective in experimental application with good angioembolic function and a potential peripheral embolization agent. (authors)

  17. Percutaneous hepatic arterial catheterization for infusion chemotherapy in treatment of primary hepatoma

    International Nuclear Information System (INIS)

    Juhn, Jae Ryang; Chang, Jae Yong; Cha, Seong Sook; Han, Sang Suk; Bae, Cheol; Kim, Sung Rok; Chae, Yoo Soon

    1984-01-01

    Chemotherapy offers palliative treatment to patient with advanced nonresectable hepatoma. The usefulness of systemic chemotherapy is limited because of serious side reaction and low concentration of drug at tumor. But this problem may be overcome by intraarterial infusion. Nonsurgical percutaneous hepatic arterial catheterization was done in 21 patients with primary hepatoma, and infusion chemotherapy was done in 19 patients who were successful in catheterization. The results were as follows: 1. Selective catheterization of hepatic artery proper, common hepatic artery, and celiac artery were successful in 4, 9 and 4 patients respectively. The success rate of selective catheterization is 80.9% including celiac artery among 21 patients with hepatoma. 2. Simple catheterization method was applied in 14 patients, and catheter exchange and Loop methods were applied in 2 and 1 patient respectively. 3. Complication related to catheterization, such as infection and bleeding on punctured site, intimal injury and dislodgement of catheter were not serious. 4. Drugs were well tolerated without serious toxicity or complication. 5. 3 patients showed objective response and median survival time of treated patients is 2.5 months.

  18. Superselective transcatheter renal arterial embolization for acute renal bleeding in patients with renal insufficiency: its clinical efficacy and safety

    International Nuclear Information System (INIS)

    Hu Tingyang; Zhou Bing; Yu Wenqiang; Luo Zuyan; Mao Yingmin; Chen Fanghong; Li Bo; Yuan Jianhua

    2010-01-01

    Objective: To discuss the clinical efficacy and complications of super selective renal arterial embolization in treating acute renal arterial bleeding in patients with renal insufficiency, and to evaluate the influence of the treatment on the renal function. Methods: During the period of January 2000 December 2009, super selective renal arterial embolization was performed in our institution for acute renal bleeding in 13 patients with renal insufficiency. The complete clinical and imaging materials of all patients were properly collected. The clinical effectiveness, the renal function, the extent of embolization and the complications were observed and the relationship between each other was analyzed. Results: The embolization procedure was successfully completed in all patients with a technical success rate of 100%. The mean embolized territory was 22% of a single kidney. Three days after the procedure, the hemoglobin level, hematocrit, blood pressure and heart rate were considerably improved in all patients. Compared to the corresponding preoperative data, all the differences were statistically significant (P 0.05), while the blood urea nitrogen was markedly decreased (P=0.011). Post embolization syndrome occurred in 5 patients and progressive aggravation of the renal function was observed in one patient, who had to receive hemodialysis finally. The embolized territory in patients occurring complications was larger than that in patients without occurring complications (U=1.500, P=0.006). Conclusion: Super selective renal arterial embolization is an effective and safe treatment for acute renal arterial bleeding in patients with renal insufficiency, the therapy will not significantly worsen the renal function. Appropriate and reasonable extent of embolization, as small as possible, is the key point for reducing the complications. (authors)

  19. ANATOMIC VARIATIONS OF HEPATIC ARTERY: A STUDY IN 479 LIVER TRANSPLANTATIONS.

    Science.gov (United States)

    Fonseca-Neto, Olival Cirilo Lucena da; Lima, Heloise Caroline de Souza; Rabelo, Priscylla; Melo, Paulo Sérgio Vieira de; Amorim, Américo Gusmão; Lacerda, Cláudio Moura

    2017-01-01

    The incidence of anatomic variations of hepatic artery ranges from 20-50% in different series. Variations are especially important in the context of liver orthotopic transplantation, since, besides being an ideal opportunity for surgical anatomical study, their precise identification is crucial to the success of the procedure. To identify the anatomical variations in the hepatic arterial system in hepatic transplantation. 479 medical records of transplanted adult patients in the 13-year period were retrospectively analyzed, and collected data on hepatic arterial anatomy of the deceased donor. It was identified normal hepatic arterial anatomy in 416 donors (86.84%). The other 63 patients (13.15%) showed some variation. According to the Michels classification, the most frequently observed abnormalities were: right hepatic artery branch of superior mesenteric artery (Type III, n=27, 5.63%); left hepatic artery branch of the left gastric artery (Type II, n=13, 2.71%); right hepatic artery arising from the superior mesenteric artery associated with the left hepatic artery arising from the left gastric artery (Type IV, n=4, 0.83%). Similarly, in relation to Hiatt classification, the most prevalent changes were: right hepatic accessory artery or substitute of the superior mesenteric artery (Type III, n=28, 6.05%)), followed by liver ancillary left artery or replacement of gastric artery left (Type II, n=16, 3.34. Fourteen donors (2.92%) showed no anatomical abnormalities defined in classifications, the highest frequency being hepatomesenteric trunk identified in five (01.04%). Detailed knowledge of the variations of hepatic arterial anatomy is of utmost importance to surgeons who perform approaches in this area, particularly in liver transplantation, since their identification and proper management are critical to the success of the procedure. A incidência das variações anatômicas da artéria hepática varia de 20-50% em diferentes casuísticas. Elas s

  20. Hepatic Arterial Configuration in Relation to the Segmental Anatomy of the Liver; Observations on MDCT and DSA Relevant to Radioembolization Treatment

    International Nuclear Information System (INIS)

    Hoven, Andor F. van den; Leeuwen, Maarten S. van; Lam, Marnix G. E. H.; Bosch, Maurice A. A. J. van den

    2015-01-01

    PurposeCurrent anatomical classifications do not include all variants relevant for radioembolization (RE). The purpose of this study was to assess the individual hepatic arterial configuration and segmental vascularization pattern and to develop an individualized RE treatment strategy based on an extended classification.MethodsThe hepatic vascular anatomy was assessed on MDCT and DSA in patients who received a workup for RE between February 2009 and November 2012. Reconstructed MDCT studies were assessed to determine the hepatic arterial configuration (origin of every hepatic arterial branch, branching pattern and anatomical course) and the hepatic segmental vascularization territory of all branches. Aberrant hepatic arteries were defined as hepatic arterial branches that did not originate from the celiac axis/CHA/PHA. Early branching patterns were defined as hepatic arterial branches originating from the celiac axis/CHA.ResultsThe hepatic arterial configuration and segmental vascularization pattern could be assessed in 110 of 133 patients. In 59 patients (54 %), no aberrant hepatic arteries or early branching was observed. Fourteen patients without aberrant hepatic arteries (13 %) had an early branching pattern. In the 37 patients (34 %) with aberrant hepatic arteries, five also had an early branching pattern. Sixteen different hepatic arterial segmental vascularization patterns were identified and described, differing by the presence of aberrant hepatic arteries, their respective vascular territory, and origin of the artery vascularizing segment four.ConclusionsThe hepatic arterial configuration and segmental vascularization pattern show marked individual variability beyond well-known classifications of anatomical variants. We developed an individualized RE treatment strategy based on an extended anatomical classification

  1. Effect of intra-hepatic arterial infusion chemotherapy for patients with liver metastasis from breast cancer

    International Nuclear Information System (INIS)

    Liu Dezhong; Li Huai; Zeng Huiying; Yang Ling

    2001-01-01

    Objective: To evaluate the efficacy of intra-hepatic arterial infusion chemotherapy for patients with liver metastasis from breast cancer. Methods: 1993-1998 years, Thirty four patients with liver metastasis from breast cancer had received epi-adriamycin, cisplatin, mitomycin and 5-fluorouracil by intrahepatic arterial infusion chemotherapy. Twelve patients had received embolization. Results: Six patients (17.65%) had a complete response, 12 patients (35.29%) had a partial response. The overall response rate was 52.94%. Cumulative survival rates at 1, 2, 3 and 4 years were 56.90%, 25.00%, 5.00% and 5.00% respectively (Kaplan-Meier method). The median overall survival time was 11.5 months. Conclusion: Intra-hepatic arterial infusion chemotherapy is safe and effective for liver metastasis from breast cancer and should be the first choice of treatment for these patients

  2. Acute Superior Mesenteric Venous Thrombosis: Transcatheter Thrombolysis and Aspiration Thrombectomy Therapy by Combined Route of Superior Mesenteric Vein and Artery in Eight Patients

    International Nuclear Information System (INIS)

    Yang, Shuofei; Liu, Baochen; Ding, Weiwei; He, Changsheng; Wu, Xingjiang; Li, Jieshou

    2015-01-01

    PurposeTo assess the feasibility, effectiveness, and safety of catheter-directed thrombolysis and aspiration thrombectomy therapy by combined route of superior mesenteric vein and artery (SMV+SMA) for acute superior mesenteric venous thrombosis (ASMVT).MethodsThis retrospective study reviewed eight ASMVT patients with transcatheter direct thrombolysis and aspiration thrombectomy therapy via SMV and indirect thrombolysis via SMA during a period of 14 months. The demographics, etiology, risk factors, therapeutic effect, complications, mortality, and follow-up of the study population were assessed. Anatomic and imaging classification of location and extent of thrombus at diagnosis and degree of thrombus lysis were described.ResultsTechnical success was achieved with substantial improvement in symptoms and thrombus resolution after thrombolytic therapy in all patients. The local urokinase infusion by SMA and SMV was performed for 5–7 (6.13 ± 0.83) and 7–15 (12 ± 2.51) days. Anticoagulation was performed catheter-directed and then orally throughout hospitalization and after discharge. Four patients required delayed localized bowel resection after thrombolytic therapy with no death. Thrombolytic therapy was not interrupted despite minor bleeding at the puncture site in two patients and sepsis in another two postoperatively. Nearly complete removal of thrombus was demonstrated by contrast-enhanced CT scan and portography before discharge. Patients were discharged in 10–27 (19.25 ± 4.89) days after admission. No recurrence developed during the follow-up of 10–13 (12.13 ± 0.99) months.ConclusionsCatheter-directed thrombolytic and aspiration therapy via SMV+SMA is beneficial for ASMVT in avoiding patient death, efficient resolving thrombus, rapid improving symptoms, reversing extensive intestinal ischemia, averting bowel resection, or localizing infarcted bowel segment and preventing short bowel syndrome

  3. Clinical value of 18F-FDG PET/CT in detecting viable tumor, recurrence and metastases of hepato-cellular carcinoma after transcatheter arterial chemoembolization

    International Nuclear Information System (INIS)

    Hu Silong; Zhang Yingjian; Zhu Beiling; Shi Wei; Men Zhiqiang; Li Peilen; Jiang Guoliang

    2009-01-01

    Objective: Accurate evaluation of treatment result of transcatheter arterial chemoembolization (TACE) in patients with hepatocellular carcinoma (HCC) by conventional imaging is difficult. The objective of this study was to investigate the clinical value of 18 F-fluorodeoxyglucose (FDG) PET/CT for detecting residual viable tumor, recurrence and metastases in patients with HCC after TACE. Methods: Twenty-two patients with HCC after TACE were investigated with 18 F-FDG PET/CT. The accuracy of FDG PET/CT was determined by the histopathological results or evidences of clinical follow-up. Results: Of all 22 HCC patients after TACE, 18 had intra- and (or) extrahepatic lesions, detected by FDG PET/CT. Six-teen patients had intrahepatic FDG-avid lesion(s). Of the 16 patients, five had intrahepatic FDG-avid lesions located at both lipiodol-rich and -deprive regions, 13 had associated extrahepatic metastases. Of the two HCC patients who had no intrahepatic FDG-avid lesion, there were extrahepatic FDG-avid lesions at the retroperitoneal lymph nodes. In all, 15 HCC had extrahepatic lesions identified by FDG PET/CT. There were lung and lymph nodes (n = 9), bone (n = 2), tumor thrombus at portal vein (n - 1) and diaphragm crus (n = 1). Two patients were false negative. The sensitivity, specificity, accuracy of FDG PET/CT in detecting intra- and (or) extrahepatic lesions after TACE were 88.9% (16/18) vs 94.7 % (18/19), 4/4 vs 3/3, and 90.9% (20/22) vs 95.5% (21/22), respectively. Conclusion: 18 F-FDG PET/CT is potential useful for detection both intra- and (or) extrahepatic lesions in HCC patients after TACE. (authors)

  4. Correlation of Hypoxia-Inducible Factor 1α with Angiogenesis in Liver Tumors After Transcatheter Arterial Embolization in an Animal Model

    International Nuclear Information System (INIS)

    Liang Bin; Zheng Chuansheng; Feng, Gan-Sheng; Wu Hanping; Wang Yong; Zhao Hui; Qian Jun; Liang Huimin

    2010-01-01

    This study sought to determine the expression of hypoxia-inducible factor 1α (HIF-1α) and its relation to angiogenesis in liver tumors after transcatheter arterial embolization (TAE) in an animal model. A total of 20 New Zealand White rabbits were implanted with VX2 tumor in liver. TAE-treated group animals (n = 10) received TAE with polyvinyl alcohol particles. Control group animals (n = 10) received sham embolization with distilled water. Six hours or 3 days after TAE, animals were humanely killed, and tumor samples were collected. Immunohistochemical staining was performed to evaluate HIF-1α and vascular endothelial growth factor (VEGF) protein expression and microvessel density (MVD). Real-time polymerase chain reaction was performed to examine VEGF mRNA levels. The levels of HIF-1α protein were significantly higher in TAE-treated tumors than those in the control tumors (P = 0.001). HIF-1α protein was expressed in viable tumor cells that were located predominantly at the periphery of necrotic tumor regions. The levels of VEGF protein and mRNA, and mean MVD were significantly increased in TAE-treated tumors compared with the control tumors (P = 0.001, 0.000, and 0.001, respectively). HIF-1α protein level was significantly correlated with VEGF mRNA (r = 0.612, P = 0.004) and protein (r = 0.554, P = 0.011), and MVD (r = 0.683, P = 0.001). We conclude that HIF-1α is overexpressed in VX2 tumors treated with TAE as a result of intratumoral hypoxia generated by the procedure and involved in activation of the TAE-associated tumor angiogenesis. HIF-1α might represent a promising therapeutic target for antiangiogenesis in combination with TAE against liver tumors.

  5. Effect of the Wnt/β-catenin signaling pathway on apoptosis, migration, and invasion of transplanted hepatocellular carcinoma cells after transcatheter arterial chemoembolization in rats.

    Science.gov (United States)

    Wang, Bao-Ming; Li, Nuo

    2018-05-01

    This study aims to investigate the influence of the Wnt/β-catenin signaling pathway on apoptosis, migration, and invasion of transplanted hepatocellular carcinoma (HCC) cells after transcatheter arterial chemoembolization (TACE) in rat models. A total of 80 rats were grouped into sham, TACE, Wnt-C59, and TACE + Wnt-C59 groups (n = 20). Ten days after model establishment, 10 rats in each group were executed to perform pathological examination and follow-up experiment, and the remaining 10 rats in each group were reared to observe the survival condition. RT-qPCR and Western blotting were applied to determine the expressions of Wnt1, β-catenin, cyclin D1, c-met, vimentin, E-cadherin, and vascular endothelial growth factor (VEGF). ELISA was performed to measure the serum alpha-fetoprotein (AFP) content of rats. Flow cytometry was used to evaluate cell apoptosis rate and transwell assay to examine cell migration and invasion. Compared with the TACE group, the Wnt-C59 and TACE + Wnt-C59 groups showed increased apoptosis and survival time (the TACE + Wnt-C59 group > the Wnt-C59 group). Compared with the sham group, the TACE + Wnt-C59 groups showed decreased cancer tissue weight and expressions of Wnt1, β-catenin, cyclin D1, vimentin, c-met, and VEGF, but increased E-cadherin expression. Compared with the TACE group, the Wnt-C59 and TACE + Wnt-C59 groups showed decreased AFP level, migration, and invasion (the TACE + Wnt-C59 group Wnt-C59 group). These findings indicate inhibition of the Wnt/β-catenin signaling pathway improves therapeutic effect on TACE via suppressing migration, invasion, and promoting apoptosis of transplanted HCC cells in rats. © 2017 Wiley Periodicals, Inc.

  6. Long-term efficiency and safety of trans-catheter uterine artery embolization by lipiodol-pingyingmycin emulsion for uterine fibroids

    International Nuclear Information System (INIS)

    Du Juan; Zuo Yuewei; Hong Nanhua; Chen Xiaoming; Li Yong

    2009-01-01

    Objective: To investigate the long-term efficiency and safety of trans-catheter uterine artery embolization using lipiodol-pingyingmycin emulsion (LPE-TUAE) for uterine fibroids. Methods: Two hundred and forty-three patients with uterine fibroids were treated by LPE-TUAE. Fourteen of them underwent hysterectomy or myomectomy 3 days to 6 months after LPE-TUAE. The specimens were studied pathologically. Another 229 patients were followed up for 1 to 4 years to observe the long-term outcomes. Results: Menorrhagia became normal or improved markedly in 96.0% (193/201). Lumbago and lower abdominal pain disappeared or relieved markedly in 949% (94/99). Bulk-related symptoms disappeared or lessened markedly in 96.0% (48/50). Ultrasound revealed that the average decreased rate in the largest fibroid volume were 60.7% at 1 year, 63.3% at 2 year, 65.6% at 3 year and 67.4% at 4 year after embolization, and the average decreased rate in the largest uterine volume were 49.6% at 1 year, 54.3% at 2 year, 55.2% at 3 year and 57.1% at 4 year after embolization. Reoccurrence rate of myoma was 10.8% 3-4 year after embolization. No significant difference was found in hormone level between pre- and post-embolization. Pathological studies of specimens showed that lipiodol was only accumulated in fibroids and was not seen in myometrium. Spotty necrosis 2 weeks after embolization and extensive patchy necrosis 3 weeks after embolization were occurred in fibroids. Necrosis was not showed in myometrium. No serious complications occurred. Conclusion: LPE-TUAE possesses a good long-term effectiveness for uterine fibroids, which doesn't cause the damage on ovarian function and normal myometrium or serious complications. (authors)

  7. Transcatheter arterial chemoembolization combined with radiofrequency ablation can improve survival of patients with hepatocellular carcinoma with portal vein tumour thrombosis: Extending the indication for ablation?

    International Nuclear Information System (INIS)

    Zheng, J.-S.; Long, J.; Sun, B.; Lu, N.-N.; Fang, D.; Zhao, L.-Y.; Du, N.

    2014-01-01

    Aim: To retrospectively assess long-term survival benefit and safety of transcatheter arterial chemoembolization (TACE) combined with radiofrequency ablation (RFA) in hepatocellular carcinoma (HCC) patients with portal vein tumour thrombosis (PVTT), and to evaluate factors that significantly affect outcomes of these patients. Materials and methods: One hundred and thirty-four HCC patients (118 men and 16 women; mean age 54.8 years, range 26–79 years) with PVTT were retrospectively assessed. Patients were treated with TACE combined with RFA. Data analysed included patient demographics, liver volume, Child–Pugh score, and Cancer of the Liver Italian Programme (CLIP) score and imaging findings. Survival time (from occurrence of PVTT to last follow-up) was calculated using the Kaplan–Meier method, predictive factors and its correlation with survival was assessed using the multivariate Cox proportional hazards regression method. Results: The median overall survival (OS) time was 29.5 months (range 16.6–42.4 months), the 1, 3, and 5 year OS were 63%, 40%, and 23%. Cox hazards regression analysis revealed that functional remnant liver volume (FRLV), remnant liver volume (RLV)/total liver volume (TLV), radiation, tumour number, vascular endothelial growth factor (VEGF) distribution, and gross type were the only independent predictive factors of outcome (p = 0.039, 0.010, 0.009, 0.034, 0.031, and 0.000, respectively). Conclusion: TACE combined with RFA was found to be an effective therapy, FRLV and RLV/TLV have close correlation with survival for HCC patients with PVTT type I, II, or partial III and Child–Pugh A or B

  8. Transcatheter Arterial Embolization for Primary Postpartum Hemorrhage: Predictive Factors of Need for Embolic Material Conversion of Gelatin Sponge Particles to N-Butyl Cyanoacrylate

    International Nuclear Information System (INIS)

    Tanahashi, Yukichi; Goshima, Satoshi; Kondo, Hiroshi; Ando, Tomohiro; Noda, Yoshifumi; Kawada, Hiroshi; Kawai, Nobuyuki; Kotoku, Junichi; Furui, Shigeru; Matsuo, Masayuki

    2017-01-01

    PurposeTo identify predictive factors for embolic material conversion to N-butyl cyanoacrylate (NBCA) for the treatment of primary postpartum hemorrhage (PPH) after failed transcatheter arterial embolization (TAE) using gelatin sponge (GS).Materials and MethodsInstitutional review board approval was obtained. We retrospectively studied 62 consecutive women with primary PPH who underwent TAE between January 2006 and March 2015. Five of them were excluded for the following: cardiopulmonary arrest at arrival (n = 1), uterine inversion (n = 1), and hysterectomy after TAE (n = 3). Remaining 57 women (age range, 21–43 years; mean, 32.6 years) comprised study population. TAE was initially performed using GS in all cases and then converted to NBCA after two embolizations using GS with persistent hemodynamic instability or vaginal bleeding. The patients’ background, uterine height, vital signs, laboratory tests, disseminated intravascular coagulation score, and details of procedure were reviewed. Univariate and multivariate analyses were performed to determine factors related to embolic material conversion.ResultsTechnical success rate was 100%. Fourteen patients (25%) needed embolic material conversion to NBCA. Univariate analysis showed that uterine height, systolic blood pressure (sBP), and hemoglobin level were significantly related to embolic material conversion to NBCA (P = 0.029, 0.030, and 0.042). Logistic regression analysis showed that uterine height (odds ratio, 1.37; P = 0.025) and sBP (odds ratio, 0.96; P = 0.003) were associated with embolic material conversion to NBCA.ConclusionUterine height and sBP can be predictive factors for embolic material conversion to NBCA for the treatment of PPH.Level of EvidenceLevel 4, Case Control Study

  9. Transcatheter Arterial Embolization for Primary Postpartum Hemorrhage: Predictive Factors of Need for Embolic Material Conversion of Gelatin Sponge Particles to N-Butyl Cyanoacrylate

    Energy Technology Data Exchange (ETDEWEB)

    Tanahashi, Yukichi; Goshima, Satoshi, E-mail: gossy@par.odn.ne.jp [Gifu University Hospital, Department of Radiology (Japan); Kondo, Hiroshi [Teikyo University School of Medicine, Department of Radiology (Japan); Ando, Tomohiro; Noda, Yoshifumi; Kawada, Hiroshi; Kawai, Nobuyuki [Gifu University Hospital, Department of Radiology (Japan); Kotoku, Junichi [Teikyo University School of Medicine, Department of Radiological Technology, Faculty of Medical Technology (Japan); Furui, Shigeru [Teikyo University School of Medicine, Department of Radiology (Japan); Matsuo, Masayuki [Gifu University Hospital, Department of Radiology (Japan)

    2017-02-15

    PurposeTo identify predictive factors for embolic material conversion to N-butyl cyanoacrylate (NBCA) for the treatment of primary postpartum hemorrhage (PPH) after failed transcatheter arterial embolization (TAE) using gelatin sponge (GS).Materials and MethodsInstitutional review board approval was obtained. We retrospectively studied 62 consecutive women with primary PPH who underwent TAE between January 2006 and March 2015. Five of them were excluded for the following: cardiopulmonary arrest at arrival (n = 1), uterine inversion (n = 1), and hysterectomy after TAE (n = 3). Remaining 57 women (age range, 21–43 years; mean, 32.6 years) comprised study population. TAE was initially performed using GS in all cases and then converted to NBCA after two embolizations using GS with persistent hemodynamic instability or vaginal bleeding. The patients’ background, uterine height, vital signs, laboratory tests, disseminated intravascular coagulation score, and details of procedure were reviewed. Univariate and multivariate analyses were performed to determine factors related to embolic material conversion.ResultsTechnical success rate was 100%. Fourteen patients (25%) needed embolic material conversion to NBCA. Univariate analysis showed that uterine height, systolic blood pressure (sBP), and hemoglobin level were significantly related to embolic material conversion to NBCA (P = 0.029, 0.030, and 0.042). Logistic regression analysis showed that uterine height (odds ratio, 1.37; P = 0.025) and sBP (odds ratio, 0.96; P = 0.003) were associated with embolic material conversion to NBCA.ConclusionUterine height and sBP can be predictive factors for embolic material conversion to NBCA for the treatment of PPH.Level of EvidenceLevel 4, Case Control Study.

  10. Acute Superior Mesenteric Venous Thrombosis: Transcatheter Thrombolysis and Aspiration Thrombectomy Therapy by Combined Route of Superior Mesenteric Vein and Artery in Eight Patients

    Energy Technology Data Exchange (ETDEWEB)

    Yang, Shuofei, E-mail: yangshuofei@gmail.com; Liu, Baochen, E-mail: 306446264@qq.com; Ding, Weiwei, E-mail: dingwei-nju@hotmail.com; He, Changsheng, E-mail: hechsh@163.com; Wu, Xingjiang, E-mail: wuxingjiang@sohu.com; Li, Jieshou, E-mail: lijieshou2013@sohu.com [Research Institute of General Surgery, Jinling Hospital, Medical School of Nanjing University (China)

    2015-02-15

    PurposeTo assess the feasibility, effectiveness, and safety of catheter-directed thrombolysis and aspiration thrombectomy therapy by combined route of superior mesenteric vein and artery (SMV+SMA) for acute superior mesenteric venous thrombosis (ASMVT).MethodsThis retrospective study reviewed eight ASMVT patients with transcatheter direct thrombolysis and aspiration thrombectomy therapy via SMV and indirect thrombolysis via SMA during a period of 14 months. The demographics, etiology, risk factors, therapeutic effect, complications, mortality, and follow-up of the study population were assessed. Anatomic and imaging classification of location and extent of thrombus at diagnosis and degree of thrombus lysis were described.ResultsTechnical success was achieved with substantial improvement in symptoms and thrombus resolution after thrombolytic therapy in all patients. The local urokinase infusion by SMA and SMV was performed for 5–7 (6.13 ± 0.83) and 7–15 (12 ± 2.51) days. Anticoagulation was performed catheter-directed and then orally throughout hospitalization and after discharge. Four patients required delayed localized bowel resection after thrombolytic therapy with no death. Thrombolytic therapy was not interrupted despite minor bleeding at the puncture site in two patients and sepsis in another two postoperatively. Nearly complete removal of thrombus was demonstrated by contrast-enhanced CT scan and portography before discharge. Patients were discharged in 10–27 (19.25 ± 4.89) days after admission. No recurrence developed during the follow-up of 10–13 (12.13 ± 0.99) months.ConclusionsCatheter-directed thrombolytic and aspiration therapy via SMV+SMA is beneficial for ASMVT in avoiding patient death, efficient resolving thrombus, rapid improving symptoms, reversing extensive intestinal ischemia, averting bowel resection, or localizing infarcted bowel segment and preventing short bowel syndrome.

  11. Three-Dimensional Conformal Radiation Therapy and Intensity-Modulated Radiation Therapy Combined With Transcatheter Arterial Chemoembolization for Locally Advanced Hepatocellular Carcinoma: An Irradiation Dose Escalation Study

    International Nuclear Information System (INIS)

    Ren Zhigang; Zhao Jiandong; Gu Ke; Chen Zhen; Lin Junhua; Xu Zhiyong; Hu Weigang; Zhou Zhenhua; Liu Luming; Jiang Guoliang

    2011-01-01

    Purpose: To determine the maximum tolerated dose (MTD) of three-dimensional conformal radiation therapy (3DCRT)/intensity-modulated radiation therapy (IMRT) combined with transcatheter arterial chemoembolization for locally advanced hepatocellular carcinoma. Methods and Materials: Patients were assigned to two subgroups based on tumor diameter: Group 1 had tumors <10 cm; Group II had tumors ≥10 cm. Escalation was achieved by increments of 4.0 Gy for each cohort in both groups. Dose-limiting toxicity (DLT) was defined as a grade of ≥3 acute liver or gastrointestinal toxicity or any grade 5 acute toxicity in other organs at risk or radiation-induced liver disease. The dose escalation would be terminated when ≥2 of 8 patients in a cohort experienced DLT. Results: From April 2005 to May 2008, 40 patients were enrolled. In Group I, 11 patients had grade ≤2 acute treatment-related toxicities, and no patient experienced DLT; and in Group II, 10 patients had grade ≤2 acute toxicity, and 1 patient in the group receiving 52 Gy developed radiation-induced liver disease. MTD was 62 Gy for Group I and 52 Gy for Group II. In-field progression-free and local progression-free rates were 100% and 69% at 1 year, and 93% and 44% at 2 years, respectively. Distant metastasis rates were 6% at 1 year and 15% at 2 years. Overall survival rates for 1-year and 2-years were 72% and 62%, respectively. Conclusions: The irradiation dose was safely escalated in hepatocellular carcinoma patients by using 3DCRT/IMRT with an active breathing coordinator. MTD was 62 Gy and 52 Gy for patients with tumor diameters of <10 cm and ≥10 cm, respectively.

  12. Segmentation of hepatic artery in multi-phase liver CT using directional dilation and connectivity analysis

    Science.gov (United States)

    Wang, Lei; Schnurr, Alena-Kathrin; Zidowitz, Stephan; Georgii, Joachim; Zhao, Yue; Razavi, Mohammad; Schwier, Michael; Hahn, Horst K.; Hansen, Christian

    2016-03-01

    Segmentation of hepatic arteries in multi-phase computed tomography (CT) images is indispensable in liver surgery planning. During image acquisition, the hepatic artery is enhanced by the injection of contrast agent. The enhanced signals are often not stably acquired due to non-optimal contrast timing. Other vascular structure, such as hepatic vein or portal vein, can be enhanced as well in the arterial phase, which can adversely affect the segmentation results. Furthermore, the arteries might suffer from partial volume effects due to their small diameter. To overcome these difficulties, we propose a framework for robust hepatic artery segmentation requiring a minimal amount of user interaction. First, an efficient multi-scale Hessian-based vesselness filter is applied on the artery phase CT image, aiming to enhance vessel structures with specified diameter range. Second, the vesselness response is processed using a Bayesian classifier to identify the most probable vessel structures. Considering the vesselness filter normally performs not ideally on the vessel bifurcations or the segments corrupted by noise, two vessel-reconnection techniques are proposed. The first technique uses a directional morphological operator to dilate vessel segments along their centerline directions, attempting to fill the gap between broken vascular segments. The second technique analyzes the connectivity of vessel segments and reconnects disconnected segments and branches. Finally, a 3D vessel tree is reconstructed. The algorithm has been evaluated using 18 CT images of the liver. To quantitatively measure the similarities between segmented and reference vessel trees, the skeleton coverage and mean symmetric distance are calculated to quantify the agreement between reference and segmented vessel skeletons, resulting in an average of 0:55+/-0:27 and 12:7+/-7:9 mm (mean standard deviation), respectively.

  13. Anatomical variations of the celiac trunk and hepatic arterial system: an analysis using multidetector computed tomography angiography

    Energy Technology Data Exchange (ETDEWEB)

    Araujo Neto, Severino Aires; Franca, Henrique Almeida; Mello Junior, Carlos Fernando de; Silva Neto, Eulampio Jose; Negromonte, Gustavo Ramalho Pessoa; Duarte, Claudia Martina Araujo; Cavalcanti Neto, Bartolomeu Fragoso; Farias, Rebeca Danielly da Fonseca, E-mail: severinoaires@hotmail.com [Universidade Federal da Paraiba (UFPB), Joao Pessoa, PB (Brazil)

    2015-11-15

    Objective: To analyze the prevalence of anatomical variations of celiac arterial trunk (CAT) branches and hepatic arterial system (HAS), as well as the CAT diameter, length and distance to the superior mesenteric artery. Materials And Methods: Retrospective, cross-sectional and predominantly descriptive study based on the analysis of multidetector computed tomography images of 60 patients. Results: The celiac trunk anatomy was normal in 90% of cases. Hepatosplenic trunk was found in 8.3% of patients, and hepatogastric trunk in 1.7%. Variation of the HAS was observed in 21.7% of cases, including anomalous location of the right hepatic artery in 8.3% of cases, and of the left hepatic artery, in 5%. Also, cases of joint relocation of right and left hepatic arteries, and trifurcation of the proper hepatic artery were observed, respectively, in 3 (5%) and 2 (3.3%) patients. Mean length and caliber of the CAT were 2.3 cm and 0.8 cm, respectively. Mean distance between CAT and superior mesenteric artery was 1.2 cm (standard deviation = 4.08). A significant correlation was observed between CAT diameter and length, and CAT diameter and distance to superior mesenteric artery. Conclusion: The pattern of CAT variations and diameter corroborate the majority of the literature data. However, this does not happen in relation to the HAS. (author)

  14. Anatomical variations of the celiac trunk and hepatic arterial system: an analysis using multidetector computed tomography angiography

    International Nuclear Information System (INIS)

    Araujo Neto, Severino Aires; Franca, Henrique Almeida; Mello Junior, Carlos Fernando de; Silva Neto, Eulampio Jose; Negromonte, Gustavo Ramalho Pessoa; Duarte, Claudia Martina Araujo; Cavalcanti Neto, Bartolomeu Fragoso; Farias, Rebeca Danielly da Fonseca

    2015-01-01

    Objective: To analyze the prevalence of anatomical variations of celiac arterial trunk (CAT) branches and hepatic arterial system (HAS), as well as the CAT diameter, length and distance to the superior mesenteric artery. Materials And Methods: Retrospective, cross-sectional and predominantly descriptive study based on the analysis of multidetector computed tomography images of 60 patients. Results: The celiac trunk anatomy was normal in 90% of cases. Hepatosplenic trunk was found in 8.3% of patients, and hepatogastric trunk in 1.7%. Variation of the HAS was observed in 21.7% of cases, including anomalous location of the right hepatic artery in 8.3% of cases, and of the left hepatic artery, in 5%. Also, cases of joint relocation of right and left hepatic arteries, and trifurcation of the proper hepatic artery were observed, respectively, in 3 (5%) and 2 (3.3%) patients. Mean length and caliber of the CAT were 2.3 cm and 0.8 cm, respectively. Mean distance between CAT and superior mesenteric artery was 1.2 cm (standard deviation = 4.08). A significant correlation was observed between CAT diameter and length, and CAT diameter and distance to superior mesenteric artery. Conclusion: The pattern of CAT variations and diameter corroborate the majority of the literature data. However, this does not happen in relation to the HAS. (author)

  15. Transcatheter aortic valve replacement

    Science.gov (United States)

    ... gov/ency/article/007684.htm Transcatheter aortic valve replacement To use the sharing features on this page, please enable JavaScript. Transcatheter aortic valve replacement (TAVR) is surgery to replace the aortic valve. ...

  16. Haemodynamic changes in hepatocellular carcinoma and liver parenchyma under balloon occlusion of the hepatic artery

    Energy Technology Data Exchange (ETDEWEB)

    Sugihara, Fumie; Murata, Satoru; Ueda, Tatsuo; Yasui, Daisuke; Yamaguchi, Hidenori; Miki, Izumi; Kumita, Shin-ichiro [Nippon Medical School, Department of Radiology, Center for Advanced Medical Technology, Tokyo (Japan); Kawamoto, Chiaki [Nippon Medical School, Department of Internal Medicine, Tokyo (Japan); Uchida, Eiji [Nippon Medical School, Department of Surgery, Tokyo (Japan)

    2017-06-15

    To investigate haemodynamic changes in hepatocellular carcinoma (HCC) and liver under hepatic artery occlusion. Thirty-eight HCC nodules in 25 patients were included. Computed tomography (CT) during hepatic arteriography (CTHA) with and without balloon occlusion of the hepatic artery was performed. CT attenuation and enhancement volume of HCC and liver with and without balloon occlusion were measured on CTHA. Influence of balloon position (segmental or subsegmental branch) was evaluated based on differences in HCC-to-liver attenuation ratio (H/L ratio) and enhancement volume of HCC and liver. In the segmental group (n = 20), H/L ratio and enhancement volume of HCC and liver were significantly lower with balloon occlusion than without balloon occlusion. However, in the subsegmental group (n = 18), H/L ratio was significantly higher and liver enhancement volume was significantly lower with balloon occlusion; HCC enhancement volume was similar with and without balloon occlusion. Rate of change in H/L ratio and enhancement volume of HCC and liver were lower in the segmental group than in the subsegmental group. There were significantly more perfusion defects in HCC in the segmental group. Hepatic artery occlusion causes haemodynamic changes in HCC and liver, especially with segmental occlusion. (orig.)

  17. Comparison of high-resolution contrast-enhanced 3D MRA with digital subtraction angiography in the evaluation of hepatic arterial anatomy

    International Nuclear Information System (INIS)

    Matoba, M.; Tonami, H.; Kuginuki, M.; Yokota, H.; Takashima, S.; Yamamoto, I.

    2003-01-01

    AIM: To evaluate the validity of high-resolution contrast-enhanced three-dimensional magnetic resonance angiography (MRA) in defining hepatic arterial anatomy and to compare this with digital subtraction angiography (DSA). MATERIALS AND METHODS: MRA and DSA were performed in 30 patients. MRA was performed with breath-hold, gadolinium-enhanced, three-dimensional, fast low-angle shot sequence with a 512 pixel matrix. MRA was compared with DSA in terms of image quality and depiction of hepatic arterial anatomy. The agreement in image quality between MRA and DSA was determined with the kappa statistic. RESULTS: With respect to image quality, there was excellent or good correlation between MRA and DSA for the common hepatic artery (κ=0.85), proper hepatic artery (κ=0.72), gastroduodenal artery (κ=0.70), left hepatic artery (κ=0.49), left gastric artery (κ=0.50), splenic artery (κ=0.84), and superior mesenteric artery (κ=0.88). Poor correlation was found for the right hepatic artery (κ=0.18) and right gastric artery (κ=0.38). With regard to hepatic arterial anatomy, MRA correlated correctly with DSA in 28 of the 29 cases, i.e. 97% of patients. CONCLUSION: MRA is a useful technique for the evaluation of the hepatic artery, and for the vast majority of patients, MRA can replace intra-arterial DSA

  18. Amyloidosis and spontaneous hepatic bleeding, transcatheter therapy for hepatic parenchymal bleeding with massive intraperitoneal hemorrhage: a case report and review of the literature.

    Science.gov (United States)

    Mousa, Albeir Y; Abu-Halimah, Shadi; Alhalbouni, Saadi; Hass, Stephen M; Yang, Calvin; Gill, Gurpreet; AbuRahma, Ali F; Bates, Mark

    2014-10-01

    Hepatic hemorrhage can be devastating, especially in patients with underlying hepatic pathology. This is a case report of a 50-year-old man who presented to the emergency room with Stage 3 shock as evidenced by a systolic blood pressure of 90 mmHg, a heart rate of 125 beats per minute, respiration of 32, with delayed capillary refill and agitation. At this time, he was found to have a massive spontaneous intra-abdominal hemorrhage with an advanced stage of amyloidosis with multiple organ malfunctions. The initial diagnosis was based on an abdominal computed tomography scan and the patient was taken expeditiously to a hybrid angiography suite for a celiac angiogram. An intraoperative diagnosis of extravasation from amyloid related vasculopathy was made based on the angiographic appearance of hepatic circulation. Coil embolization of the feeding branch of the bleeder was achieved using the interlock coil system and a completion angiogram was done showing complete cessation of active bleeding. The postoperative phase was uneventful and the patient was discharged home on postoperative day three. His postoperative visit at five months later was unremarkable. © The Author(s) 2013 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

  19. Partial Portal Vein Arterialization Attenuates Acute Bile Duct Injury Induced by Hepatic Dearterialization in a Rat Model.

    Science.gov (United States)

    Jiang, Jun; Wei, Jishu; Wu, Junli; Gao, Wentao; Li, Qiang; Jiang, Kuirong; Miao, Yi

    2016-01-01

    Hepatic infarcts or abscesses occur after hepatic artery interruption. We explored the mechanisms of hepatic deprivation-induced acute liver injury and determine whether partial portal vein arterialization attenuated this injury in rats. Male Sprague-Dawley rats underwent either complete hepatic arterial deprivation or partial portal vein arterialization, or both. Hepatic ischemia was evaluated using biochemical analysis, light microscopy, and transmission electron microscopy. Hepatic ATP levels, the expression of hypoxia- and inflammation-associated genes and proteins, and the expression of bile transporter genes were assessed. Complete dearterialization of the liver induced acute liver injury, as evidenced by the histological changes, significantly increased serum biochemical markers, decreased ATP content, increased expression of hypoxia- and inflammation-associated genes and proteins, and decreased expression of bile transporter genes. These detrimental changes were extenuated but not fully reversed by partial portal vein arterialization, which also attenuated ductular reaction and fibrosis in completely dearterialized rat livers. Collectively, complete hepatic deprivation causes severe liver injury, including bile infarcts and biloma formation. Partial portal vein arterialization seems to protect against acute ischemia-hypoxia-induced liver injury.

  20. Partial Portal Vein Arterialization Attenuates Acute Bile Duct Injury Induced by Hepatic Dearterialization in a Rat Model

    Directory of Open Access Journals (Sweden)

    Jun Jiang

    2016-01-01

    Full Text Available Hepatic infarcts or abscesses occur after hepatic artery interruption. We explored the mechanisms of hepatic deprivation-induced acute liver injury and determine whether partial portal vein arterialization attenuated this injury in rats. Male Sprague-Dawley rats underwent either complete hepatic arterial deprivation or partial portal vein arterialization, or both. Hepatic ischemia was evaluated using biochemical analysis, light microscopy, and transmission electron microscopy. Hepatic ATP levels, the expression of hypoxia- and inflammation-associated genes and proteins, and the expression of bile transporter genes were assessed. Complete dearterialization of the liver induced acute liver injury, as evidenced by the histological changes, significantly increased serum biochemical markers, decreased ATP content, increased expression of hypoxia- and inflammation-associated genes and proteins, and decreased expression of bile transporter genes. These detrimental changes were extenuated but not fully reversed by partial portal vein arterialization, which also attenuated ductular reaction and fibrosis in completely dearterialized rat livers. Collectively, complete hepatic deprivation causes severe liver injury, including bile infarcts and biloma formation. Partial portal vein arterialization seems to protect against acute ischemia-hypoxia-induced liver injury.

  1. Multiple Enlarged Aneurysms in Primary Racemose Hemangioma of the Bronchial Artery: Successful Prophylactic Transcatheter Arterial Embolization Using N-butyl-2-cyanoacrylate and Coils.

    Science.gov (United States)

    Saiga, Atsushi; Sugiura, Toshihiko; Higashide, Takashi; Tsuchiya, Satoshi; Nishiyama, Akira; Kubota, Yoshihiro; Horikoshi, Takuro; Uno, Takashi

    2018-05-01

    An asymptomatic 48-year-old man presented with multiple aneurysms in a primary racemose hemangioma of the right bronchial artery. Bronchial arteriography revealed a tortuous artery with four fusiform aneurysms of varying sizes and aneurysmal dilatation with marked thrombus formation in the long segment of the distal portion. Because the tip of catheter could not pass beyond the aneurysmal dilatation, we performed balloon-occluded embolization using a mixture of N-butyl-2-cyanoacrylate (NBCA) and iodized oil. For four other aneurysms, we performed embolization using a coil alone or with NBCA. After 6 months, right bronchial arteriography revealed no enhancement of the aneurysms. Despite the rarity of this procedure, embolization with NBCA is a good option for bronchial artery aneurysm embolization.

  2. CT perfusion of the liver during selective hepatic arteriography. Pure arterial blood perfusion of liver tumor and parenchyma

    International Nuclear Information System (INIS)

    Komemushi, Atsushi; Tanigawa, Noboru; Kojima, Hiroyuki; Kariya, Shuji; Sawada, Satoshi

    2003-01-01

    The purpose of this study was to quantify pure arterial blood perfusion of liver tumor and parenchyma by using CT perfusion during selective hepatic arteriography. A total of 44 patients underwent liver CT perfusion study by injection of contrast medium via the hepatic artery. CT-perfusion parameters including arterial blood flow, arterial blood volume, and arterial mean transit time in the liver parenchyma and liver tumor were calculated using the deconvolution method. The CT-perfusion parameters and vascularity of the tumor were compared. A complete analysis could be performed in 36 of the 44 patients. For liver tumor and liver parenchyma, respectively, arterial blood flow was 184.6±132.7 and 41.0±27.0 ml/min/100 g, arterial blood volume was 19.4±14.6 and 4.8±4.2 ml/100 g, and arterial mean transit time was 8.9±4.2 and 10.2±5.3 sec. Arterial blood flow and arterial blood volume correlated significantly with the vascularity of the tumor; however no correlation was detected between arterial mean transit time and the vascularity of the tumor. This technique could be used to quantify pure hepatic arterial blood perfusion. (author)

  3. Embolization of Hepatic Arterial Branches to Simplify Hepatic Blood Flow Before Yttrium 90 Radioembolization: A Useful Technique in the Presence of Challenging Anatomy

    International Nuclear Information System (INIS)

    Karunanithy, Narayan; Gordon, Fabiana; Hodolic, Marina; Al-Nahhas, Adil; Wasan, Harpreet S.; Habib, Nagy; Tait, Nicholas P.

    2011-01-01

    Purpose: In the presence of variant hepatic arterial anatomy, obtaining whole-liver coverage with yttrium 90 (Y90) radioembolization may be challenging. The purpose of this study was to determine whether a technique whereby variant hepatic arterial branches are embolized and then Y90 is administered selectively into one remaining hepatic arterial branch results in whole-liver coverage and effective therapy. A retrospective comparison of treatment response was made between a group of patients who underwent this technique before Y90 administration and a group of patients who received standard Y90 administration as a single dose into the proper hepatic artery or in divided doses into the immediate hepatic artery branches. The rest of the workup and treatment were identical in both groups, including routine embolization of potential nonhepatic, nontarget vessels (e.g., the gastroduodenal artery). Methods: A total of 32 patients (mean age 56.9 years, range 39–77 years) treated with Y90 between June 2004 and March 2008 were analyzed. The primary malignancy was colorectal in 29, breast in 2, and cholangiocarcinoma in 1. Group 1 comprised 20 patients who had no alterations to their hepatic arterial supply. Group 2 comprised 12 cases who had undergone prior embolization of hepatic arterial branches before administration of Y90. The response to treatment was assessed by comparing standardized uptake value (SUV) on the pre- and postprocedure fludeoxyglucose positron emission tomographic studies of representative lesions within the right and left lobes of the liver. Results: In group 1, significant response (P < 0.001) was seen among right lobe lesions but not among left lobe lesions (P = 0.549). In group 2, there was a significant response among both right (P = 0.028) and left (P = 0.014) lobe lesions. No difference was found in the response of right lobe lesions (P = 0.726) between groups 1 and 2; a significantly greater response was found in group 2 compared to group 1 (P

  4. Endovascular Treatment of Pseudoaneurysm of the Common Hepatic Artery with Intra-aneurysmal Glue (N-Butyl 2-Cyanoacrylate) Embolization

    International Nuclear Information System (INIS)

    Garg, Ashwin; Banait, Swati; Babhad, Sudeep; Kanchankar, Niraj; Nimade, Pradeep; Panchal, Chintan

    2007-01-01

    A 40-year-old man, a chronic alcoholic, presented with acute epigastric pain. Selective celiac arteriography showed a pseudoaneurysm arising from the common hepatic artery. We hereby describe a technical innovation where complete pseudoaneurysm exclusion was seen after intra-aneurysmal N-butyl 2-cyanoacrylate (glue) injection with preservation of antegrade hepatic arterial flow and conclude that intra-aneurysmal liquid injection may have potential as a therapeutic option to reconstruct a defective vessel wall and thereby maintain the antegrade flow

  5. Hepatic Artery Mycotic Aneurysm Associated with Staphylococcal Endocarditis with Successful Treatment: Case Report with Review of the Literature

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    Dhara Chaudhari

    2013-01-01

    Full Text Available Mycotic hepatic artery aneurysm is a vascular pathology associated with bacterial endocarditis. It is rare in occurrence after the introduction of effective antibiotics. We present a young patient with injection drug abuse associated staphylococcal endocarditis which was successfully treated with antibiotics and valve replacement who presented with abdominal pain. He was found to have mycotic aneurysm of hepatic artery which was successfully treated with coil embolization.

  6. Clinical application of transcatheter arterial thermo-chemotherapy and thermo-lipiodol embolization in treatment of hepatocellular carcinoma

    International Nuclear Information System (INIS)

    Wang Xuan; Chen Xiaofei; Dong Weihua

    2007-01-01

    Objective: To evaluate the clinical efficacy of thermo-chemotherapy and thermo-lipiodol embolization in treatment of primary hepatocellular carcinoma(PHC). Methods: One hundred and sixteen cases of PHC were divided into three groups. Group A (38 cases)was treated with normal temperature chemotherapy and normal temperature lipiodol, Group B(40 cases)with thermo-chemotherapy and normal temperature lipiodol and group C (38 cases)with thermo-chemotherapy and thermo-lipiodol. Group B and group C were called the thermotherapy group. Results: In the thermotherapy groups, the rates of tumor size reduction were significantly greater than those in the normal group. There were no significant different in the hepatic function tests among the three groups. The 6-, 12-, 18-, and 24- month survival rates of the normal group and thermotherapy groups were 97%, 58%, 39% and 18%, versus 99%, 79%, 57% and 36%, respectively. No significant differences were found in the rates of reduction of tumor size and survival rates between group B and group C. Conclusion: Thermo-chemotherapy and thermo-embolization possess significant effect on PHC but without conspicuous damage to liver function. (authors)

  7. Estimation of the Arterial Fraction of Total Hepatic Flow from Radionuclide Angiogram Using 99mTc-DISIDA

    International Nuclear Information System (INIS)

    Lee, Hae Gin; Lim, Gye Yeon; Yang, Il Kwon; Kim, Hack Hee; Lim, Jung Ik; Bahk, Yong Whee; Han, Sok Won; Han, Nam Ik; Lee, Young Sok

    1991-01-01

    Arterial fraction of total hepatic blood flow was estimated by a new method, slope method, on radionuclide angiogram using 99m Tc-DISIDA and was compared with that from 99m Tc-Phytate radionuclide angiogram. This study included 11 of normal subjects, 37 of intermediate group with various liver diseases, and 25 patients with liver cirrhosis. We analyzed the data with slope method from radionuclide angiograms and the results were compared with hepatic arterial fractions from uptake method, introduced by Lee et al. at 1986. The hepatic arterial fractions from radionuclide angiograms using 99m Tc-DISIDA and 99m Tc- Phytate were 0.32 ± 0.09 and 0.31 ± 0.11 respectively in normal subjects, and 0.75 ± 0.18 and 0.77 ± 0.21 respectively in patients with liver cirrhosis. The hepatic arterial fractions by the slope method was well correlated with those of the uptake method on 99m Tc-DISIDA scan. There was high correlation between the hepatic arterial fractions from 99m Tc-DISIDA and 99m Tc-Phytate scans. Hepatic arterial fraction estimated by the slope method is a useful index for the diagnosis of liver cirrhosis and the evaluation of status of portal hypertension.

  8. Dynamic study of efficacy of transcatheter arterial chemoembolization (TACE) of primary liver carcinoma with the MR diffusion-weighted imaging (DWI)

    International Nuclear Information System (INIS)

    Shang Quanliang; Xiao Enhua; He Zhong; Tan Lihua; Situ Weijun; Bao Moliao; Yuan Shiwen; Du Wanping

    2006-01-01

    Objective: To dynamically evaluate the efficacy of treatment of primary liver carcinoma (PLC) by transcatheter arterial ehemoembolization(TACE) with the MR diffusion-weighted imaging(DWI). Methods: DWI and the measurement of mean apparent diffusion coeffecient (ADC) value were performed in 25 masses of PLC with the same SE-EPI sequence (b=800 s/mm 2 and 0) at 1.5 T MRI within the 24- 48 hours before TACE (group A) and 36-48 hours, 7-10 days, 30-38 days after TACE (group B, group C, group D). The differences of the mean ADC values of PLC between groups were analyzed. Results: The mean ADC values of the three groups after TACE the mean ADC value of group B: (1.598±0.012) x 10 -3 mm 2 /s, the mean ADC value of group C: (1.723±0.012) x 10 -3 mm 2 /s, the mean ADC value of group D: (1.684±0.012) x 10 -3 mm 2 /s were significantly greater than that of the group before TACE the mean ADC value of group A: (1.376±0.012) x 10 -3 mm 2 /s (p<0.05). The mean ADC values of the group C and the group D were significantly greater than that of the group B (P<0.05). The mean ADC values of the group D was lower than that of the group C (P<0.05). Through contrasting the digital subtraction angiography (DSA) imaging of the second TACE with that of the first TACE, we found that every PLC whose mean ADC value after 30-38 days of the TACE was lower than that after 7-10 days of the TACE could be found the recurrence, especially in those PLC whose mean ADC values were decreased greatly. Conclusion: With the measurement of ADC value of the different time of the PLC we could excellently evaluate the necrosis and the recurrence of the PLC after the operation of the TACE. (authors)

  9. Celiac artery stenosis/occlusion treated by interventional radiology

    International Nuclear Information System (INIS)

    Ikeda, Osamu; Tamura, Yoshitaka; Nakasone, Yutaka; Yamashita, Yasuyuki

    2009-01-01

    Severe stenosis/occlusion of the proximal celiac trunk due to median arcuate ligament compression (MALC), arteriosclerosis, pancreatitis, tumor invasion, and celiac axis agenesis has been reported. However, clinically significant ischemic bowel disease attributable to celiac axis stenosis/occlusion appears to be rare because the superior mesenteric artery (SMA) provides for rich collateral circulation. In patients with celiac axis stenosis/occlusion, the most important and frequently encountered collateral vessels from the SMA are the pancreaticoduodenal arcades. Patients with celiac artery stenosis/occlusion are treated by interventional radiology (IR) via dilation of the pancreaticoduodenal arcade. In patients with dilation of the pancreaticoduodenal arcade on SMA angiograms, IR through this artery may be successful. Here we provide several tips on surmounting these difficulties in IR including transcatheter arterial chemoembolization for hepatocellular carcinoma, an implantable port system for hepatic arterial infusion chemotherapy to treat metastatic liver tumors, coil embolization of pancreaticoduodenal artery aneurysms, and arterial stimulation test with venous sampling for insulinomas.

  10. Celiac artery stenosis/occlusion treated by interventional radiology

    Energy Technology Data Exchange (ETDEWEB)

    Ikeda, Osamu [Department of Diagnostic Radiology, Kumamoto University Graduate School of Medical and Pharmaceutical Sciences, 1-1-1, Honjo Kumamoto 860-8505 (Japan)], E-mail: osamu-3643ik@do9.enjoy.ne.jp; Tamura, Yoshitaka; Nakasone, Yutaka; Yamashita, Yasuyuki [Department of Diagnostic Radiology, Kumamoto University Graduate School of Medical and Pharmaceutical Sciences, 1-1-1, Honjo Kumamoto 860-8505 (Japan)

    2009-08-15

    Severe stenosis/occlusion of the proximal celiac trunk due to median arcuate ligament compression (MALC), arteriosclerosis, pancreatitis, tumor invasion, and celiac axis agenesis has been reported. However, clinically significant ischemic bowel disease attributable to celiac axis stenosis/occlusion appears to be rare because the superior mesenteric artery (SMA) provides for rich collateral circulation. In patients with celiac axis stenosis/occlusion, the most important and frequently encountered collateral vessels from the SMA are the pancreaticoduodenal arcades. Patients with celiac artery stenosis/occlusion are treated by interventional radiology (IR) via dilation of the pancreaticoduodenal arcade. In patients with dilation of the pancreaticoduodenal arcade on SMA angiograms, IR through this artery may be successful. Here we provide several tips on surmounting these difficulties in IR including transcatheter arterial chemoembolization for hepatocellular carcinoma, an implantable port system for hepatic arterial infusion chemotherapy to treat metastatic liver tumors, coil embolization of pancreaticoduodenal artery aneurysms, and arterial stimulation test with venous sampling for insulinomas.

  11. Value of non-contrast sequences in magnetic resonance angiography of hepatic arterial vasculature

    Energy Technology Data Exchange (ETDEWEB)

    Kalra, Vivek B., E-mail: vivek.kalra@yale.edu [Department of Diagnostic Radiology, Yale School of Medicine, Box 208042, Tompkins East 2, 333 Cedar Street, New Haven, CT 06520-8042, United States of America (United States); Gilbert, John W., E-mail: jwgilbert@partners.org [Department of Radiology, Brigham and Women' s Hospital, Harvard Medical School, Francis Street, Boston, MA 02115, United States of America (United States); Krishnamoorthy, Saravanan, E-mail: sk3552@columbia.edu [Department of Radiology, Columbia University Medical Center, Milstein 3rd Fl, New York NY 10032 United States (United States); Cornfeld, Daniel, E-mail: daniel.cornfeld@yale.edu [Department of Diagnostic Radiology, Yale School of Medicine, Box 208042, Tompkins East 2, 333 Cedar St, New Haven, CT 06520-8042, United States of America (United States)

    2014-06-15

    Objective: To evaluate value of adding non-contrast MR angiographic sequence (In-Flow Inversion Recovery [IFIR]) to standard fat-suppressed T1-weighted postcontrast sequence (3D spoiled gradient echo [3D-GRE]) for evaluating hepatic arterial anatomy. Methods: Retrospective evaluation of 30 consecutive patients undergoing multiphase liver MRI. Individual vessels for IFIR/3D-GRE sequences were evaluated by two blinded readers using a four-point scale. Statistical analysis was performed using the Wilcoxon signed-rank test for vessel conspicuity between IFIR/3D-GRE sequences. Results: IFIR alone diagnostically imaged 8.1% of vessels, 3D-GRE alone 25.8%, 55.8% by both 3D-GRE/IFIR, and 10.3% of vessels by neither. Two patients with variant vascular anatomy were visualized with both sequences. Addition of IFIR to 3D-GRE resulted in statistically significant increase in arterial visualization (p < 0.001), 10% relative increase in identified vessels, and 3–5 mi increase in acquisition time for total scan time of 30–35 min. Conclusions: IFIR may be a useful adjunct to 3D-GRE in hepatic angiography without adding considerably to scan time. 10% more hepatic arteries were seen when combining information from IFIR/3D-GRE vs. 3D-GRE alone.

  12. Spatial relationship between intrahepatic artery and portal vein based on the fusion image of CT-arterial portography (CTAP) and CT-angiography (CTA): New classification for hepatic artery at hepatic hilum and the segmentation of right anterior section of the liver

    International Nuclear Information System (INIS)

    Ibukuro, Kenji; Takeguchi, Takaya; Fukuda, Hozumi; Abe, Shoko; Tobe, Kimiko; Tanaka, Rei; Tagawa, Kazumi

    2012-01-01

    Purpose: To clarify the variations of the intrahepatic artery and portal vein and to verify the proper segmentation for the right anterior section of the liver. Materials and methods: CT during arterial portography and CT angiography were performed on 64-slice multi detector row CT in 147 patients. All images were transferred to a workstation for analysis using multi-image-fusion mode. We investigated the spatial relationship between hepatic artery and portal vein in the right hemiliver and the segmentation of the right anterior hepatic artery and portal vein. Results: The spatial anatomy of right hepatic arteries and portal vein was (1) anterior and posterior hepatic artery run superior and inferior to anterior portal vein, respectively (47.6%), (2) one anterior hepatic artery runs superior to and another one runs inferior to anterior portal vein (15%), (3) anterior and posterior hepatic arteries run superior to anterior portal vein (11.6%), (4) anterior and posterior hepatic arteries run inferior to anterior portal vein (7.5%), and (5) one posterior hepatic artery runs superior to and another one runs inferior to anterior portal vein (6.8%). The combined anatomy of right anterior artery and portal vein with regard to segmentation was classified as (1) dorso-ventral (26.5%), (2) dorso-ventral and inferior (10.9%), (3) multiple (18.4%), and (4) superior and inferior segments (1.4%). Conclusion: There are various types of spatial anatomy of intrahepatic artery and portal vein. The hepatic arteries as well as portal veins of right anterior section of the liver could be divided into dorsal and ventral, not superior and inferior.

  13. Hepatic Artery Resection for Bismuth Type III and IV Hilar Cholangiocarcinoma: Is Reconstruction Always Required?

    Science.gov (United States)

    Hu, Hai-Jie; Jin, Yan-Wen; Zhou, Rong-Xing; Shrestha, Anuj; Ma, Wen-Jie; Yang, Qin; Wang, Jun-Ke; Liu, Fei; Cheng, Nan-Sheng; Li, Fu-Yu

    2018-03-06

    The objective of the study is to examine the feasibility of hepatic artery resection (HAR) without subsequent reconstruction (RCS) in specified patients of Bismuth type III and IV hilar cholangiocarcinoma. We retrospectively reviewed 63 patients who underwent hepatic artery resection for Bismuth type III and IV hilar cholangiocarcinoma. These patients were subsequently enrolled into two groups based on whether the artery reconstruction was conducted. Postoperative morbidity and mortality, and long-term survival outcome were compared between the two groups. There were 29 patients in HAR group and 34 patients in the HAR + RCS group. Patients with hepatic artery reconstruction tended to have longer operative time (545.6 ± 143.1 min vs. 656.3 ± 192.8 min; P = 0.013) and smaller tumor size (3.0 ± 1.1 cm vs. 2.5 ± 0.9 cm; P = 0.036). The R0 resection margin was comparable between the HAR group and HAR + RCS group (86.2 vs. 85.3%; P > 0.05). Twelve patients (41.4%) with 24 complications in HAR group and 13 patients (38.2%) with 25 complications in HAR + RCS group were recorded (P = 0.799). The postoperative hepatic failure rate (13.8 vs. 5.9%) and postoperative mortality rate (3.4% vs. 2.9%) were also comparable between the two groups. In the HAR group, the overall 1-, 3-, and 5-year survival rates were 72, 41, and 19%, respectively; while in the HAR + RCS group, the overall 1-, 3-, and 5-year survival rates were 79, 45, and 25%, respectively (P = 0.928). Hepatic artery resection without reconstruction is also a safe and feasible surgical procedure for highly selected cases of Bismuth type III and IV hilar cholangiocarcinoma.

  14. Computed tomography arterial portography for assessment of portal vein injury after blunt hepatic trauma.

    Science.gov (United States)

    Fu, Chen Ju; Wong, Yon Cheong; Tsang, Yuk Ming; Wang, Li Jen; Chen, Huan Wu; Ku, Yi Kang; Wu, Cheng Hsien; Chen, Huan Wen; Kang, Shih Ching

    2015-01-01

    Intrahepatic portal vein injuries secondary to blunt abdominal trauma are difficult to diagnose and can result in insidious bleeding. We aimed to compare computed tomography arterial portography (CTAP), reperfusion CTAP (rCTAP), and conventional computed tomography (CT) for diagnosing portal vein injuries after blunt hepatic trauma. Patients with blunt hepatic trauma, who were eligible for nonoperative management, underwent CTAP, rCTAP, and CT. The number and size of perfusion defects observed using the three methods were compared. A total of 13 patients (seven males/six females) with a mean age of 34.5±14.1 years were included in the study. A total of 36 hepatic segments had perfusion defects on rCTAP and CT, while there were 47 hepatic segments with perfusion defects on CTAP. The size of perfusion defects on CT (239 cm3; interquartile range [IQR]: 129.5, 309.5) and rCTAP (238 cm3; IQR: 129.5, 310.5) were significantly smaller compared with CTAP (291 cm3; IQR: 136, 371) (both, P = 0.002). Perfusion defects measured by CTAP were significantly greater than those determined by either rCTAP or CT in cases of blunt hepatic trauma. This finding suggests that CTAP is superior to rCTAP and CT in evaluating portal vein injuries after blunt liver trauma.

  15. Multidetector computed tomography angiography of the celiac trunk and hepatic arterial system: normal anatomy and main variants

    Energy Technology Data Exchange (ETDEWEB)

    Araujo-Neto, Severino Aires; Mello-Junior, Carlos Fernando de; Franca, Henrique Almeida; Duarte, Claudia Martina Araujo; Borges, Rafael Farias; Magalhaes, Ana Guardiana Ximenes de, E-mail: severinoaires@hotmail.com [Universidade Federal da Paraiba (UFPB), Joao Pessoa, PB (Brazil)

    2016-01-15

    Although digital angiography remains as the gold standard for imaging the celiac arterial trunk and hepatic arteries, multidetector computed tomography in association with digital images processing by software resources represents a useful tool particularly attractive for its non invasiveness. Knowledge of normal anatomy as well as of its variations is helpful in images interpretation and to address surgical planning on a case-by-case basis. The present essay illustrates several types of anatomical variations of celiac trunk, hepatic artery and its main branches, by means of digitally reconstructed computed tomography images, correlating their prevalence in the population with surgical implications. (author)

  16. Left hepatectomy combined with hepatic artery resection for hilar cholangiocarcinoma: A retrospective cohort study.

    Science.gov (United States)

    Peng, Chihan; Li, Chuan; Wen, Tianfu; Yan, Lvnan; Li, Bo

    2016-08-01

    To investigate the efficacy of our technique and policy on left hepatectomy (LH) with hepatic artery resection but without arterial reconstruction (HAR) in selected patients with hilar cholangiocarcinoma. From May 2005 to May 2012, 61 patients with hilar cholangiocarcinoma underwent left hepatectomy. These patients were divided into two groups: the LH with HAR group (n = 26) and the LH alone group (n = 35), based on whether hepatic artery resection was performed. We evaluated the serum total and direct bilirubin on postoperative day 7, length of hospital stay after surgery, postoperative complications, long-term postoperative survival and disease-free survival. The improvement in jaundice after surgery was comparable between the two groups (P = 0.837). There were no significant differences in the rates of postoperative complications or mortality between the LH with HAR group and the LH group (P = 0.654 and no assessment, respectively). The cumulative 1-, 2-, 3- and 5-year survival rates were 61.5%, 49%, 40.8% and 30.6% and 71.4%, 58.7%, 51.3% and 38.5%, respectively, in the LH with HAR group and the LH group (P = 0.383, including perioperative deaths). The cumulative 1-, 2-, 3- and 5-year disease-free survival rates were 61.9%, 41.6%, 29.7% and 14.8% and 58.2%, 50.7%, 44.3% and 23.6% in the LH with HAR group and the LH group, respectively (P = 0.695, including perioperative deaths). The postoperative complication rate was higher in patients with severe jaundice than those with non-severe jaundice, but no significant difference was detected (56.3% (9/16) vs. 46.7% (46.7%), P = 0.804). Similarly, 18.8% (3/16) postoperative mortality was found in patients with severe jaundice, compared to 4.4% (2/45) in those with non-severe jaundice. The difference was not significant (P = 0.139). For the cumulative 1-, 2-, 3- and 5-year survival and cumulative 1-, 2-, 3- and 5-year disease-free survival rates, patients with severe jaundice had poorer outcomes than

  17. Hepatic Arterial Perfusion Scintigraphy with '99mTc-Macroaggregated Albumin in Hepatocellular Carcinoma

    International Nuclear Information System (INIS)

    Kim, Gang Deuk; Sohn, Kwang Joon; Min, Kyung Yoon; Kwon, Young Mi; Kim, Chang Guhn; Noh, Byung Suk; Won, Jong Jin

    1994-01-01

    Hepatic arterial perfusion scintigraphy with '9 9m Tc macroggregated albumin (HAPS) study was carried out in 16 patients with hepatocellular carcinoma (HCC) and in six patients without liver tumor to evaluate HAPS findings of hepatocellular carcinoma and use fullness of HAPS. HAPS with planar and SPECT study were performed in 22 patients after conventional hepatic or celiac arteriography. For HAPS study, 4 5 mCi of MAA mixed with 2 ml of saline was injected into proper hepatic artery or its distal branches at the rate of approximately 1 ml/sec. We analysed 21 HCCs over 2 cm in diameter(average diameter: 6.4 cm) and 17 of 21 HCCs were over 4 cm in diameter. CT, sonography and angiography were performed within two week in all 16 patients and liver scan was performed in 12 patients. Three different pattern of tumor perfusion were observed in 16 patients with HCC. 1) diffuse increased perfusion in 16 of 21(76%) 2) increased peripheral perfusion in 4 of 21(19%) 3) diffuse decreased perfusion in 1 of 21 (5%) Arteriovenous shunt indicated by lung uptake of MAA were observed in 9 of 16 (56% ). In contrast, angiography demonstrates arteriovenous shunt in 2 of 16 (13%). There was no accumulation of radioactivity on RRC blood pool scan in all six patients with HCC examined. HAPS is useful study in evaluation of perfusion pattern or vascularity of HCC and in detection of arteriovenous shunt.

  18. A gamma camera method to monitor the use of degradable starch microspheres in hepatic arterial chemotherapy

    International Nuclear Information System (INIS)

    Britten, A.; Fleming, J.; Flowerdew, A.; Hunt, T.; Taylor, I.; Ackery, D.

    1989-01-01

    A gamma camera method to quantify the haemodynamic effects of degradable starch microspheres (DSM) in intra arterial hepatic therapy is described. Results are presented from ten patients with colorectal liver metastases. Intra hepatic arterio venous shunting was present in 1 patient prior to DSM and in 2 subjects after three 300 mg DSM fractions. DSM reduced the rate of flow of injectate to the lung in all cases. Conversely, an increased rate of flow of injectate to gut or spleen occurred with 300 mg fractions of DSM in 7/9 cases. Lower dose DSM fractions are indicated. At 2-3 min after DSM injection the mean fraction of the activity retained in the liver was 0.22. A DSM induced enhancement of tumour relative to normal tissue perfusion was obtained in four out of five tumour regions identified. All indices showed a wide variation between patients and between individual DSM doses, and the high incidence of extra hepatic shunting confirms the need for monitoring when using intra arterial microspheres. (orig.)

  19. Infusion MR arteriography during hepatic arterial infusion chemotherapy. Evaluation of clinical usefulness

    International Nuclear Information System (INIS)

    Uchino, Minako; Takizawa, Kenji

    2003-01-01

    We developed a new method of infusion MR arteriography (IMRA) via an implantable port system using an infusion pump for the evaluation of drug distribution during hepatic arterial infusion chemotherapy. The purposes of this study were to optimize the method and evaluate its clinical usefulness. We used 3D-T1 turbo field echo (TFE) as the most suitable sequence for IMRA according to the results of a phantom model experiment. We examined 33 cases of liver cancer that had been treated by arterial infusion chemotherapy via the port system. The following investigations were performed: degree of tumor enhancement, intra- and extra- hepatic perfusion abnormality, and related toxicity. The evaluation of images was performed separately by two radiologists. IMRA provided good images of contrast enhancement, to reveal the perfusion patterns. The treatment response rate in the tumor group with well enhancement was higher than that of the group with poor enhancement (p<0.0001). Extrahepatic perfusion was well visualized and was correlated with toxicity (p<0.0001). IMRA is a useful method to evaluate drug perfusion for the optimization of arterial infusion chemotherapy. (author)

  20. Significance of diagnosis of liver metastases from colorectal cancer by angio helical CT and intermittent hepatic arterial infusion chemotherapy after hepatic resection in terms of prognosis

    International Nuclear Information System (INIS)

    Hatsuse, Kazuo; Aoki, Hideki; Murayama, Michinori

    1997-01-01

    Seventy five cases had undergone hepatic resection for liver metastases from colorectal cancer from 1979 to 1994. Computed tomography during hepatic angiography (angio CT) was tried in 27 cases. At first, we compared detection ratios of angio CT for liver metastase to those of ultrasonography, conventional CT, and operative ultrasonography on these 27 cases. Next, the prognosis of seventy five cases was examined. They were divided into three groups; the HX group 29 cases with only hepatic resection; the HX+AP group of 19 cases with intermittent hepatic arterial infusion chemotherapy after hepatic resection; the angio CT group of 27 cases selected for hepatic resection by angio CT, followed by the same infusion chemotherapy as that given to the HX+AP group. Fifty metastases were diagnosed histopathologically in twenty seven cases that underwent hepatic resection after angio CT. Detection ratios for small metastases 1.0 cm or smaller in diameter were 8.3% with ultrasonography, 25% with CT, 75% with angio CT, and 50% with operative ultrasonography. Detection ratios of angio CT were superior to those of ultrasonography and CT. Recurrence rates of the remnant liver were significantly low and survival rates were significantly superior in the angio CT group compared to the other two groups (p<0.02). The prognosis with and without intermittent hepatic arterial infusion chemotherapy after hepatic resection were significantly different (p<0.03). The above data suggest that improvement of detection ratios for liver metastases by angio CT, and probably concomitant intermittent hepatic infusion chemotherapy contribute to decreased remnant liver recurrence and an increased survival rate. (author)

  1. Endovascular Mechanical Thromboaspiration of Right Hepatic Arterial Thrombosis After Liver Transplantation

    International Nuclear Information System (INIS)

    Gandini, Roberto; Konda, Daniel; Toti, Luca; Abrignani, Sergio; Merolla, Stefano; Tisone, Giuseppe; Floris, Roberto

    2017-01-01

    A 56-year-old male Patient presented 27 days after a liver transplantation (LT) with fever and hyperbilirubinemia. He underwent CT examination resulting in a diagnosis of right hepatic artery (HA) occlusion with hepatic bilomas. Once placed a long right femoral 6F introducer at the origin of the HA, a 0.014” guidewire was advanced over the thrombus, in a segmental branch. A 4MAX (Penumbra, Alameda, USA) catheter was advanced and withdrawn under constant aspiration until complete clot removal was achieved. Follow-up CT and D-US assessments at 12 months demonstrated regular HA patency and bilomas reduction. Endovascular thromboaspiration is an effective strategy in cases of E-HAT after LT.

  2. Endovascular Mechanical Thromboaspiration of Right Hepatic Arterial Thrombosis After Liver Transplantation

    Energy Technology Data Exchange (ETDEWEB)

    Gandini, Roberto; Konda, Daniel [University of Rome “Tor Vergata”, Department of Diagnostic Imaging, Molecular Imaging, Interventional Radiology and Radiotherapy, PTV Foundation, “Tor Vergata” Hospital (Italy); Toti, Luca [University of Rome “Tor Vergata”, Department of Surgery, Section of Transplantation, PTV Foundation, “Tor Vergata” Hospital (Italy); Abrignani, Sergio, E-mail: stem83@gmail.com; Merolla, Stefano [University of Rome “Tor Vergata”, Department of Diagnostic Imaging, Molecular Imaging, Interventional Radiology and Radiotherapy, PTV Foundation, “Tor Vergata” Hospital (Italy); Tisone, Giuseppe [University of Rome “Tor Vergata”, Department of Surgery, Section of Transplantation, PTV Foundation, “Tor Vergata” Hospital (Italy); Floris, Roberto [University of Rome “Tor Vergata”, Department of Diagnostic Imaging, Molecular Imaging, Interventional Radiology and Radiotherapy, PTV Foundation, “Tor Vergata” Hospital (Italy)

    2017-04-15

    A 56-year-old male Patient presented 27 days after a liver transplantation (LT) with fever and hyperbilirubinemia. He underwent CT examination resulting in a diagnosis of right hepatic artery (HA) occlusion with hepatic bilomas. Once placed a long right femoral 6F introducer at the origin of the HA, a 0.014” guidewire was advanced over the thrombus, in a segmental branch. A 4MAX (Penumbra, Alameda, USA) catheter was advanced and withdrawn under constant aspiration until complete clot removal was achieved. Follow-up CT and D-US assessments at 12 months demonstrated regular HA patency and bilomas reduction. Endovascular thromboaspiration is an effective strategy in cases of E-HAT after LT.

  3. Anatomical variants of celiac trunk, hepatic and renal arteries in a population of developing country using multidetector computed tomography angiography

    International Nuclear Information System (INIS)

    Arifuzzaman, M.; Naqvi, S.S.N.; Rasool, M.; Hussain, M.

    2017-01-01

    Background: Multidetector Computed Tomography (MDCT)s has become a major part in evaluation of hepatic and renal tumours. With improvements in MDCT, CT angiography has also improved and normal anatomy and its variants in patients undergoing operative or interventional procedures can be effectively studied. The purpose of this study was to evaluate the frequency of anatomical variation of celiac trunk, hepatic and renal arterial systems in patients undergoing multidetector CT (MDCT) angiography of the abdominal aorta. Methods: A descriptive, retrospective cross-sectional study was carried out on CT angiographies performed during the months of October till December 2015. Hepatic and renal arteries and celiac trunk were studied and normal and anatomical variations were noted. All patients with abnormalities affecting the vessels or a history of any vascular abnormality were excluded from the study. Results: Out of total 110 patients, 69.1% had normal and 30.9% had variant hepatic artery with Michel Type IV being the most common variant whereas 88.2% had normal celiac trunk and 8.2% had gastrosplenic trunk variant. Variation in renal arterial system was observed in 15.5% of the patients with two renal arteries on right and two on left being the most common type. Multiple variants were identified in 11.8% of the patients. Conclusion: The type and knowledge of anatomy is of prime importance for an optimum preoperative planning in surgical or radiological procedure. MDCT allows minimally invasive assessment of arterial anatomy with high quality 3D reconstruction images. (author)

  4. Downstream Hepatic Arterial Blood Pressure Changes Caused by Deployment of the Surefire AntiReflux Expandable Tip

    International Nuclear Information System (INIS)

    Rose, Steven C.; Kikolski, Steven G.; Chomas, James E.

    2013-01-01

    Purpose: The purpose of this work was to evaluate blood pressure changes caused by deployment of the Surefire antireflux expandable tip. The pressure measurements are relevant because they imply changes in hepatoenteric arterial blood flow within this liver compartment during hepatic artery delivery of cytotoxic agents. Methods: After positioning the Surefire antireflux system in the targeted hepatic artery, blood pressure was obtained initially with the tip collapsed (or through a femoral artery sheath), then again after the tip was expanded before chemoembolization or yttrium 90 ( 90 Y) radioembolization. Results: Eighteen patients with liver malignancy underwent 29 procedures in 29 hepatic arteries (3 common hepatic, 22 lobar, 4 segmental). Systolic, diastolic, and mean blood pressure were all decreased by a mean of 29 mm Hg (p = 0.000004), 14 mm Hg (p = 0.0000004), and 22 mm Hg (p = 0.00000001), respectively. Conclusion: When the Surefire expandable tip is deployed to prevent retrograde reflux of agents, it also results in a significant decrease in blood pressure in the antegrade distribution, potentially resulting in hepatopedal blood flow in vessels that are difficult to embolize, such as the supraduodenal arteries

  5. Rare Type of Course and Distribution of an Additional Right Hepatic Artery: A Possible Source of Iatrogenic Injury During Hepato-biliary and Pancreatic Surgeries

    Directory of Open Access Journals (Sweden)

    Prakashchandra Shetty

    2017-07-01

    Full Text Available Celiac artery shows frequent variations in its branching pattern. Knowledge of its possible variations is useful in gastric, pancreatic and hepato-biliary surgeries. During our dissection classes, we observed a rare variation of the branching pattern of celiac trunk. It divided normally into its three branches; left gastric, splenic and common hepatic arteries. Left gastric and splenic arteries were normal in their course and distribution. The common hepatic artery trifurcated to give hepatic artery proper, gastroduodenal artery and an additional right hepatic artery. The branching pattern of hepatic artery proper and gastroduodenal arteries was normal. The additional right hepatic artery gave origin to a right gastric artery and a large pancreatic branch to the head of the pancreas. It coursed parallel to the bile duct, being on its right side, passed through the Calot’s triangle and entered the right lobe of liver through the fossa for gall bladder. In the Calot’s triangle, it gave a cystic branch to the gall bladder. We discuss the clinical importance of this rare variation in this paper.

  6. The Main Anatomic Variations of the Hepatic Artery and Their Importance in Surgical Practice: Review of the Literature.

    Science.gov (United States)

    Noussios, George; Dimitriou, Ioannis; Chatzis, Iosif; Katsourakis, Anastasios

    2017-04-01

    Anatomical variations of the hepatic artery are important in the planning and performance of abdominal surgical procedures. Normal hepatic anatomy occurs in approximately 80% of cases, for the remaining 20% multiple variations have been described. The purpose of this study was to review the existing literature on the hepatic anatomy and to stress out its importance in surgical practice. Two main databases were searched for eligible articles during the period 2000 - 2015, and results concerning more than 19,000 patients were included in the study. The most common variation was the replaced right hepatic artery (type III according to Michels classification) which is the chief source of blood supply to the bile duct.

  7. Hilar anatomy of the hepatic artery and surgical procedure for hilar cholangiocarcinoma

    International Nuclear Information System (INIS)

    Uesaka, Katsuhiko; Maeda, Atsuyuki; Kanamoto, Hideyuki; Matsunaga, Kazuya; Yuasa, Ichiro; Okamura, Yukiyasu; Yamaguchi, Shigeki; Bando, Etsuro; Furukawa, Hiroyoshi

    2006-01-01

    This paper describes the examination of findings by multi-detector-row CT (MDCT) and by surgery to obtain the anatomy of hilar arteries and portal vein, which is necessary for the procedure in the title. Subjects are those findings of 38 patients with hilar cholangiocarcinoma, who underwent its excision during the period of 1 year from 2002 Nov. Before operation, MDCT with 16-row detector was done 20-120 sec after infusion of a non-ionized contrast medium to compose the 3D images. The left hepatic arterial system was found to be classifiable in 3 types of common, anti-clockwise and clockwise one with the respective frequency of 63, 24 and 11%, and the right system, infra-portal (76%) and supra-portal (24%) types. It was concluded that to the arterial clockwise and supra-portal types, particular attention should be paid for the cancer invasion there and for avoidance of the artery damage during the operation. (T.I.)

  8. Patent hepatic falciform artery detected after Tc-99m-macroaggregated albumin injection on SPECT/CT prior to Yttrium-90 microsphere radioembolization: a case report

    International Nuclear Information System (INIS)

    Karaman, B.; Aslan, A.; Hamcan, S.; Ugurel, M.

    2012-01-01

    Full text: Introduction: Yttrium-90 (Y-90) microsphere radioembolization is increasingly used for the treatment of unresectable hepatocellular carcinoma and liver metastasis. Objectives and tasks: We aim to present the upper abdominal wall skin involvement detected during routine pre-therapy Technetium-99m-macroaggregated albumin (Tc-99m-MAA) on SPECT/CT due to patent hepatic falciform artery and the precautions to avoid this potential complication. Material and methods: 38-year-old male with colon cancer and multiple liver metastasis was evaluated prior to radioembolization and Tc-99 MAA was slowly hand injected at the bifurcation of the proper hepatic artery. Then, the SPECT/CT scan was performed in order to investigate the systemic shunt or gastric involvement. Results: On SPECT/CT scan, involvement of the upper abdominal wall through falciform ligament was seen. Re-evaluation of the hepatic angiogram identified a patent hepatic falciform artery arising from the left hepatic artery. Y-90 microspheres were slowly hand injected to the left hepatic artery superselectively and no extra-hepatic activity was seen on SPECT/CT scan. Conclusion: Upper abdominal pain and dermatitis are uncommon findings after radioembolization and may occur due to inadvertent delivery of Y-90 microspheres into patent hepatic falciform artery. To prevent these complications, either patent hepatic falciform artery must be embolized by coil or Y-90 injection must be performed superselectively

  9. Transplantation of autologous bone marrow stem cells via hepatic artery for the treatment of acute hepatic injury: an experimental study in rabbits

    International Nuclear Information System (INIS)

    Zhu Yinghe; Han Jinling; Liu Yanping; Gao Jue; Xu Ke; Zhang Xitong; Ding Guomin

    2009-01-01

    Objective: To evaluate the transplantation of autologous bone marrow stem cells via hepatic artery in treating acute hepatic injury in experimental rabbit models and to clarify the synergistic effect of hepatocyte growth-promoting factor (pHGF) in stem cell transplantation therapy for liver injury. Methods Acute hepatic injury models were established in 15 experimental rabbits by daily subcutaneous injection of CCl 4 olive oil solution with the dose of 0.8 ml/kg for 4 days in succession. The experimental rabbits were randomly and equally divided into three groups: study group A (stem cell transplant, n = 5), study group B (stem cell transplant + pFHG, n = 5), and control group (n = 5). Bone marrow of 5 ml was drawn from the tibia in all rabbits of both study groups, from which bone marrow stem cells were isolated by using density gradient centrifugation, and 5 ml cellular suspension was prepared. Under fluoroscopic guidance, catheterization through the femoral artery was performed and the cellular suspension was infused into the liver via the hepatic artery. Only injection of saline was carried out in the rabbits of control group. For the rabbits in group B, pFHG (2.0 mg/kg) was administered intravenously every other day for 20 days. At 2, 4 and 8 weeks after stem cell transplantation, hepatic function was determined. Eight weeks after the transplantation all the rabbits were sacrificed and the liver specimens were collected and sent for pathological examination. Results After stem cell transplantation, the hepatic function was gradually improved.Eight weeks after the transplantation, the activity of AST, ALT and the content of ALB, TBIL were significantly lower than that before the procedure, while the content of GOLB was markedly increased in all rabbits. In addition, the difference in the above parameters between three groups was statistically significant (P < 0.05). Pathologically, the hepatocyte degeneration and the fiberous hyperplasia in the study groups

  10. Transcatheter emboilization therapy of massive colonic bleeding

    International Nuclear Information System (INIS)

    Shin, G. H.; Oh, J. H.; Yoon, Y.

    1996-01-01

    To evaulate the efficacy and safety of emergent superselective transcatheter embolization for controlling massive colonic bleeding. Six of the seven patients who had symptom of massive gastrointestinal bleeding underwent emergent transcatheter embolization for control of the bleeding. Gastrointestinal bleeding in these patients was originated from various colonic diseases: rectal cancer(n=1), proctitis(n=1), benign ulcer(n=1), mucosal injury by ventriculoperitoneal shunt(n=1), and unknown(n=2). All patients except one with rectal cancer were critically ill. Superselective embolization were done by using Gelfoam particles and/or coils. The vessels embolized were ileocolic artery(n=1). superior rectal artery(n=2), inferior rectal artery (n=1), and middle and inferior rectal arteries(n=1). Hemostasis was successful immediately in all patients. Two underwnet surgery due to recurrent bleeding developed 3 days after the procedure(n=1) or in associalion with underlying rectal cancer(n=1). On surgical specimen of two cases, there was no mucosal ischemic change. Transcatheter embolization is a safe and effective treatment of method for the control of massive colonic bleeding

  11. Hilar Inflammatory Pseudotumour with Hepatic Artery Atheroma- mimicker of Klatskin Tumour.

    Science.gov (United States)

    Rastogi, Archana; Bihari, Chhagan; Gupta, Nalini; Deka, Pranjal; Kumar, Arvind; Negi, Sanjay Singh; Arora, Ankur

    2015-03-01

    Inflammatory pseudotumour of hilar biliary structures is an extremely rare benign lesion that can mimic hilar cholangiocarcinoma. Clinical presentation and imaging findings often pose diagnostic difficulties. Main histopathological findings are the presence of myofibroblastic spindle cells, plasma cells, macrophages, and lymphocytes without cellular atypia or atypical mitotic figures. We describe a case of 62 year old male who presented with surgical obstructive jaundice. Imaging revealed a mass lesion involving the biliary confluence with upstream dilatation of biliary tree. Diagnosis of hilar cholangiocarcinoma with type III hilar block was made. Intraoperately hilar mass lesion was found which was encasing right hepatic artery with no evidence of metastasis. The patient underwent Right hepatectomy with caudate lobectomy with complete common bile duct (CBD) excision with Roux en Y hepaticojejunostomy. Unexpectedly histopathological examination showed no evidence of malignancy and revealed hilar inflammatory pseudotumour with hepatic artery atherosclerosis. Preoperative imaging, operative management, pathologic diagnosis and literature review are being presented in view of rarity of the case.

  12. Palonosetron-A Single-Dose Antiemetic Adjunct for Hepatic Artery Radioembolization: A Feasibility Study

    International Nuclear Information System (INIS)

    Siddiqi, Nasir H.; Khan, Atif J.; Devlin, Phillip M.

    2009-01-01

    Nausea and vomiting may occur in a significant minority of patients following hepatic artery embolization with yttrium-90 spheres (K. T. Sato et al. Radiology 247:507-515, 2008). This encumbers human and economic resources and undercuts the assertion that it is as a well-tolerated outpatient treatment. A single intravenous dose of palonosetron HCl was administered before hepatic artery embolization with yttrium-90 spheres to ameliorate posttreatment nausea and vomiting, in 23 consecutive patients. The patients were discharged the day of procedure on oral antiemetics, steroids, and blockers of gastric acid release. All patients had clinical and laboratory evaluation at 2 weeks after the procedure. The data were gathered and reviewed retrospectively. At 2-week follow-up, none reported significant nausea, vomiting, additional antiemetic use, need for parenteral therapy, hospital readmission, or palonosetron-related side effects. All patients recovered from postembolization symptoms within a week after treatment. In conclusion, this retrospective study suggests that single-dose palonosetron is feasible, safe, and effective for acute and delayed nausea and vomiting in this group of patients. The added cost may be offset by benefits.

  13. Intra-Arterial Hepatic Chemotherapy: A Comparison of Percutaneous Versus Surgical Implantation of Port-Catheters

    International Nuclear Information System (INIS)

    Deschamps, F.; Elias, D.; Goere, D.; Malka, D.; Ducreux, M.; Boige, V.; Auperin, A.; Baere, T. de

    2011-01-01

    Purpose: To compare retrospectively the safety and efficacy of percutaneous and surgical implantations of port-catheters for intra-arterial hepatic chemotherapy (IAHC). Materials and Methods: Between January 2004 and December 2008, 126 consecutive patients (mean age 58 years) suffering from liver colorectal metastases were referred for intra-arterial hepatic chemotherapy (IAHC). Port-catheters were percutaneously implanted (P) through femoral access with the patient under conscious sedation when no other surgery was planned or were surgically implanted (S) when laparotomy was performed for another purpose. We report the implantation success rate, primary functionality, functionality after revision, and complications of IAHC. Results: The success rates of implantation were 97% (n = 65 of 67) for P and 98% (n = 58 of 59) for S. One hundred eleven patients received IAHC in our institution (n = 56P and n = 55S). Primary functionality was the same for P and S (4.80 vs. 4.82 courses), but functionality after revision was significantly higher for P (9.18 vs. 5.95 courses, p = 0.004) than for S. Forty-five complications occurred during 516 courses for P and 28 complications occurred during 331 courses for S. The rates of discontinuation of IAHC linked to complications of the port-catheters were 21% (n = 12 of 56) for P and 34% (n = 19 of 55) for S. Conclusion: Overall, significantly better functionality and similar complication rates occurred after P versus S port-catheters.

  14. Transcatheter closure of patent ductus arteriosus: past, present and future.

    Science.gov (United States)

    Baruteau, Alban-Elouen; Hascoët, Sébastien; Baruteau, Julien; Boudjemline, Younes; Lambert, Virginie; Angel, Claude-Yves; Belli, Emre; Petit, Jérôme; Pass, Robert

    2014-02-01

    This review aims to describe the past history, present techniques and future directions in transcatheter treatment of patent ductus arteriosus (PDA). Transcatheter PDA closure is the standard of care in most cases and PDA closure is indicated in any patient with signs of left ventricular volume overload due to a ductus. In cases of left-to-right PDA with severe pulmonary arterial hypertension, closure may be performed under specific conditions. The management of clinically silent or very tiny PDAs remains highly controversial. Techniques have evolved and the transcatheter approach to PDA closure is now feasible and safe with current devices. Coils and the Amplatzer Duct Occluder are used most frequently for PDA closure worldwide, with a high occlusion rate and few complications. Transcatheter PDA closure in preterm or low-bodyweight infants remains a highly challenging procedure and further device and catheter design development is indicated before transcatheter closure is the treatment of choice in this delicate patient population. The evolution of transcatheter PDA closure from just 40 years ago with 18F sheaths to device delivery via a 3F sheath is remarkable and it is anticipated that further improvements will result in better safety and efficacy of transcatheter PDA closure techniques. Copyright © 2014 Elsevier Masson SAS. All rights reserved.

  15. Hepatic Arterial Chemoembolization Using Drug-Eluting Beads in Gastrointestinal Neuroendocrine Tumor Metastatic to the Liver

    International Nuclear Information System (INIS)

    Gaur, Shantanu K.; Friese, Jeremy L.; Sadow, Cheryl A.; Ayyagari, Rajasekhara; Binkert, Christoph A.; Schenker, Matthew P.; Kulke, Matthew; Baum, Richard

    2011-01-01

    Purpose: This study was designed to evaluate short ( 3 months) follow-up in patients with metastatic neuroendocrine tumor to the liver who underwent hepatic arterial chemoembolization with drug-eluting beads at a single institution. Methods: Institutional review board approval was obtained for this retrospective review. All patients who were treated with 100–300 or 300–500 μm drug-eluting LC Beads (Biocompatibles, UK) preloaded with doxorubicin (range, 50–100 mg) for GI neuroendocrine tumor metastatic to the liver from June 2004 to June 2009 were included. CT and MRI were evaluated for progression using Response Evaluation Criteria In Solid Tumors (RECIST) or European Association for the Study of the Liver (EASL) criteria. Short-term ( 3 months) imaging response was determined and Kaplan–Meier survival curves were plotted. Results: Thirty-eight drug-eluting bead chemoembolization procedures were performed on 32 hepatic lobes, comprising 21 treatment cycles in 18 patients. All procedures were technically successful with two major complications (biliary injuries). At short-term follow-up (<3 months), 22 of 38 (58%) procedures and 10 of 21 (48%) treatment cycles produced an objective response (OR) with the remainder having stable disease (SD). At intermediate-term follow-up (mean, 445 days; range, 163–1247), 17 of 26 (65%) procedures and 8 of 14 (57%) treatment cycles produced an OR. Probability of progressing was approximately 52% at 1 year with a median time to progression of 419 days. Conclusions: Drug-eluting bead chemoembolization is a reasonable alternative to hepatic arterial embolization and chemoembolization for the treatment of metastatic neuroendocrine tumor to the liver.

  16. Asparagus polysaccharide and gum with hepatic artery embolization induces tumor growth and inhibits angiogenesis in an orthotopic hepatocellular carcinoma model.

    Science.gov (United States)

    Weng, Ling-Ling; Xiang, Jian-Feng; Lin, Jin-Bo; Yi, Shang-Hui; Yang, Li-Tao; Li, Yi-Sheng; Zeng, Hao-Tao; Lin, Sheng-Ming; Xin, Dong-Wei; Zhao, Hai-Liang; Qiu, Shu-Qi; Chen, Tao; Zhang, Min-Guang

    2014-01-01

    Liver cancer is one of leading digestive malignancies with high morbidity and mortality. There is an urgent need for the development of novel therapies for this deadly disease. It has been proven that asparagus polysaccharide, one of the most active derivates from the traditional medicine asparagus, possesses notable antitumor properties. However, little is known about the efficacy of asparagus polysaccharide as an adjuvant for liver cancer chemotherapy. Herein, we reported that asparagus polysaccharide and its embolic agent form, asparagus gum, significantly inhibited liver tumor growth with transcatheter arterial chemoembolization (TACE) therapy in an orthotopic hepatocellular carcinoma (HCC) tumor model, while significantly inhibiting angiogenesis and promoting tumor cell apoptosis. Moreover, asparagine gelatinous possessed immunomodulatory functions and showed little toxicity to the host. These results highlight the chemotherapeutic potential of asparagus polysaccharide and warrant a future focus on development as novel chemotherapeutic agent for liver cancer TACE therapy.

  17. The prognosis and prognostic risk factors of patients with hepatic artery complications after liver transplantation treated with the interventional techniques

    International Nuclear Information System (INIS)

    Shan Hong; Huang Mingsheng; Jiang Zaipo; Zhu Kangshun; Yang Yang; Chen Guihua

    2008-01-01

    Objective: To investigate the prognosis and prognostic risk factors of hepatic artery complications after orthotopic liver transplantation (OLT) treated with the interventional techniques. Methods: The clinical data of 21 patients with hepatic artery complication after liver transplantation receiving thrombolysis, PTA, and stent placement in our institute from November 2003 to April 2007 were retrospectively analyzed. Based on the prognosis of grafts, 21 patients were divided into poor-prognosis group and non-poor-prognosis group. Fifteen variables (including biliary complication, hepatic artery restenosis, early or late artery complication, and so on) were analyzed in both groups with binary logistic regression analysis to screen out the risk factors related to prognosis of pereutaneous interventional treatment for hepatic artery complications after OLT. Results: Twenty-one patients were followed for mean 436 days, median 464 days (3-1037 days). The poor-prognosis group included 11 patients (5 cases received retransplantation, and 6 died). The mean survival time of grafts in poor-prognosis group was 191 days, and median survival time was 73 days (3-616 days). The mean survival time of grafts in non-poor-prognosis group which included 10 patients was 706 days, and median survival time was 692 days (245-1037 days). Univariate analysis showed there were significant difference in biliary complication, total bilimbin and indirect bilirubin between the two groups. The binary, logistic regression analysis showed the risk factor related to prognosis was with biliary complication before the interventional management (P=0.027, OR=22.818). Conclusion: Biliary complication before interventional management is the risk factor related to poor prognosis of patients with hepatic artery stenosis or thrombosis receiving interventional treatment. (authors)

  18. Concurrent Hepatic Artery and Portal Vein Thrombosis after Orthotopic Liver Transplantation with Preserved Allografts

    Directory of Open Access Journals (Sweden)

    Arshad Khan

    2014-01-01

    Full Text Available In contrast to early HAT, late HAT has an insidious clinical presentation. Nevertheless, biliary and vascular reconstructions in this late setting are unlikely to improve outcome. Patent portal flow makes an important contribution to the viability of liver in case of late HAT while the allograft reconstitutes intrahepatic arterial flow through neovascularization. Concurrent HAT with PVT without immediate graft necrosis is extremely rare, and allograft and patient survival are seemingly impossible without retransplantation. In fact, hepatopetal arterial and portal venous neovascularization are known albeit obscure phenomena that can preserve posttransplant hepatic function under the extenuating circumstances of complete interruption of blood flow to the graft. We describe two such cases that developed combined HAT and PVT more than six months after OLT with perfect preservation of graft function. The survival of allografts in our cases was due to extensive hepatopetal arterial and portal venous collateralization. Simultaneous HAT and PVT after OLT are rare events and almost uniformly fatal, if they occur early. Due to paucity of such cases, however, underlying mechanisms and etiology remain elusive, and despite radiological diagnosis of these complications, there is no way to predict these events in the wake of stable graft function.

  19. Experimental treatment of the transplanted hepatoma in rabbit by hepatic arterial embolization using interleukin-2 dextran microsphere and iodized

    International Nuclear Information System (INIS)

    Zeng Xiaohua; Wang Songzhang; Jin Deqin; Tang Ying; Ding Jinya; Feng Gansheng

    2006-01-01

    Objective: To observe the degree of necrosis in the transplanted hepatic tumor and the changes in immunity of the rabbits after hepatic arterial embolization using interleukin-2 (IL-2) dextran microsphere and iodized oil. Methods: IL-2 dextran microsphere and iodized oil were infused into hepatic artery of 20 rabbits with transplanted hepatic tumor. Infusion of dextran microspheres and iodized oil were taken in another transplanted hepatic tumor group of rabbits as the control. The blood samples were acquired pre-and post-embolization to measure the changes of IL-2 and sIL-2R in both groups. The rabbits were killed one week after the performance to get tumor tissue for pathologic examination. The comparison between using IL-2 dextran microsphere and dextran microsphere was made through optic and electronic microscopy for pathologic analysis. Results: Obvious increase of IL-2 and apparent decrease of sIL-2R in blood were demonstrated after the performance. The transplanted tumors mass underwent complete necrosis with false membranous capsule formation. In controlled group, slight increase of IL-2 and slight decrease of sIL-2R in blood were shown with partial central necrosis without false membraneous capsule formation of the transplanted tumor. Conclusions: The afficacy of the group IL-2 dextran microsphere was superior to group of arterial infusion of dextran microsphere in outcoming with tumor necrosis and strengthening the immunity of the rabbits. (authors)

  20. Giant hepatic artery aneurysm associated with immunoglobulin G4-related disease successfully treated using a liquid embolic agent

    Energy Technology Data Exchange (ETDEWEB)

    Rossi, Michele; Virgilio, Edoardo; Laurino, Florindo; Orgera, Gianluigi; Mene, Paolo; Pirozzi, Nicola; Ziparo, Vincenzo; Cavallini, Marco [St. Andrea Hospital, Rome (Italy)

    2015-08-15

    The occurrence of a giant hepatic artery aneurysm (GHAA) in a patient with systemic vasculitis is very rare. Herein, we describe our endovascular treatment experience of a GHAA associated with immunoglobulin G4-related disease (IgG4-RD) consisting primarily of a liquid embolic injection and deployment of a vascular plug.

  1. Transaxillary intra-arterial treatment of hepatic metastases with cytostatics and embolization: its control by isotope studies

    International Nuclear Information System (INIS)

    Voorthuisen, A.E. van; Herben, M.G.; Pauwels, E.K.J.

    1980-01-01

    Intra-arterial treatment of hepatic metastases has indicated that this is a rewarding procedure and that embolization of the liver has in a few cases resulted in a high remission rate lasting up to one or two years. The distribution of a cytostatic agent can be accurately controlled by isotope studies. (C.F.)

  2. Giant hepatic artery aneurysm associated with immunoglobulin G4-related disease successfully treated using a liquid embolic agent

    International Nuclear Information System (INIS)

    Rossi, Michele; Virgilio, Edoardo; Laurino, Florindo; Orgera, Gianluigi; Mene, Paolo; Pirozzi, Nicola; Ziparo, Vincenzo; Cavallini, Marco

    2015-01-01

    The occurrence of a giant hepatic artery aneurysm (GHAA) in a patient with systemic vasculitis is very rare. Herein, we describe our endovascular treatment experience of a GHAA associated with immunoglobulin G4-related disease (IgG4-RD) consisting primarily of a liquid embolic injection and deployment of a vascular plug

  3. Development of a New Technique for Reconstruction of Hepatic Artery during Liver Transplantation in Sprague-Dawley Rat.

    Directory of Open Access Journals (Sweden)

    Xingmu Liu

    Full Text Available Sleeve anastomosis is the most common technique used to rearterialize orthotopic liver transplants (OLT. However, this technique has a number of disadvantages, including difficulty of performance of the technique visually unaided. We herein describe a novel rearterialized OLT model in the rat.Forty-six male Sprague Dawley rats (300-400 g were used as donors and recipients. Based on Kamada's cuff technique, the new model involved performing a modified "sleeve" anastomosis between the celiac trunk of the donor and common hepatic artery of the recipient to reconstruct blood flow to the hepatic artery. An additional ten male Sprague Dawley rats underwent liver transplantation without artery reconstruction. Liver grafts were retrieved from the two groups and histological examination was performed following surgery.Total mean operating times were ~42 minutes for the donor liver extraction and 57 minutes for the recipient transplantation. Graft preparation took an additional 15 minutes and the time to fix the arterial bracket was ~3 minutes. During transplantation, the anhepatic phase lasted 18 ± 2.5 min and the artery reconstruction only required ~3 minutes. The patency rate was 94.44% and the 4-week survival rate was 90%. Histology indicated obvious fibrosis in the liver grafts without artery reconstruction, while normal histology was observed in the arterialized graft.This new method allows for the surgical procedure to be performed visually unaided with good survival and patency rates and represents an alternative model investigating OLT in rats.

  4. Classification of hypervascular liver lesions based on hepatic artery and portal vein blood supply coefficients calculated from triphasic CT scans.

    Science.gov (United States)

    Boas, F Edward; Kamaya, Aya; Do, Bao; Desser, Terry S; Beaulieu, Christopher F; Vasanawala, Shreyas S; Hwang, Gloria L; Sze, Daniel Y

    2015-04-01

    Perfusion CT of the liver typically involves scanning the liver at least 20 times, resulting in a large radiation dose. We developed and validated a simplified model of tumor blood supply that can be applied to standard triphasic scans and evaluated whether this can be used to distinguish benign and malignant liver lesions. Triphasic CTs of 46 malignant and 32 benign liver lesions were analyzed. For each phase, regions of interest were drawn in the arterially enhancing portion of each lesion, as well as the background liver, aorta, and portal vein. Hepatic artery and portal vein blood supply coefficients for each lesion were then calculated by expressing the enhancement curve of the lesion as a linear combination of the enhancement curves of the aorta and portal vein. Hepatocellular carcinoma (HCC) and hypervascular metastases, on average, both had increased hepatic artery coefficients compared to the background liver. Compared to HCC, benign lesions, on average, had either a greater hepatic artery coefficient (hemangioma) or a greater portal vein coefficient (focal nodular hyperplasia or transient hepatic attenuation difference). Hypervascularity with washout is a key diagnostic criterion for HCC, but it had a sensitivity of 72 % and specificity of 81 % for diagnosing malignancy in our diverse set of liver lesions. The sensitivity for malignancy was increased to 89 % by including enhancing lesions that were hypodense on all phases. The specificity for malignancy was increased to 97 % (p = 0.039) by also examining hepatic artery and portal vein blood supply coefficients, while maintaining a sensitivity of 76 %.

  5. Transcatheter embolization of a congenital intrahepatic arterioportal venous malformation: A case report

    International Nuclear Information System (INIS)

    Sing, T.M.Y.S.; Wong, K.P.; Young, N.; Le, S.D.V.

    1997-01-01

    Congenital intrahepatic arterioportal venous malformations (APVM) are uncommon lesions. A congenital intrahepatic APVM found incidentally in a 51 -year-old man during pre-operative aortography for an abdominal aortic aneurysm is reported here. This was successfully treated by transcatheter embolization of the involved hepatic artery prior to surgical repair of the aortic aneurysm. A 51-year-old smoker was admitted for pre-operative aortography of an abdominal aortic aneurysm (AAA). Liver function tests showed a mildly elevated alkaline phosphatase. There was no previous history of liver disease or trauma. Aortography demonstrated a large infra-renal AAA measuring 10 cm in diameter and 20 cm in length. The coeliac axis was noted to be grossly dilated with tortuous veins seen to the right side of the lower thoracic spine on delayed images. Coeliac angiography revealed a dilated intrahepatic vascular abnormality in the left lobe of the liver with late opacification of the portal vein. Contrast abdominal CT demonstrated the AAA and the dilated coeliac axis feeding a large vascular malformation in the lateral aspect of the left lobe of the liver. The arterial inflow was via the left hepatic artery and a large vein was seen leading into the left portal vein. Endoscopy showed no oesophageal varices. (authors)

  6. Transcatheter embolization of a congenital intrahepatic arterioportal venous malformation: A case report

    Energy Technology Data Exchange (ETDEWEB)

    Sing, T.M.Y.S.; Wong, K.P.; Young, N. [Westmead Hospital, Westmead, NSW, (Australia). Department of Radiaology; Le, S.D.V. [Bankstown-Lidcombe Hospital, Bankstown, NSW, (Australia). Department of Nuclear Medicine and Ultrasound

    1997-08-01

    Congenital intrahepatic arterioportal venous malformations (APVM) are uncommon lesions. A congenital intrahepatic APVM found incidentally in a 51 -year-old man during pre-operative aortography for an abdominal aortic aneurysm is reported here. This was successfully treated by transcatheter embolization of the involved hepatic artery prior to surgical repair of the aortic aneurysm. A 51-year-old smoker was admitted for pre-operative aortography of an abdominal aortic aneurysm (AAA). Liver function tests showed a mildly elevated alkaline phosphatase. There was no previous history of liver disease or trauma. Aortography demonstrated a large infra-renal AAA measuring 10 cm in diameter and 20 cm in length. The coeliac axis was noted to be grossly dilated with tortuous veins seen to the right side of the lower thoracic spine on delayed images. Coeliac angiography revealed a dilated intrahepatic vascular abnormality in the left lobe of the liver with late opacification of the portal vein. Contrast abdominal CT demonstrated the AAA and the dilated coeliac axis feeding a large vascular malformation in the lateral aspect of the left lobe of the liver. The arterial inflow was via the left hepatic artery and a large vein was seen leading into the left portal vein. Endoscopy showed no oesophageal varices. (authors). 11 refs., 7 figs.

  7. Radiological management of multiple hepatic artery pseudoaneurysms associated with cholangitic abscesses

    International Nuclear Information System (INIS)

    Goyal, Ankur; Madhusudhan, Kumble S; Gamanagatti, Shivanand; Baruah, Bhaskar; Shalimar; Sharma, Raju

    2016-01-01

    Hepatic artery pseudoaneurysms (HAP) are uncommon, occurring mostly as a complication of trauma (accidental or iatrogenic). Liver abscess rarely causes HAP and multiple HAP associated with cholangitic abscesses have not been reported in the literature. We present a patient of acute necrotizing pancreatitis with stent block cholangitis and multiple cholangitic abscesses who developed hemorrhagic output through drainage catheter in the liver abscess. A multiphasic CT angiography demonstrated three HAP, which were treated with a combination of endovascular coil embolization and percutaneous thrombin injection. The fact that cholangitic abscesses may be associated with pseudoaneurysms should not be neglected, considering the potentially catastrophic complication and relatively easy radiological management. CT angiography permits accurate diagnosis and lays down the roadmap for endovascular procedures

  8. Radiological management of multiple hepatic artery pseudoaneurysms associated with cholangitic abscesses

    Directory of Open Access Journals (Sweden)

    Ankur Goyal

    2016-01-01

    Full Text Available Hepatic artery pseudoaneurysms (HAP are uncommon, occurring mostly as a complication of trauma (accidental or iatrogenic. Liver abscess rarely causes HAP and multiple HAP associated with cholangitic abscesses have not been reported in the literature. We present a patient of acute necrotizing pancreatitis with stent block cholangitis and multiple cholangitic abscesses who developed hemorrhagic output through drainage catheter in the liver abscess. A multiphasic CT angiography demonstrated three HAP, which were treated with a combination of endovascular coil embolization and percutaneous thrombin injection. The fact that cholangitic abscesses may be associated with pseudoaneurysms should not be neglected, considering the potentially catastrophic complication and relatively easy radiological management. CT angiography permits accurate diagnosis and lays down the roadmap for endovascular procedures.

  9. Significance of the Hepatic Artery Anatomy and Radionuclide Flow Data for the Technique and Results of Intra-arterial Infusion Chemotherapy in Patients with Liver Neoplasms

    International Nuclear Information System (INIS)

    Vaicekavicius, E.; Satkevicius, Z.; Kiudelis, J. and others

    2002-01-01

    The aim of this study was to evaluate the impact of different variations of liver vascular anatomy and hemodynamics in achieving the maximum effect of the hepatic artery infusion chemotherapy (HAIC) in patients with primary or metastatic hepatic malignancies. The retrograde analysis of hepatic artery (HA) anatomy and of radionuclide flow data on 23 patients treated by HAIC was performed. The HA anatomy was analysed according to two classification systems: the first one proposed by Michels, which describes 10 variants, and the second one proposed by Suzuki, which describes 3 variants - single, double or multiple HA with 3 subtypes of each variant (celiac, mesenteric and mixed). Additionally, before starting HAIC, 99mTc human macroalbumin was injected through the catheter at a slow rate into the HA of 10 patients with abnormal variants of HA anatomy. Radionuclide testing was performed with the aim to evaluate the subsequent intrahepatic distribution of chemotherapy agents. The intra-arterial regimen of HAIC for all patients consisted of a 5-day infusion of 5-ftorouracil or floxuridine with addition of doxorubicin or cisplatin. Such treatment was repeated every 3-4 weeks 3-6 times for every patient. The typical anatomy of HA branching was seen in 12 (52.2%) patients. The double origin of HA (according to Suzuki's classification) was seen in 9 (39.1%). In 5 (21.7%) of them the right HA was coming out from the superior mesenteric artery. In the remaining 4 (17.4%) patients the left HA was coming out from the left gastric artery. In one patient, multiple HA were observed, and there was no possibility to perform HAIC at all. The preliminary embolization of one of HA was performed in 3 patients with double HA according to Suzuki's classification. Redistribution of hepatic flow through intrahepatic collaterals was achieved in all 3 patients and assessed by radionuclide examination. The aberrant left HA was not embolized in 4 patients, because the metastatic tumours were

  10. Occlusive Hepatic Artery Thrombus in a Deceased-Donor Liver Procured From a Donor With Blunt Abdominal Trauma Following a Road Traffic Collision Accident.

    Science.gov (United States)

    Ahmad, Niaz; Tahir, Wasif; Haque, Ali; Dar, Faisal; Vilca-Melendez, Hector; Srinavasan, Parthi; Heaton, Nigel

    2018-04-09

    Here, we describe a case of occlusive hepatic artery thrombus in a liver procured from an 18-year-old deceased donor after circulatory death. The donor had died of multiple trauma following a road traffic collision. Occlusive thrombus was found at the hepatic artery bifurcation during back-table preparation. Consequently, the liver transplant did not proceed. We suggest careful assessment of hepatic arteries of all donor livers before transplant, particularly those from donors who are involved in deceleration injuries. Transplanting such livers may lead to primary nonfunction.

  11. A Simplified Technique of Percutaneous Hepatic Artery Port-Catheter Insertion for the Treatment of Advanced Hepatocellular Carcinoma with Portal Vein Invasion

    Energy Technology Data Exchange (ETDEWEB)

    Choi, Sun Young [Hallym University Sacred Heart Hospital, Anyang (Korea, Republic of); Kim, Ah Hyun; Lee, Do Yun; Lee, Kwang Hun; Won, Jong Yun [Yonsei University College of Medicine, Severance Hospital, Seoul (Korea, Republic of); Kim, Kyung Ah [Inje University Ilsan Paik Hospital, Ilsan (Korea, Republic of)

    2010-12-15

    We assessed the outcomes of a simplified technique for the percutaneous placement of a hepatic artery port-catheter system for chemotherapy infusion in advanced hepatocellular carcinoma with portal vein invasion. From February 2003 to February 2008, percutaneous hepatic artery port-catheter insertion was performed in 122 patients who had hepatocellular carcinoma with portal vein invasion. The arterial access route was the common femoral artery. The tip of the catheter was wedged into the right gastroepiploic artery without an additional fixation device. A side hole was positioned at the distal common hepatic artery to allow the delivery of chemotherapeutic agents into the hepatic arteries. Coil embolization was performed only to redistribute to the hepatic arteries or to prevent the inadvertent delivery of chemotherapeutic agents into extrahepatic arteries. The port chamber was created at either the supra-inguinal or infra-inguinal region. Technical success was achieved in all patients. Proper positioning of the side hole was checked before each scheduled chemotherapy session by port angiography. Catheter-related complications occurred in 19 patients (16%). Revision was achieved in 15 of 18 patients (83%). This simplified method demonstrates excellent technical feasibility, an acceptable range of complications, and is hence recommended for the management of advanced hepatocellular carcinoma with portal vein thrombosis

  12. Hepatitis

    Science.gov (United States)

    ... most common types of viral hepatitis. What Is Hepatitis A? For kids, hep A is the most common ... they recover, it does not come back. Can Hepatitis A Be Prevented? The following will help keep people ...

  13. First pass effect by infusing 99mTc-human serum albumin into the hepatic artery

    International Nuclear Information System (INIS)

    Ozawa, Takashi; Kimura, Kousaburou; Koyanagi, Yasuhisa

    1988-01-01

    The fundamental principles of intra-arterial infusion chemotherapy are thought to be increased local drug concentration and the ''first-pass'' effect. The concentration in the rest of the body can only be decreased if there is local elimination of the infused drug before reaching the systemic circulation. This is referred to as the ''first-pass'' effect. In the evaluation of ''first-pass'' effect, the uptake of liver after infusing 99m Tc-human serum albumin ( 99m Tc-HSA) in the hepatic artery by injecting the subcutaneously implanted silicon reservoir was compared with that obtained after intravenous administration of 99m Tc-HSA. In order to remove the factor of portal infusion, each count of liver up take had been continued for only 24 seconds after starting the liver uptake. The results are as follows : for 24 cases excepting 6 cases with catheter obstruction, the mean i.a./i.v. ratio was 7.92 ± 3.34 (range 3.25 to 17.25). Although the elimination rate of drugs in the liver varies with each drug, the infusion of intraarterial chemotherapy should be about 8 times more concentrative than intravenous administration on the ''first-pass'' effect. (author)

  14. Place of Arterial Embolization in Severe Blunt Hepatic Trauma: A Multidisciplinary Approach

    International Nuclear Information System (INIS)

    Monnin, Valerie; Sengel, Christian; Thony, Frederic; Bricault, Ivan; Voirin, David; Letoublon, Christian; Broux, Christophe; Ferretti, Gilbert

    2008-01-01

    This study evaluates the efficacy of arterial embolization (AE) for blunt hepatic traumas (BHT) as part of a combined management strategy based on the hemodynamic status of patients and CT findings. From 2000 to 2005, 84 patients were admitted to our hospital for BHT. Of these, 14 patients who had high-grade injuries (grade III [n = 2], grade IV [n = 9], grade V [n = 3]) underwent AE because of arterial bleeding and were included in the study. They were classified into three groups according to their hemodynamic status: (1) unresponsive shock, (2) shock improved with resuscitation, and (3) hemodynamic stability. Four patients (group 1) underwent, first, laparotomy with packing and, then, AE for persistent bleeding. Ten patients who were hemodynamically stable (group 1) or even unstable (group 2) underwent AE first, based on CT findings. AE was successful in all cases. The mortality rate was 7% (1/14). Only two angiography-related complications (gallbladder infarction) were reported. Liver-related complications (abdominal compartment syndrome and biliary complications) were frequent and often required secondary interventions. Our multidisciplinary approach for the management of BHT gives a main role to embolization, even for hemodynamically unstable patients. In this strategy AE is very efficient and has a low complication rate.

  15. Hepatic arterial perfusion increases in the early stage of severe acute pancreatitis patients: Evaluation by perfusion computed tomography

    International Nuclear Information System (INIS)

    Koyasu, Sho; Isoda, Hiroyoshi; Tsuji, Yoshihisa; Yamamoto, Hiroshi; Matsueda, Kazuhiro; Watanabe, Yuji; Chiba, Tsutomu; Togashi, Kaori

    2012-01-01

    Purpose: Although hepatic perfusion abnormalities have been reported in patients with acute pancreatitis, hepatic perfusion with severe acute pancreatitis (SAP) has not been quantitatively evaluated in humans. Therefore, we investigated hepatic perfusion in patients with SAP using perfusion CT. Materials and methods: Hepatic perfusion CT was performed in 67 patients with SAP within 3 days after symptom onset. The patients were diagnosed as having SAP according to the Atlanta criteria. Fifteen cases were established as a control group. Perfusion CT was obtained for 54 s beginning with a bolus injection of 40 ml of contrast agent (600–630 mgI/kg) at a flow rate of 4 ml/s. Perfusion data were analyzed by the dual-input maximum slope method to obtain hepatic arterial perfusion (HAP) and hepatic portal perfusion (HPP). Finally, we compared HAP and HPP in SAP patients with those in the control group, respectively. Results: Average HAP was significantly higher in SAP patients than in the control group (75.1 ± 38.0 vs. 38.2 ± 9.0 ml/min/100 ml; p < 0.001). There was no significant difference in average HPP between SAP patients and the control group (206.7 ± 54.9 vs. 204.4 ± 38.5 ml/min/100 ml; p = 0.92). Conclusion: Using quantitative analysis on perfusion CT, we first demonstrated an increase of HAP in the right hepatic lobe in SAP patients.

  16. [Effect of PMU hepatic arterial chemotherapy for liver metastases of gastric cancer. Hokuriku Cisplatin Round-table Conference].

    Science.gov (United States)

    Sakuma, H; Matsuki, N; Katayama, K; Hirosawa, H; Tomita, F; Takano, N; Tanaka, T; Sawa, T; Ueno, K; Uogishi, M

    1989-08-01

    We performed PMU hepatic arterial chemotherapy (a combination therapy consisting of intra-hepatic arterial infusion of CDDP and MMC, oral administration of UFT) in 20 patients with gastric cancer and liver metastases. In this method, 1-6 courses of one infusion of CDDP at 70-100 mg/body and MMC of 10 mg/body into the proper hepatic artery were administered at intervals of 3-4 weeks. UFT of 300-400 mg/day was orally administered with the infusion. The primary response for hepatic metastatic lesions was observed in one case of CR, 14 cases of PR, 4 cases of NC, and one case of PD. The efficacy for CR and PR was high at 75%. The median disease-free interval was 56 weeks in responders. The 50% survival period was 11.1 months; one-year survival rate, 42.1%; two-year survival rate, 12.3%; the longest survival period was 108 weeks. Mild and transient side effects were recognized in 17 cases (85%): gastrointestinal symptoms, sense of general malaise, fever, leukocytopenia, and elevated BUN. Thus, the results indicated that this combination chemotherapy was effective for liver metastases of gastric cancer.

  17. Prospect of drug distribution to hepatic cancer in intra-arterial infusion chemotherapy. Examination by infusion of sup(81m)Kr and /sup 133/Xe via catheter into hepatic artery

    Energy Technology Data Exchange (ETDEWEB)

    Sasaki, Y; Imaoka, S; Matsui, Y; Ishikawa, O; Taniguchi, K [Osaka Prefectural Center for Adult Diseases (Japan)

    1982-04-01

    Cannulation into the hepatic artery under laparotomy was performed to nine patients of non-resectable hepatic cancer (eight of hepatocellular carcinoma, and one of cholangiocellular carcinoma), and injected sup(81m)Kr (Tsub(1/2) = 13 sec.) continuously via catheter into hepatic artery as the model of continuous intra-arterial infusion chemotherapy, and /sup 133/Xe (Tsub(1/2) = 5.3 days) by bolus injection as the model of one-shot ones. During and immediately after injection, sequential scintigrams were carried out and simultaneously images were acquired on a medical computer. Higher radioactivities of both sup(81m)Kr and /sup 133/Xe were observed in tumor than non-tumor region in seven of eight patients of hepatocellular carcinoma. The radioactive ratio of tumor to non-tumor (T/C ratio) was over 1.0 in these cases. This result indicated that there was more arterial blood flow in tumor than non-tumor region, and it could be expected to obtain higher distribution of drugs in tumor on both continuous and one-shot infusion chemotherapy. The pattern of distribution of sup(81m)Kr changed according to positions of patients, and in some cases T/C ratio was higher in other positions than supine position. The most effective position of the intra-arterial infusion chemotherapy could be selected by this method. This technique seems to make it possible to prospect the arrival of drugs to the tumor and presume the effectiveness of intra-arterial infusion chemotherapy.

  18. Long-term results of interventional treatment of large unresectable hepatocellular carcinoma (HCC): significant survival benefit from combined transcatheter arterial chemoembolization (TACE) and percutaneous ethanol injection (PEI) compared to TACE monotherapy

    International Nuclear Information System (INIS)

    Lubienski, A.; Bitsch, R.G.; Grenacher, L.; Kauffmann, G.W.; Schemmer, P.; Duex, M.

    2004-01-01

    Purpose: A retrospective analysis of long-term efficacy of combined transcatheter arterial chemoembolization (TACE) and percutaneous ethanol injection (PEI) and TACE monotherapy was conducted in patients with large, non-resectable hepatocellular carcinoma (HCC). Methods and Materials: Fifty patients with large, unresectable HCC lesions underwent selective TACE. Liver cirrhosis was present in 42 patients, due to alcohol abuse (n = 22) and viral infection (n = 17). In three patients, the underlying cause for liver cirrhosis remained unclear. Child A cirrhosis was found in 22 and Child B cirrhosis in 20 patients. Repeated and combined TACE and PEI were performed in 22 patients and repeated TACE monotherapy was performed in 28 patients. Survival and complication rates were determined and compared. Results: The 6-, 12-, 24- and 36-month survival rates were 61%, 21%, 4%, and 4% for TACE monotherapy and 77%, 55%, 39% and 22% for combined TACE and PEI (Kaplan-Meier method). The kind of treatment significantly affected the survival rate (p=0.002 log-rank test). Severe side effects were present in two patients of the monotherapy group and in three patients of the combination therapy group. (orig.)

  19. Perioperative Hemodynamic Monitoring of Common Hepatic Artery for Endovascular Embolization of a Pancreaticoduodenal Arcade Aneurysm with Celiac Stenosis

    Energy Technology Data Exchange (ETDEWEB)

    Shibata, Eisuke, E-mail: eisuke.shibata1130@gmail.com; Takao, Hidemasa; Amemiya, Shiori; Ohtomo, Kuni [The University of Tokyo, Department of Radiology, Graduate School of Medicine (Japan)

    2017-03-15

    This report describes perioperative hemodynamic monitoring of the common hepatic artery (CHA) during endovascular treatment of a pancreaticoduodenal arcade aneurysm, in a patient with celiac artery stenosis caused by the median arcuate ligament. Pressure monitoring was performed as a safety measure against critical complications such as liver ischemia. As the aneurysm was located in the anterior pancreaticoduodenal artery (APDA) and the posterior pancreaticoduodenal artery (PPDA) was small in caliber, the patient was considered to be at a high risk of liver ischemia. No significant change in pressure was observed in the CHA on balloon occlusion test in the APDA. Immediately after embolization, the PPDA enlarged and the pressure in the CHA was well maintained. Pressure monitoring appears to improve patient safety during endovascular treatment of visceral aneurysms.

  20. Perioperative Hemodynamic Monitoring of Common Hepatic Artery for Endovascular Embolization of a Pancreaticoduodenal Arcade Aneurysm with Celiac Stenosis

    International Nuclear Information System (INIS)

    Shibata, Eisuke; Takao, Hidemasa; Amemiya, Shiori; Ohtomo, Kuni

    2017-01-01

    This report describes perioperative hemodynamic monitoring of the common hepatic artery (CHA) during endovascular treatment of a pancreaticoduodenal arcade aneurysm, in a patient with celiac artery stenosis caused by the median arcuate ligament. Pressure monitoring was performed as a safety measure against critical complications such as liver ischemia. As the aneurysm was located in the anterior pancreaticoduodenal artery (APDA) and the posterior pancreaticoduodenal artery (PPDA) was small in caliber, the patient was considered to be at a high risk of liver ischemia. No significant change in pressure was observed in the CHA on balloon occlusion test in the APDA. Immediately after embolization, the PPDA enlarged and the pressure in the CHA was well maintained. Pressure monitoring appears to improve patient safety during endovascular treatment of visceral aneurysms.

  1. Safety and effectiveness of repeat arterial closure using the AngioSeal device in patients with hepatic malignancy.

    Science.gov (United States)

    Hieb, Robert A; Neisen, Melissa J; Hohenwalter, Eric J; Molnar, Jim A; Rilling, William S

    2008-12-01

    To retrospectively evaluate the safety and effectiveness of the use of the AngioSeal device for repeat arterial closure in patients with hepatic malignancy. A retrospective analysis of patients with hepatic malignancy who had undergone repeated arterial closure with the AngioSeal device was performed. All charts for patients undergoing transarterial chemoembolization or TheraSphere radioembolization were reviewed for the method of hemostasis and the number of arterial closures. A total of 53 patients (58.5% men, 41.5% women; mean age, 58.7 years) had repeat AngioSeal arterial puncture closure after chemoembolization or TheraSphere treatment. Percutaneous closure of the common femoral artery with the AngioSeal device was performed in accordance with the manufacturer's recommendations. The patients were examined for complications on follow-up. Effectiveness was defined by the ability to obtain satisfactory hemostasis. Safety was assessed by the absence of groin complications and by vessel patency on follow-up angiograms of the puncture site obtained at subsequent liver-directed therapy sessions. Fifty-three patients in this study group had a total of 203 common femoral artery punctures. There were a total of 161 closures with the AngioSeal device (79.3%): 58 (36%) single closures and 103 (64.0%) repeat closures. Of the 161 attempts at AngioSeal closure, there was one closure failure in the single-puncture group, yielding a success rate of 98.3%; and one closure failure in the repeat-puncture group, yielding a success rate of 99%. In these two patients, hemostasis was achieved with traditional manual compression without the need for any other device, and no complications were noted. The overall success rate of AngioSeal device closure was 98.7%. The repeat use of the AngioSeal closure device is safe and effective in patients with hepatic malignancy undergoing regional oncologic interventional procedures.

  2. The DSA findings and interventional therapy of hepatic alveolar echinococcus

    International Nuclear Information System (INIS)

    Ren Weixin; Xiao Xiangsheng; Chen Peng; Ma Jun

    2004-01-01

    Objective: To analyse the DSA findings of hepatic alveolar echinococcus (HAE) and evaluate the feasibility of the interventional therapy. Methods: Eight patients with HAE were all examined by DSA, CT and lab test. Three of them were performed the transcatheter arterial embolization by iodized oil. All of them were confirmed by surgical operation and followed-up for three months. Results: The DSA findings of HAE included hepatic arterial curling and enlargement with hypertrophied circled encircling as typical 'handed ball'. Eight cases presented the ring stain during the capillary stage. After embolization, the retention of iodized oil was revealed by DSA in 3 cases. CT three months later showed fine iodized oil retention and the enlarged necrosis. Ischemic necrosis around the lesion and the cut margins were clearly seen in operation biopsy. Conclusions: HAE possesses special DSA findings and interventional therapy is a new therapeutic method of choice. (authors)

  3. Combined therapy involving hepatic arterial chemoinfusion through a percutaneously implanted port, and external irradiation for advanced hepatocellular carcinoma

    International Nuclear Information System (INIS)

    Kim, Jong Won; Suh, Sang Hyun; Won, Jong Yun

    2002-01-01

    To evaluate the efficacy of combined therapy involving intra-arterial hepatic chemoinfusion through a percutaneously implanted port and external irradiation for the treatment of advanced hepatocellular carcinoma. Fifteen patients (2 males and 3 females; mean age=47.5 years) with advanced hepatocellular carcinoma localized in one lobe and with portal vein thrombosis (stage IVa) were included in this study. To permit chemoinfusion through the hepatic artery, a chemoport was implanted percutaneously in the right inguinal area via the femoral artery. Initial external radiation therapy lasted five weeks (44 Gy in a daily fraction of 1.8 Gy), with concurrent intra-arterial hepatic infusion of 5-fluorouracil. This initial treatment was followed by five cycles of intra-arterial hepatic infusion of cisplatin and 5-fluorouracil for three consecutive days every month.Two and six months after treatment was begun, the patients underwent CT scanning and angiography, and their response was assessed in terms of change in tumor size and vascularity, the degree of portal vein thrombosis and arterio-portal shunt, and alpha-fetoprotein levels. Any complications arising from this combined therapy and the clinical status of each patient were also followed up during the treatment period. The response rates at months 2 and 6 were 60% and 33.3%, respectively. One patient (6.7%) showed complete remission, and serum alpha-fetoprotein levels decreased significantly in all patients who responded. In five of the twelve patients, the thrombi in the main portal vein showed marked regression. The one-year survival rate was 30% and the median survival period was 10.6 (range, 3.7 to 28) months. The complications arising after treatment involved the catheter-port system (n=2) or were due to gastroduodenitis (n=9). In these patients with advanced hepatocellular carcinoma and portal vein thronbosis, combined therapy involving hepatic arterial chemoinfusion through a chemoport and external irradiation

  4. Combined therapy involving hepatic arterial chemoinfusion through a percutaneously implanted port, and external irradiation for advanced hepatocellular carcinoma

    International Nuclear Information System (INIS)

    Kim, Jong Won; Suh, Sang Hyun; Won, Jong Yun; Lee, Do Yun; Park, Sung Il; Lee, Jong Tae; Moon, Young Myoung; Chon, Chae Yoon; Han, Kwang Hyup; Seoung, Jin Sil

    2002-01-01

    To evaluate the efficacy of combined therapy involving intra-arterial hepatic chemoinfusion through a percutaneously implanted port and external irradiation for the treatment of advanced hepatocellular carcinoma. Fifteen patients (12 males and 3 females; mean age = 47.5 years) with advanced hepatocellular carcinoma localized in one lobe and with portal vein thrombosis (stage IVa) were included in this study. To permit chemoinfusion through the hepatic artery, a Chemoport was implanted percutaneously in the right inguinal area via the femoral artery. Initial external radiation therapy lasted five weeks (44 Gy in a daily fraction of 1.8 Gy), with concurrent intra-arterial hepatic infusion of 5-fluorouracil. This initial treatment was followed by five cycles of intra-arterial hepatic infusion of cisplatin and 5-fluorouracil for three consecutive days every month. Two and six months after treatment was begun, the patients underwent CT scanning and angiography, and their response was assessed in terms of change in tumor size and vascularity, the degree of portal vein thrombosis and arterio-portal shunt, and alpha-fetoprotein levels. Any complications arising from this combined therapy and the clinical status of each patient were also followed up during the treatment period. The response rates at months 2 and 6 were 60% and 33.3%, respectively. One patient (6.7%) showed complete remission, and serum alpha-fetoprotein levels decreased significantly in all patients who responded. In five of the twelve patients, the thrombi in the main portal vein showed marked regression. The one-year survival rate was 30% and the median survival period was 10.6 (range, 3.7 to 28) months. The complications arising after treatment involved the catheter-port system (n=2) or were due to gastroduodenitis (n=9). In these patients with advanced hepatocellular carcinoma and portal vein thronbosis, combined therapy involving hepatic arterial chemoinfusion through a chemoport and external

  5. Combined therapy involving hepatic arterial chemoinfusion through a percutaneously implanted port, and external irradiation for advanced hepatocellular carcinoma

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Jong Won; Suh, Sang Hyun; Won, Jong Yun [Yonsei University College of Medicine, Seoul (Korea, Republic of)] [and others

    2002-12-01

    To evaluate the efficacy of combined therapy involving intra-arterial hepatic chemoinfusion through a percutaneously implanted port and external irradiation for the treatment of advanced hepatocellular carcinoma. Fifteen patients (2 males and 3 females; mean age=47.5 years) with advanced hepatocellular carcinoma localized in one lobe and with portal vein thrombosis (stage IVa) were included in this study. To permit chemoinfusion through the hepatic artery, a chemoport was implanted percutaneously in the right inguinal area via the femoral artery. Initial external radiation therapy lasted five weeks (44 Gy in a daily fraction of 1.8 Gy), with concurrent intra-arterial hepatic infusion of 5-fluorouracil. This initial treatment was followed by five cycles of intra-arterial hepatic infusion of cisplatin and 5-fluorouracil for three consecutive days every month.Two and six months after treatment was begun, the patients underwent CT scanning and angiography, and their response was assessed in terms of change in tumor size and vascularity, the degree of portal vein thrombosis and arterio-portal shunt, and alpha-fetoprotein levels. Any complications arising from this combined therapy and the clinical status of each patient were also followed up during the treatment period. The response rates at months 2 and 6 were 60% and 33.3%, respectively. One patient (6.7%) showed complete remission, and serum alpha-fetoprotein levels decreased significantly in all patients who responded. In five of the twelve patients, the thrombi in the main portal vein showed marked regression. The one-year survival rate was 30% and the median survival period was 10.6 (range, 3.7 to 28) months. The complications arising after treatment involved the catheter-port system (n=2) or were due to gastroduodenitis (n=9). In these patients with advanced hepatocellular carcinoma and portal vein thronbosis, combined therapy involving hepatic arterial chemoinfusion through a chemoport and external irradiation

  6. 188Re-SSS lipiodol: radiolabelling and biodistribution following injection into the hepatic artery of rats bearing hepatoma.

    Science.gov (United States)

    Garin, Etienne; Denizot, Benoit; Noiret, Nicolas; Lepareur, Nicolas; Roux, Jerome; Moreau, Myriam; Herry, Jean-Yves; Bourguet, Patrick; Benoit, Jean-Pierre; Lejeune, Jean-Jacques

    2004-10-01

    Although intra-arterial radiation therapy with 131I-lipiodol is a useful therapeutic approach to the treatment of hepatocellular carcinoma, various disadvantages limit its use. To describe the development of a method for the labelling of lipiodol with 188Re-SSS (188Re (S2CPh)(S3CPh)2 complex) and to investigate its biodistribution after injection into the hepatic artery of rats with hepatoma. 188Re-SSS lipiodol was obtained after dissolving a chelating agent, previously labelled with 188Re, in cold lipiodol. The radiochemical purity (RCP) of labelling was checked immediately. The 188Re-SSS lipiodol was injected into the hepatic artery of nine rats with a Novikoff hepatoma. They were sacrificed 1, 24 and 48 h after injection, and used for ex vivo counting. Labelling of 188Re-SSS lipiodol was achieved with a yield of 97.3+/-2.1%. The immediate RCP was 94.1+/-1.7%. Ex vivo counting confirmed a predominantly hepatic uptake, with a good tumoral retention of 188Re-SSS lipiodol, a weak pulmonary uptake and a very faint digestive uptake. The 'tumour/non-tumoral liver' ratio was high at 1, 24 and 48 h after injection (2.9+/-1.5, 4.1+/-/4.1 and 4.1+/-0.7, respectively). Using the method described here, 188Re-SSS lipiodol can be obtained with a very high yield and a satisfactory RCP. The biodistribution in rats with hepatoma indicates a good tumoral retention of 188Re-SSS lipiodol associated with a predominant hepatic uptake, a weak pulmonary uptake and a very faint digestive uptake. This product should be considered for intra-arterial radiation therapy in human hepatoma.

  7. Utilizing generalized autocalibrating partial parallel acquisition (GRAPPA) to achieve high-resolution contrast-enhanced MR angiography of hepatic artery: Initial experience in orthotopic liver transplantation candidates

    Energy Technology Data Exchange (ETDEWEB)

    Xu Pengju [Department of Radiology, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai (China)]. E-mail: xpjbfc@163.com; Yan Fuhua [Department of Radiology, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai (China)]. E-mail: yanfuhua@yahoo.com; Wang Jianhua [Department of Radiology, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai (China); Lin Jiang [Department of Radiology, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai (China); Fan Jia [Liver Cancer Institute, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai (China)

    2007-03-15

    Objective: To evaluate feasibility of using GRAPPA to acquire high-resolution 3D contrast-enhanced MR angiography (CE-MRA) of hepatic artery and value of GRAPPA for displaying vessels anatomy. Materials and methods: High-resolution CE-MRA using GRAPPA was performed in 67 orthotopic liver transplantation recipient candidates. Signal intensity (SI) and relative SI, i.e., Cv-ro (vessel-to-liver contrast) of the aorta and the hepatic common artery (HCA), were measured. The SI and the relative SI were compared and analyzed using T-test. For purpose of qualitative evaluation, the vessel visualization quality and the order of depicted hepatic artery branches were evaluated by two radiologists independently and assessed by weighted kappa analysis. The depiction of hepatic arterial anatomy and variations was evaluated, and results were correlated with the findings in surgery. Results: The mean SI values were 283.29 {+-} 65.07 (mean {+-} S.D.) for aorta and 283.16 {+-} 64.07 for HCA, respectively. The mean relative SI values were 0.698 {+-} 0.09 for aorta and 0.696 {+-} 0.09 for HCA, respectively. Homogeneous enhancement between aorta and HCA was confirmed by statistically insignificant differences (p-values were 0.89 for mean SI values and 0.12 for mean relative SI values, respectively). The average score for vessel visualization ranged from good to excellent for different artery segments. Overall interobserver agreement in the visualization of different artery segments was excellent (kappa value > 0.80). The distal intrahepatic segmental arteries were well delineated for majority of patients with excellent interobserver agreement. Normal hepatic arterial anatomy was correctly demonstrated in 53 patients, and arterial anomalies were accurately detected on high-resolution MRA image of all 14 patients. Conclusion: High-resolution hepatic artery MRA acquired using GRAPPA in a reproducible manner excellently depicts and delineates small vessels and can be routinely used for

  8. Comparison of CT during arterial portography, delayed iodine CT, and MR imaging for the preoperative evaluation of hepatic tumors

    International Nuclear Information System (INIS)

    Nelson, R.C.; Chezmar, J.L.; Sugarbaker, P.H.; Bernardino, M.E.

    1988-01-01

    Twenty-eight patients with neoplastic involvement of the liver were studied with CT during arterial portography, delayed iodine CT, and MR imaging, to determine the number, size, and location of focal hepatic lesions prior to hepatic tumor surgery. The MR pulse-sequences used included T1- and T2-weighted spin-echo (SE) sequences and inversion-recovery (IR) sequences at 0.5 T, 1.5 T, or both. Results were compared with operative and pathologic findings. The sensitivities for the detection of individual focal lesions are as follows: CT during arterial portography, delayed iodine CT, 77%, IR at 0.5 T, 74%; T1-weighted SE at 0.5 T, 69%; T2-weighted SE at 1.5 T, 55%, IR at 1.5 T, 50%; T2-weighted SE at 0.5 T, 48%, and T1-weighted SE at 1.5 T, 31%. The positive predictive values ranged from 88% to 100% for all techniques. The authors' data suggest that CT during arterial portography is a superior technique for evaluating patients prior to hepatic tumor surgery

  9. Biliary Cast Syndrome: Hepatic Artery Resistance Index, Pathological Changes, Morphology and Endoscopic Therapy

    Directory of Open Access Journals (Sweden)

    Hu Tian

    2015-01-01

    Full Text Available Background: Biliary cast syndrome (BCS was a postoperative complication of orthotopic liver transplantation (OLT, and the reason for BSC was considered to relate with ischemic type biliary lesions. This study aimed to evaluate the relationship between BCS following OLT and the hepatic artery resistance index (HARI, and to observe pathological changes and morphology of biliary casts. Methods: Totally, 18 patients were diagnosed with BCS by cholangiography following OLT using choledochoscope or endoscopic retrograde cholangiopancreatography. In addition, 36 patients who did not present with BCS in the corresponding period had detectable postoperative HARI on weeks 1, 2, 3 shown by color Doppler flow imaging. The compositions of biliary casts were analyzed by pathological examination and scanning electron microscopy. Results: HARI values of the BCS group were significantly decreased as compared with the non-BCS group on postoperative weeks 2 and 3 (P 1 (OR = 1.300; 1.223; and 1.889, respectively. The OR of HARI 3 was statistically significant (OR = 1.889; 95% confidence interval = 1.166-7.490; P = 0.024. The compositions of biliary casts were different when bile duct stones were present. Furthermore, vascular epithelial cells were found by pathological examination in biliary casts. Conclusions: HARI may possibly serve as an independent risk factor and early predictive factor of BCS. Components and formation of biliary casts and bile duct stones are different.

  10. Experiment of embolizing hepatocarcinoma with heated lipiodol via hepatic artery in VX2 rabbit model

    International Nuclear Information System (INIS)

    Cao Wei; Wang Zhimin; Zhang Hongxin; Wan Yi

    2006-01-01

    Objective: To evaluate the anti-tumour effect of 60 degree C Lipiodol in the embolization of VX 2 hepatocarcinoma in rabbits. Methods: VX 2 carcinoma cells were surgically implanted into the left liver lobe in 30 male New Zealand white rabbits, which were randomly divided into 3 groups by figure and table method with 10 rabbits in each group. Physiological saline, Lipiodol (37 degree C), and Lipiodol (60 degree C) were injected in each group via hepatic artery and liver cancer was embolized. The volume of tumour and serum level of aspartate aminotransferase (AST) were observed after one week, and the survival period of VX 2 rabbits was also observed. Results: In the group of Lipiodol (60 degree C), the growth rate of tumour (0.92± 0.21) was significantly lower than that of control group (3.48±) and Lipiodol (37 degree C) groups (1.69±0.26), respectively (F=34.95, P 0.05), but was significantly higher than the control group (68.6±6.6) U/L (t=19.24, P<0.05). Conclusion: Lipiodol (60 degree C) greatly decreases the tumour's growth rate and prolongs the survival period. It is a safe method and has stronger inhibitory effect than other groups. (authors)

  11. Evaluation of long-term effect of hepatic arterial embolization with pingyangmycin-lipiodol emulsion in patients with hepatic cavernous hemangiomas

    International Nuclear Information System (INIS)

    Zhang Xuejun; Ouyang Yong; Ma Heping; Chao Lumeng; Zhen Yanli; Gu Subin; Zhou Qunhui; Liu Pengzhi; Wang Hong

    2010-01-01

    Objective: To evaluate the long-term effect of hepatic arterial embolization with pingyanmycin-lipiodol emulsion (PLE) in patients with cavernous hemangiomas of the liver (CHL) and its influence factors. Methods: One hundred and fifty-six hemangiomas that were diagnosed by imaging examinations or confirmed pathologically by surgery in 105 patients with integral follow-up data were analyzed retrospectively in this paper. All hemangiomas were divided into 4 groups according to their size (the largest size of hemangioma) by the authors as follows: A group (≤3 cm, n=25); B group (>3 cm and 2 test respectively. And the influence factors, included of the variant size of hemangiomas, abundant or sparse of abnormal sinusoids and the number of treatment procedures, were also analyzed respectively. Results: The total effective rate of the 156 hemangiomas in 105 patients was 92.95% (145/156). After single procedure of hepatic arterial embolization with PLE, the total effective rate of A and B groups were 100% (57/57), that of C and D groups were 85.86% (85/99), and the difference reach significant (X 2 =8.8553, P 2 =5.2642, P<0.05) than those of group with single procedure (72.73%, 8/11). Conclusions: A best long-term curative effect (complete cure) is usually obtained in the small hemangiomas with abundant abnormal sinusoids, and a satisfactory long-term curative effect can also be achieved in the larger or multiple hemangiomas, particularly in those hemangiomas with abundant abnormal sinusoids by using the repeat procedures of hepatic arterial embolization with PLE. (authors)

  12. Utility of Amplatzer Vascular Plug with Preoperative Common Hepatic Artery Embolization for Distal Pancreatectomy with En Bloc Celiac Axis Resection

    International Nuclear Information System (INIS)

    Toguchi, Masafumi; Tsurusaki, Masakatsu; Numoto, Isao; Hidaka, Syojiro; Yamakawa, Miho; Asato, Nobuyuki; Im, SungWoon; Yagyu, Yukinobu; Matsuki, Mitsuru; Takeyama, Yoshifumi; Murakami, Takamichi

    2017-01-01

    PurposeTo evaluate the feasibility and safety of the Amplatzer vascular plug (AVP) for preoperative common hepatic embolization (CHA) before distal pancreatectomy with en bloc celiac axis resection (DP-CAR) to redistribute blood flow to the stomach and liver via the superior mesen