Abnormalities in pulmonary perfusion scans after transcatheter arterial embolization of the liver

Abstract

Thirteen patients with hepatocellular carcinoma who underwent transcatheter arterial embolization (TAE) were studied to evaluate the incidence of pulmonary embolism and methods for diagnosing this complication. Pulmonary perfusion scans and changes in indexes of coagulation and of fibrinolysis, and in the partial pressure of oxygen in arterial blood were evaluated as possible signs of pulmonary embolism complicating TAE. In 3 out of 13 patients (23%), perfusion lung scans showed perfusion defects. These 3 patients were asymptomatic and their perfusion defects had disappeared by 4 weeks later. TAE was followed by significant decreases in platelet counts (p < 0.01) and in serotonin levels (p < 0.05); and by increases in A-aDO2 (p < 0.01), in levels of fibrinogen in plasma (p < 0.01), and in levels of thrombin-antithrombin III complex (TAT) (p < 0.05), with no significant increase in levels of D-dimer in plasma. Similar hematologic changes were observed in patients without perfusion defects after TAE. In 3 patients with perfusion defects, plasma levels of TAT before TAE were significantly higher than the levels in patients without perfusion defects (p < 0.01). Perfusion defects that occur after TAE may be caused by pulmonary thromboemboli, by pulmonary fat emboli, and by microatelectasis or discoid atelectasis, and the most common cause is probably pulmonary thromboemboli. We conclude that the risk of pulmonary embolism complicating TAE is higher in patients with hepatocellular carcinoma who have high levels of TAT in plasma.