Gelatin Sponge Particles Research Articles

Chemoembolization of the hepatic artery with BCNU for metastatic uveal melanoma: results of a phase II study

Uveal melanoma is the most common primary intraocular malignancy in adults and the liver is the most common site for systemic metastases. We conducted a phase II clinical trial for patients with hepatic metastases from uveal melanoma using chemoembolization of the hepatic artery with 1,3-bis(2-chloroethyl)-1-nitrosourea (BCNU) dissolved in ethiodized oil. Gelatin sponge particles were used as a transiently occlusive agent. The responses in hepatic metastases, overall survival, time to progression and side-effects related to chemoembolization were evaluated. Thirty patients were enrolled. Twenty-four patients completed at least one treatment to all targeted liver metastases and were evaluable for hepatic response. Eighteen of these 24 patients experienced regression or stabilization of hepatic metastases for at least 6 weeks (one complete response in hepatic metastases; four partial responses; 13 stable disease). One of the 13 patients with stable disease was rendered free of disease by surgical removal of metastases after chemoembolization (surgical complete response). The overall response rates (complete and partial responses) for intention-to-treat patients and for patients who were evaluable for response were 16.7 and 20.4%, respectively. The median overall survival of the entire intention-to-treat group of patients was 5.2 months (range, 0.1-27.6 months), for patients with complete or partial response in hepatic metastases 21.9 months (range, 7.4-27.6 months), for patients with stable disease 8.7 months (range, 2.9-14.4 months) and for patients with progressive disease 3.3 months (range, 1.6-5.6 months). Importantly, 13 of the 18 patients who achieved complete response, partial response or stable disease subsequently developed progression of extrahepatic metastases with control of hepatic metastases. Chemoembolization with BCNU is a useful palliative treatment for the control of hepatic metastases in uveal melanoma patients. However, progression in extrahepatic sites after stabilization of hepatic metastases requires further improvement in the therapeutic approach to this disease.

Immunoembolization of malignant liver tumor with granulocyte/macrophage colony stimulating factor (GM-CSF) and ethiodized oil followed by gelatin sponge pledgets: The final results of phase I/IIa study

2514 Background We have developed a novel treatment approach for liver tumors: Immunoembolization with GM-CSF. In this approach, liver tumors are embolized with gelatin sponge particles after infusing a mixture of ethiodized oil and recombinant human GM-CSF (Leukine, Berlex Laboratories). A phase I/IIa study was conducted to investigate the safety and effectiveness of this treatment. Methods Patients with surgically unresectable malignant liver tumors were enrolled. The treatments were given every four weeks until maximum clinical benefit. Toxicity was assessed using the WHO criteria. The primary endpoint included dose limiting toxicity and maximum tolerated dose (MTD). Various dose levels of GM-CSF (25 mcg-2,000 mcg) were tested. Results In 39 patients with liver tumors (34 uveal melanoma, 4 skin melanoma, 1 hepatocellular carcinoma), there was no substantive toxicity observed up to the 1,000 mcg dose level. One of 6 patients at the 1,500 mcg dose level and 2 of 10 patients at the 2,000 mcg dose level developed grade 3/4 toxicity (transient elevation of alkaline phosphatase, n=1; significant liver pain, n=2; acute respiratory failure related to narcotics, n=1). There were no treatment-related deaths and MTD was not reached up to the dose level of 2,000 mcg. Subset analyses on uveal melanoma patients demonstrated 9 PR and 12 SD in 31 evaluable patients. With median follow-up of 29.8 months, the median overall survival of “intent to treat” patients was 14.5 months (range 1.5–42.6 months) and the projected one-year survival rate was 61.4% (CI 43.0–79.7%). In 3 of 6 patients whose extra-hepatic metastases were removed after immunoembolization, significant inflammatory changes were found in remote metastases. Conclusions Immunoembolization with GM-CSF is a safe and feasible approach. Encouraging preliminary results in metastatic uveal melanoma patients warrants a further clinical study for this disease. No significant financial relationships to disclose.

Extension of Radiofrequency Ablation of the Liver by Transcatheter Arterial Embolization with Iodized Oil and Gelatin Sponge: Results in a Pig Model

To determine whether transcatheter arterial embolization (TAE) with iodized oil and gelatin sponge particles can be used to expand radiofrequency (RF)-induced coagulation necrosis, the morphology and histologic characteristics of ablation lesions were evaluated in the normal pig liver after three different TAE procedures. Ten consecutive animals with 33 ablation lesions produced with an RF ablation system were randomly assigned to one of three treatment groups and a control group: a group treated with TAE with iodized oil, a group treated with TAE with gelatin sponge, a group treated with TAE with iodized oil and gelatin sponge, and a control group in which TAE was not performed. After the completion of ablation, the lesions were excised for gross and histologic examination. The longest and shortest diameters of ablation lesions were greatest in the group treated with TAE with iodized oil and gelatin sponge, followed by the groups treated with TAE with gelatin sponge and TAE with iodized oil (P < .05 vs controls, respectively). The hemorrhagic rim was also widest in the group treated with TAE with iodized oil and gelatin sponge (P < .05 vs controls), and it spread toward the liver periphery like a segmental hemorrhagic area adjacent to the ablation lesion. Histochemical staining for lactate dehydrogenase, maleate dehydrogenase, and nicotinamide adenine dinucleotide diaphorase showed what appeared to be 100% cellular destruction in all the ablation lesions and their hemorrhagic rims. RF ablation combined with TAE with iodized oil and gelatin sponge induces the greatest area of coagulation necrosis accompanied by peripherally spreading segmental necrosis in normal pig liver tissue.

Massive Hemorrhage from Internal Carotid Artery Pseudoaneurysm Successfully Treated by Transcatheter Arterial Embolization with Assessment of Regional Cerebral Oxygenation

A 54-year-old male presented with intermittent massive hemorrhage from recurrent oropharyngeal cancer. The angiogram showed the encasements at the main trunk of the left internal carotid artery (ICA) and external carotid artery (ECA). Transcatheter arterial embolization (TAE) of the ECA with gelatin sponge particles and microcoils was performed. However, hemorrhage recurred several hours after the initial TAE. The second angiogram showed a large pseudoaneurysm of the ICA developing at the encasement on the initial angiogram. As a simple neurologic test, regional cerebral oxygenation (rSO2) was assessed with and without manual compression of the common carotid artery (CCA). With compression of the left CCA, the rSO2 did not change. We therefore performed isolation of the pseudoaneurysm. We embolized proximally and distally to the ICA pseudoaneurysm with microcoils and the pseudoaneurysm disappeared. No major complications occurred and no massive hemorrhage recurred until death from the cancer. TAE was an effective treatment for massive hemorrhage caused by tumor invasion to ICA. Assessment of rSO2 was a simple and useful neurologic test predicting the cerebral blood flow to prevent complications of TAE.

Polyvinyl alcohol and gelatin sponge particle embolization of splenic artery pseudoaneurysm complicating chronic alcoholic pancreatitis

To assess the effectiveness of and complications associated with polyvinyl alcohol (PVA) and gelatin sponge particles embolization of splenic artery pseudoaneurysm complicating chronic alcoholic pancreatitis. A 42-year-old man with splenic artery pseudo-aneurysm formation secondary to chronic alcoholic pancreatitis was admitted. We used PVA and gelatin sponge particles embolization of splenic artery pseudoaneurysm by superselective embolization techniques. The splenic artery pseudoaneurysm was successfully controlled with splenic embolization. The patient was discharged in 9 d with complete recovery. This case confirms that superselective transcatheter embolization by PVA and gelatin sponge particles may represent an effective treatment for pseudoaneurysm caused by chronic alcoholic pancreatitis in the absence of other therapeutic alternatives.

Uterus and bladder necrosis after uterine artery embolisation for postpartum haemorrhage

Case reportA 32 year old primipara was admitted for prematurerupture of the membranes at 37 weeks of gestation. Shehad a history of miscarriage with curettage in associa-tion with previous pregnancy. She delivered a healthymale child. After manual delivery of the placenta, ex-ploration of the uterus and oxytocin was required tocontrol bleeding. Selective uterine artery embolisationwas carried out because there was an adherent placentalcotyledon in the left uterine horn causing uncontrollablebleeding.Selective catheterisation of the left internal iliac arteryand superselective catheterisation of the left uterine arterieswere performed using a 5F cobra-shaped catheter (Cobra;Terumo, Tokyo, Japan) and a 0.035-in. diameter hydro-philicpolymer-coatedguidewire(Radifocus;Terumo)fromthe contralateral groin. The angiography showed no anasto-mosis between the uterine and the ovarian artery anddemonstrated an arterial tear with massive extravasationof contrast material in the uterine cavity. Bilateral free-flowembolisation was performed under fluoroscopic controlusing iodinated contrast media mixed with gelatine spongepledgets (Curaspon; Curaspon Healthcare, Netherlands)particles obtained by scraping a piece of gelfoam with asurgical blade. No vascular spasm was observed.On day 21, the patient was readmitted for pelvic pain andabnormal bleeding.Vaginal examination revealed thathalf ofthe uterine cervix presented an abnormal colour suggestiveof ischaemia. Pelvic magnetic resonance imaging revealeda bulky uterus with a small peripheral enhancement rim.The central portion of the organ was completely necrotic.Subtotal hysterectomy was performed. Both uterineartery pedicles were filled with thrombus. Surgical explo-ration also revealed a 5-cm necrotic area on the bladderwall (Fig. 1). Cystoscopic examination demonstrated mu-cosal deterioration and the necrotic portion was excised.Cystography on day 13 was normal. Two months aftersurgery, the cervix and the vagina were normal.Histological examination of the surgical specimensshowed massive ischaemic necrosis of the whole uterusexcept the deep myometrium. Plurinuclear and giant cellsoccupying the vessels in the lower part of the uterus hadphagocytosed small foreign bodies. Some vessels containedunusual weakly coloured star-shaped structures probablycorresponding to the gelatine sponge particles used forembolisation. Vessels containing those structures were lessdilated, smaller in diameter and thicker-walled than othervessels. Examination of bladder tissue demonstrated com-plete disappearance of the mucosa together with ischaemicchanges throughout the wall.DiscussionPostpartum haemorrhage is the leading cause of maternalmortality throughout the world.

Vascular administration of adenoviral vector soaked in absorbable gelatin sponge particles (GSP) prolongs the transgene expression in hepatocytes

Transcatheter hepatic arterial chemoembolization using emulsions composed of anticancer agents and gelatin sponges (GS) has been an efficient and safe palliative treatment for inoperable hepatocellular carcinoma (HCC). We employed catheter-mediated left hepatic arterial embolization (CHAE) to increase transduction efficiency of adenoviral vector in canine hepatocytes. The emulsion was prepared by mixing pieces of GSP and adenoviral vectors expressing recombinant beta-galactosidase (Ad.LacZ) or human hepatocyte growth factor (Ad.hHGF). After the left hepatic artery was catheterized under angiography, CHAE with Ad.LacZ or Ad.hHGF was performed. Livers were removed and stained for LacZ activity on day 7. The expression pattern of LacZ staining was either scarce or patchy around the central hilum of the hepatic artery, or was homogeneously distributed in whole lobes, depending on whether large or small pieces of GSP were used. Hematological and serum biochemical changes during CHAE exhibited only a few effects. The chronological measurement of serum HGF concentration showed that the duration of transgene expression was greater after CHAE with Ad.hHGF. A similar pattern of transgene expression was observed in a rat model after hepatic arterial embolization with differential doses of Ad.hHGF soaked in GSP. These results suggest that hepatic arterial embolization by transcatheter mediated infusion with a mixture of adenovirus-GSP could be used for human HCC.

Quantified short-term outcome of uterine artery embolization with gelatin sponge particles and lipiodol for symptomatic myoma

Objective To investigate and quantify clinical outcomes and spectral Doppler analyses of uterine arteries in patients with myoma undergoing uterine artery embolization (UAE) with gelatin sponge particles and lipiodol. Design Prospective observational study. Setting Tertiary medical center. Patient(s) Forty premenopausal women with symptomatic myoma. Intervention(s) Uterine artery embolization with gelatin sponge particles and lipiodol. Main outcomes measure(s) Hemoglobin, hematocrit, CA-125, pictorial blood loss assessment, visual analogue pain scale, questionnaire for symptoms, tumor volume, and spectral Doppler analyses of uterine arteries. Result(s) The mean follow-up period was 8.1 months (range, 6–12). Menstrual flow improved in 29 of 35 patients (83%) and decreased significantly by 78.4%. Menstrual pain improved in 27 of 35 patients (77%) and decreased significantly by 70%. Hematocrit and CA-125 improved significantly. The mean percentage reductions of uterine and myomal volumes were 40.2% and 54.9%, respectively. The mean peak systolic velocity of the uterine arteries decreased by 52%. The major complication rate was 2.56%. There was no correlation between tumor volume reduction and clinical outcome. Conclusion(s) Uterine artery embolization with gelatin sponge particles and lipiodol had satisfactory short-term outcomes, comparable to those associated with polyvinyl alcohol particles. Quantified and semiquantified measurements provided objective assessment of clinical outcomes. Serum CA-125 might play a role in clinical follow-up. Reduction of tumor volume is not predictive of UAE efficacy.

Utility of CT during Arteriography in Superselective Transarterial Chemoembolization for Invasive Bladder Cancer

Background & Aims : To assess the effectiveness of CT during arteriography (CTA) in superselective transarterial chemoembolization (TACE) for invasive bladder cancer, and to report preliminary results of superselective TACE. Methods : Angiography was performed in 20 patients with invasive bladder cancer, using a combined CT-Angiography system. Of the 20 tumors, 19 were T3, one was T2. The vesical arteries were selected using a 3F microcatheter, and perfusion was confirmed using CTA. TACE was performed after administrating 40 to 100 mg of cisplatin, with and without gelatin sponge particles. The effects of TACE were assessed by surgery or a combination of cystoscopy and CT in 15 cases. Results : The vesical arteries were successfully selected in 18 of 20 patients. In 16 small tumors, the tumor stain was clearly depicted on CTA. In two large tumors, the vascular supply was identified as involving multiple arteries. One case showed complete remission, six showed partial remission, and eight showed no change. Complications included mild local pain around the perineum during TACE, and transient nausea in some patients. Conclusion : CTA may be useful in superselective TACE for invasive bladder cancer, and may contribute to effective treatment of bladder tumors.

Causes of arterial bleeding after living donor liver transplantation and the results of transcatheter arterial embolization.

ObjectiveTo analyze the causes of arterial bleeding after living donor liver transplantation (LDLT) and to evaluate the efficacy of transcatheter arterial embolization (TAE).Materials and MethodsForty-two sessions of conventional arteriography were performed in 32 of the 195 patients who underwent LDLT during the past 2 years. This was done in search of bleeding foci of arterial origin. TAE was performed with microcoils or gelatin sponge particles. The causes of arterial bleeding, the technical and clinical success rates of TAE and the complications were retrospectively evaluated.ResultsForty-two bleeding foci of arterial origin were identified on 30 sessions of arteriography in 21 patients. The most common cause of bleeding was percutaneous procedures in 40% of the patients (17 of the 42 bleeding foci) followed by surgical procedures in 36% (15/42). The overall technical and clinical success rates of TAE were 21 (70%) and 20 (67%) of the 30 sessions, respectively. The overall technical success rate of TAE for the treatment of bleeding from the hepatic resection margin, hepatic artery anastomotic site and hepaticojejunostomy was only 18% (2/11), whereas for the treatment of bleeding in the other locations the technical and clinical success rates of TAE were 100% and 95%, respectively. No procedure-related major complications occurred.ConclusionIn the case of arterial bleeding after LDLT, percutaneous procedure-related hemorrhages were as common as surgery-related hemorrhages. There were technical difficulties in using TAE for the treatment of hepatic arterial bleeding. However, in the other locations, TAE seems to be safe and effective for the control of arterial bleeding in LDLT recipients.

Emergency Arterial Embolization in the Management of Primary Postpartum Hemorrhage

Objective: To evaluate the efficacy of emergency selective arterial embolization in the management of intractable primary postpartum hemorrhage. Material(s) and Method(s): A retrospective review was undertaken of 25 women with life-threatening primary postpartum hemorrhage who underwent uterine embolization from May 1992 to May 2002. In all cases, hemostatic embolization was perlormed because of intractable hemorrhage which could not be controlled with vaginal packing and administration of uterotonic drugs. Result(s): The major clinical indications for transcatheter embolization included uterine atony in 12 women, a genital tract lesion (vaginal or cervical tears) in 7 women, placenta previa in 2 women, and placenta accreta in 2 women. Two patients were known to have myomas. All were already in-house. Twenty-four women were successfully treated using transcatheter arterial embolization with gelatin sponge particles, and 1 patient expired due to irreversible shock. Conclusion(s): Transcatheter arterial embolization therapy is a safe and effective means for treating hemodynamically stable patients. It may fail when patients have an unstable hemodynamic status with uncontrollable hemorrhaging.

Partial splenic embolization in patients with idiopathic portal hypertension

Purpose: To evaluate the effectiveness of partial splenic embolization (PSE) in patients with idiopathic portal hypertension (IPH) in reducing variceal bleeding episodes, splenomegaly and thrombocytopenia. Materials and methods: Six patients (2M, 4F, mean age 30.3 years) with IPH presenting with splenomegaly, thrombocytopenia and recurrent variceal bleeding were treated with PSE using gelatin sponge (four patients) or Contour particles (two patients) as embolization material. Results: PSE was performed successfully in all cases; 3F coaxial microcatheters were necessary in two patients due to extreme splenic artery tortuosity. The average amount of devascularized parenchyma at CT 1 week after PSE was 71%. Splenomegaly and thrombocytopenia improved in all cases, with a mean platelet count increase of 120 000/mm3 and an average 68% reduction of spleen volume at follow up. Variceal bleeding did not recur after PSE. Esophageal or gastroesophageal varices disappeared (one patient) or significantly reduced (five patients) at endoscopic controls. No significant complications were noted. The follow up was of at least 18 months in all patients; mean follow up was 28.2 months. Conclusion: In patients with IPH PSE can be effective in preventing variceal bleedings, in reducing spleen volume and in significantly increasing platelet count; therapeutic results were durable in our population.

Morphologic and histopathologic changes in the bowel after super-selective transcatheter embolization for focal lower gastrointestinal hemorrhage.

To evaluate the safety of superselective arterial embolization therapy in the lower gastrointestinal tract. The sequelae on normal enteric tissue in lower gastrointestinal arterial embolization were retrospectively reviewed. To control hemorrhage and tumor blood supply, 14 patients were treated by superselective transcatheter embolization at different levels of the colonic and small intestine vessels via the superior and inferior mesenteric arteries using microcoils and/or gelatin sponge. Normal enteric tissues in the embolized areas were analyzed for the occurrence of ischemic changes by clinical follow-up, colonoscopy, and surgery. Normal bowel function was preserved in 13 patients. In 1 patient treated with numerous gelatin sponge particles delivered from the proximal arcade of the superior mesenteric artery, significant muscular fibrosis occurred. Superselective arterial embolization for lower gastrointestinal hemorrhage can be safely performed by minimizing the amount of embolic materials and delivering them as distally as possible.

Morphologic and Histopathologic Changes in the Bowel after Super-Selective Transcatheter Embolization for Focal Lower Gastrointestinal Hemorrhage

To evaluate the safety of superselective arterial embolization therapy in the lower gastrointestinal tract. The sequelae on normal enteric tissue in lower gastrointestinal arterial embolization were retrospectively reviewed. To control hemorrhage and tumor blood supply, 14 patients were treated by superselective transcatheter embolization at different levels of the colonic and small intestine vessels via the superior and inferior mesenteric arteries using microcoils and/or gelatin sponge. Normal enteric tissues in the embolized areas were analyzed for the occurrence of ischemic changes by clinical follow-up, colonoscopy, and surgery. Normal bowel function was preserved in 13 patients. In 1 patient treated with numerous gelatin sponge particles delivered from the proximal arcade of the superior mesenteric artery, significant muscular fibrosis occurred. Superselective arterial embolization for lower gastrointestinal hemorrhage can be safely performed by minimizing the amount of embolic materials and delivering them as distally as possible.

Randomized controlled trial of transarterial lipiodol chemoembolization for unresectable hepatocellular carcinoma

This randomized, controlled trial assessed the efficacy of transarterial Lipiodol (Lipiodol Ultrafluide, Laboratoire Guerbet, Aulnay-Sous-Bois, France) chemoembolization in patients with unresectable hepatocellular carcinoma. From March 1996 to October 1997, 80 out of 279 Asian patients with newly diagnosed unresectable hepatocellular carcinoma fulfilled the entry criteria and randomly were assigned to treatment with chemoembolization using a variable dose of an emulsion of cisplatin in Lipiodol and gelatin-sponge particles injected through the hepatic artery (chemoembolization group, 40 patients) or symptomatic treatment (control group, 40 patients). One patient assigned to the control group secondarily was excluded because of unrecognized systemic metastasis. Chemoembolization was repeated every 2 to 3 months unless there was evidence of contraindications or progressive disease. Survival was the main end point. The chemoembolization group received a total of 192 courses of chemoembolization with a median of 4.5 (range, 1-15) courses per patient. Chemoembolization resulted in a marked tumor response, and the actuarial survival was significantly better in the chemoembolization group (1 year, 57%; 2 years, 31%; 3 years, 26%) than in the control group (1 year, 32%; 2 years, 11%; 3 years, 3%; P = .002). When adjustments for baseline variables that were prognostic on univariate analysis were made with a multivariate Cox model, the survival benefit of chemoembolization remained significant (relative risk of death, 0.49; 95% CI, 0.29-0.81; P = .006). Although death from liver failure was more frequent in patients who received chemoembolization, the liver functions of the survivors were not significantly different. In conclusion, in Asian patients with unresectable hepatocellular carcinoma, transarterial Lipiodol chemoembolization significantly improves survival and is an effective form of treatment. (H EPATOLOGY 2002;35:1164-1171.)

Percutaneous Microwave Tumor Coagulation for Hepatocellular Carcinomas with Interruption of Segmental Hepatic Blood Flow

To assess the effect of hepatic artery occlusion with or without hepatic venous outflow interruption on coagulation diameter during percutaneous microwave coagulation therapy (PMCT) for hepatocellular carcinoma (HCC) by a prospective and randomized trial. Thirty-one patients with 36 HCCs (10-38 mm in diameter) were randomly separated into two treatment groups as follows: group 1 (14 tumors in 14 patients) was treated with PMCT in conjunction with both segmental hepatic artery embolization with gelatin sponge particles and temporary interruption of hepatic venous flow by means of a 6-F balloon catheter to reduce the portal venous flow; group 2 (22 tumors in 17 patients) was treated with PMCT with segmental hepatic artery embolization only. PMCT under ultrasound (US) guidance was performed with 2,450 MHz of microwave frequency at 40-60 W and a needle applicator 1.6 mm in diameter. The coagulated area was measured at the maximum diameter perpendicular to the needle tract on enhanced computed tomography (CT) performed immediately after PMCT. The local effect of the treatment was evaluated by follow-up enhanced CT (6-33 mo). Patients in group 1 had a significantly larger coagulation area (mean +/-SD = 42.9 mm +/- 8.3), with coagulation times of 5.3 min +/- 1.4, than patients in group 2 (32.6 mm +/- 8.0), with coagulation times of 4.2 min +/- 1.3 (P <.05). Follow-up enhanced CT showed no local enhancement of the tumor, indicating complete necrosis and no local recurrence, except for four tumors. There were no major complications after PMCT except liver abscess that developed after PMCT in one patient with pneumobilia. PMCT with combined hepatic arterial embolization and temporary hepatic venous flow interruption can coagulate significantly larger volumes of tumor than PMCT with only hepatic arterial embolization.

Uterine artery embolization using gelatin sponge particles alone for symptomatic uterine fibroids: midterm results.

The purpose of this study was to assess the safety and effectiveness of uterine artery embolization using gelatin sponge particles alone for women with symptomatic uterine fibroids. During 38 months, 60 patients (age range, 32-52 years; mean age, 42.5 years) with symptomatic uterine fibroids underwent uterine artery embolization. Only gelatin sponge particles, approximately 500-1000 microm in diameter, were used in all patients. The improvement of clinical symptoms was assessed by questionnaire. Reduction of the largest tumor and uterine volume reductions were assessed using MR imaging. The follow-up period ranged from 1 to 38 months (mean, 10.6 months). Menorrhagia improved markedly or moderately in 41 (98%) of 42 of patients 4 months after embolization and in 20 (100%) of 20 patients 1 year after embolization. Bulk-related symptoms improved markedly or moderately in 31 (97%) of 32 of patients 4 months after embolization and in 19 (100%) of 19 of patients 1 year after embolization. MR imaging revealed that the mean largest tumor volume reduction rates were 55% at 4 months and 70% at 1 year after embolization, and the mean uterine volume reduction rates were 40% at 4 months and 56% at 1 year after embolization. Follow-up MR imaging showed no new fibroids and no regrowth of existing fibroids. No major complications were observed in any women. We suggest that uterine artery embolization with gelatin sponge particles alone is a safe and effective treatment for symptomatic fibroids. The outcomes bear comparison with those of uterine artery embolization using polyvinyl alcohol particles, which have been reported in the literature.

Palliative treatment of hepatocellular carcinoma by chemoembolization

Purpose: The efficacy of transcatheter arterial chemoembolization (TACE) and the correlation between iodized oil uptake pattern and tumor response were investigated in cases with inoperable hepatocellular carcinoma (HCC).Material and Methods: TACE, using sequential intra-arterial doxorubicin, mitomycin, iodized oil and gelatin sponge particles, was used to treat patients with inoperable HCC localized to the liver. One hundred and two patients (aged 16-80) were treated in this manner from 1995 to 2001. The objective response was determined by sequential CT. Iodized oil uptake pattern as well as the relationship between uptake pattern and tumor response was evaluated in each case.Results: The one-year survival rate was 46%. Tumor response was found to be better in cases with dense and peripheral iodized oil uptake in comparison to those displaying scarce and patchy iodized oil uptake.Conclusion: TACE is an efficient and safe palliative treatment for inoperable HCC with prolonged survival and good life quali...

Ischemic bile duct injury as a serious complication after transarterial chemoembolization in patients with hepatocellular carcinoma.

Bile duct injuries after transarterial chemoembolization (TACE) have been reported; however, the exact pathogenic mechanisms and clinical implications of the injuries remain to be clarified. A total of 950 consecutive patients with hepatocellular carcinoma (HCC) were studied. Among them, 807 were treated with TACE and the remaining 143 were treated with transarterial chemoinfusion (TACI) of cisplatin. None of 143 patients with HCC treated with TACI were found to have any radiographic evidence of biliary injury. In contrast, of the 807 patients treated with TACE, 17 (2%) developed biliary complications. Of all complications, 12 (71%) were subcapsular bilomas; 3 (17%), focal strictures of the common hepatic duct or common bile duct; and 2 (12%), diffuse mild dilatation of the intrahepatic bile ducts. Interestingly, 2 of the 12 bilomas were found in the lobe that was not embolized with gelatin sponge particles. The median numbers of TACE tended to be greater in the patients with focal stricture than in those with bilomas (6.0 vs. 2.5; p = 0.08). All 3 patients with focal strictures and 4 of the 12 patients with bilomas had associated serious bacterial infections at presentation. Bilomas seem to be caused by iodized oil rather than gelatin sponge particles; focal strictures of large bile ducts seem to be caused by gelatin sponge particles. We suggest that adjustments in the amounts of iodized oil or gelatin sponge particles and in the sites of embolization may reduce ischemic biliary injuries after TACE.

RENAL ARTERY EMBOLIZATION FOR BENIGN OBSTRUCTIVE UROPATHY

We demonstrate safety of renal artery embolization as an alternative to nephrectomy in symptomatic patients with obstructed, poorly functioning kidneys who are unfit for surgery. We performed renal artery embolization in 2 medically unfit patients with benign obstructive uropathy and poorly functioning kidneys. The affected kidney was initially drained with a nephrostomy tube and the kidney was then selectively embolized using absorbable gelatin sponge particles and Gianturco coils. The nephrostomy tube was removed before hospital discharge. Urine production by the affected kidney ceased and symptoms resolved. Renal artery embolization with antegrade drainage is a safe alternative to surgery in unfit symptomatic patients with benign obstructive uropathy and poorly functioning kidneys.