Hepatic Artery Research Articles

Risk factors for postoperative liver dysfunction in robot-assisted gastrectomy for gastric cancer.

Risk factors for postoperative liver dysfunction in robot-assisted gastrectomy for gastric cancer.

Common hepatic artery true aneurysm: Case report and review of the literature

Common hepatic artery true aneurysm: Case report and review of the literature

Sintilimab combined with lenvatinib versus hepatic artery infusion chemotherapy (HAIC) for neoadjuvant treatment of resectable primary hepatocellular carcinoma with high risk of recurrence: A prospective, two-arm, randomized, phase II clinical study.

e16301 Background: The high recurrence rate after resection is closely associated with poor prognosis for resectable hepatocellular carcinoma (HCC). There is no standard of care neoadjuvant therapy. HAIC or the combination of lenvatinib and anti-PD-1 antibodies has shown better trend in tumor response and survival outcomes on unresectable HCC. This study aims to compare the safety and efficacy of lenvatinib combined with sintilimab versus HAIC as neoadjuvant therapy for resectable HCC with high recurrence risk. Methods: This prospective, two-arm, randomized, phase II clinical study (NCT05519410) enrolled patients (pts) with resectable primary HCC who met at least one of the following risk factors, as assessed by the investigators before surgery: CNLC stage Ib (2-3 tumors with a maximum diameter ≤ 3 cm) or CNLC stage IIa (2-3 tumors, with the largest having a diameter > 3 cm). Pts with ECOG 0-1, Child Pugh A, and without prior anti-tumor treatment had at least one measurable lesion. Eligible pts were randomly assigned to receive sintilimab 200 mg Q3W and lenvatinib 8 mg QD for 2 cycles (S+L) or HAIC-FOLFOX for 2 cycles (HAIC), and surgery was performed within 3-4 weeks after treatment. The primary endpoint was 1-year disease-free survival (DFS) rate. Secondary endpoints were objective response rate (ORR, by RECIST v1.1), percentage of microvascular invasion, pathological complete response (pCR) rate, 2-year DFS and OS rate and safety. Results: Until December 31, 2024, a total 46 pts were enrolled. However, 6 pts were excluded due to refusal of resection (3 pts) or protocol violations (3 pts). The remaining 40 pts were randomly (1:1) allocated to receive neoadjuvant S+L or HAIC. At the cutoff date, 2 pts in S+L group and 1 in HAIC group were still undergoing treatment. Radiological evaluations were conducted for 37 pts (S+L, n = 18; HAIC, n = 19). ORR based on RECIST v1.1 and mRECIST were 0% and 38.9% in S+L group, 5.3% and 21.1% in HAIC group, respectively. All 37 pts underwent radical resection, the pCR rates were 5.8% (1/18) in S+L group while no pts achieved complete pathological response in HAIC group. No grade 3 or higher TREAs occurred in both groups. Conclusions: For resectable HCC pts with CNLC stage Ib (2-3 tumors with a maximum diameter ≤ 3 cm) or CNLC stage IIa (2-3 tumors, with the largest having a diameter > 3 cm), the safety of neoadjuvant therapy with HAIC or sintilimab combined with lenvatinib was comparable. Given that the current data on disease free survival are not yet mature, the efficacy of these two groups were unclear. Clinical trial information: NCT05519410 .

FOLFOX-HAIC/TACE combined with lenvatinib plus tislelizumab as a conversion therapy in initial unresectable hepatocellular carcinoma: A retrospective real-world study.

e16201 Background: Systemic and locoregional combination therapy has demonstrated promising outcomes for unresectable hepatocellular carcinoma (uHCC). The purpose of this study was to evaluate the efficacy and safety of Tislelizumab and Lenvatinib in combination with hepatic artery infusion chemotherapy (HAIC) plus transarterial chemoembolization (TACE) for initial uHCC with high tumor burden. Methods: From January 2023 to December 2024, 20 uHCC patients who received FOLFOX-HAIC/TACE combined with Tislelizumab (200mg, q3w) and Lenvatinib (8/12mg, qd) were retrospectively analyzed in The Third People's Hospital of Shenzhen. The primary endpoint was objective response rate (ORR) per mRECIST. Results: Among the 20 patients, 5 (25.0%) patients were in BCLC stage B, and 15 (75.0%) patients were in stage C. In the Japanese Vp classification, 7 (35.0%) patients were in Vp3 stage, and 2 (10.0%) patients were in Vp4 stage. The average treatment cycle of the patients was 3.7 months. After treatment, the tumor volume of 14 (70.0%) patients decreased to varying degrees, among which 6 (30.0%) patients had a reduction of ≥30%. The confirmed ORR and disease control rate (DCR) were 60.0% and 85.0% per mRECIST, with 7 (35.0%) patients achieving complete response (CR), 5 (25.0%) patients reaching partial response (PR), 5 (25.0%) patients having stable disease (SD), and 3 (15.0%) patients having progressive disease (PD). A total of 5 (25.0%) patients successfully underwent radical resection following conversion treatment. 4 of them were confirmed as pathological CR (pCR), and 1 patient manifested massive tumor necrosis. Among the 15 patients with abnormal preoperative AFP, 10 patients (50.0%) had a decrease in AFP level, and 9 patients (45.0%) had a decrease of ≥60%. No severe adverse reactions occurred during the treatment period. Conclusions: FOLFOX-HAIC/TACE combined with Lenvatinib plus Tislelizumab as a conversion therapy afforded promising efficacy and safety in tumor control in patients with initial uHCC with high tumor burden and a satisfactory surgical conversion rate was observed. However, more mature survival data are still needed. Surgical information of 5 patients. Patient Sex Age (years) BCLC stage Treatment times (months) Pathologic condition 1 male 52 C 4 pCR 2 female 56 C 1 massive tumor necrosis 3 male 61 C 3 pCR 4 male 51 B 2 pCR 5 male 46 C 5 pCR

Case Report: Biliary hemorrhage by intrahepatic pseudoaneurysm and asymptomatic right coronary artery pseudoaneurysm in a patient with STAT3 hyper IgE syndrome

STAT3-hyper IgE syndrome (STAT3-HIES) is a primary immunodeficiency disorder caused by dominant-negative mutations in STAT3, leading to defects in Th17 cell differentiation, immune regulation, and tissue repair. Patients are susceptible to recurrent infections and vascular abnormalities, such as vasculopathy and pseudoaneurysms. While involvement of cerebral, bronchial, and coronary arteries has been reported, hepatic artery involvement is rare. We describe a 25-year-old woman with genetically confirmed STAT3-HIES who presented with biliary hemorrhage secondary to a ruptured hepatic pseudoaneurysm. Emergency transcatheter arterial embolization successfully controlled the hemorrhage, and the patient was discharged without complications. Systemic vascular screening revealed an asymptomatic right coronary artery dilation, necessitating medical management with statin therapy. This case highlights hepatic pseudoaneurysm as a rare but life-threatening vascular complication in STAT3-HIES. Given the potential for multi-organ vasculopathy, systemic vascular screening by contrast-enhanced CT or MRI is crucial for early detection and management. Further research is needed to elucidate the mechanisms underlying vasculopathy in STAT3-HIES and establish optimal screening strategies to improve patient outcomes.

If You Can Superselect a Hepatic Artery, You Can Learn Prompt Engineering.

If You Can Superselect a Hepatic Artery, You Can Learn Prompt Engineering.

Rarely Seen, Highly Significant: Aberrant Distal Esophageal Artery in TARE Treatments.

Transarterial radioembolization (TARE) is a 2-stage procedure involving a simulation phase and a treatment phase. The initial phase aims to define hepatic arterial anatomy, tumor-feeding vessels, and variations, and to perform technical simulation for the treatment phase. The treatment phase involves the administration of Yttrium-90 (Y-90)-loaded microspheres. This report presents a 60-year-old man with cholangiocarcinoma, exhibiting a rare variation of a distal esophageal artery originating from the hepatic artery, detected using contrast-enhanced Cone-Beam CT during the simulation phase. SPECT after 99mTc MAA injection confirmed extrahepatic accumulation in the distal esophagus and gastric cardia.

Evaluating the diagnostic significance of the R2* value on 3.0T MRI for assessing the severity of warm hepatic ischemia-reperfusion injury

BackgroundMagnetic resonance imaging (MRI) may be a non-invasive tool for managing warm hepatic ischemia-reperfusion injury (WHIRI).PurposeWe aimed to evaluate the diagnostic utility of the R2* values derived from 3.0T blood oxygen level-dependent (BOLD) MRI in assessing the severity of WHIRI.MethodsFifty healthy adult New Zealand white rabbits were randomly divided into 5 groups with 10 rabbits in each. The experimental groups (40 rabbits) underwent clamping of the hepatic artery and the portal vein for 10, 20, 30, or 40 min, followed by 6 h of reperfusion to induce WHIRI. The other 10 rabbits comprised the normal control group. All animals were underwent conventional 3.0 T and BOLD MRI. Animals were euthanized and the serum levels of biochemical indicators were determined. Correlations between R2* values, biochemical indicators, and WHIRI staging were assessed using Spearman’s rank correlation coefficient. The diagnostic efficacy of R2* values was evaluated using ROC curves.ResultsR2* values increased gradually with prolonged warm ischemia with significant differences across groups (F = 133.25, P < 0.05). A strong positive correlation was detected between R2* values and WHIRI staging (r = 0.878, P = 0.000). Biochemical indicators (ALT, AST, LDH, MDA, and MPO) increased significantly, while SOD levels decreased with prolonged warm ischemia (P < 0.05). R2* values exhibited a strong positive correlation with biochemical indicators (r > 0.495) and a negative correlation with SOD levels (r=-0.658). The diagnostic efficacy of the R2* values was highest for predicting WHIRI above stage S4 (AUC = 1.000).ConclusionR2* values on BOLD MRI provide a sensitive and accurate method for assessing WHIRI. The diagnostic efficacy of the R2* values was the best for predicting WHIRI above stage S4.

Hepatic artery infusion of FOLFOX chemotherapy plus camrelizumab combined with sorafenib for advanced hepatocellular carcinoma in Barcelona Clinic Liver Cancer stage C (Double-IA-001): a phase II trial

BackgroundHepatic arterial infusion chemotherapy (HAIC) with a combination of oxaliplatin, fluorouracil, and leucovorin (FOLFOX) has shown excellent local control for patients with Barcelona Clinic Liver Cancer (BCLC) stage C hepatocellular carcinoma (HCC). In China, both camrelizumab (a programmed cell death-1 [PD-1] inhibitor) and sorafenib have been approved for the first-line treatment of advanced HCC. This study aimed to investigate the efficacy and safety of hepatic artery infusion of FOLFOX chemotherapy plus camrelizumab combined with sorafenib in BCLC stage C advanced HCC.MethodsThis was a single-arm phase II trial (ChiCTR2100041874) with a Simon’s two-stage design. Eligible patients were given a maximum of 6 cycles of hepatic artery infusion with FOLFOX chemotherapy plus camrelizumab (200 mg once every 3 weeks). Sorafenib (400 mg orally twice daily) was given since day 3 after the completion of the first cycle of hepatic artery infusion until disease progression, intolerable toxicity, or conversion to surgical resection. The primary endpoint was objective response rate (ORR) based on the modified Response Evaluation Criteria In Solid Tumors (mRECIST).ResultsBetween January 4, 2021, and December 11, 2023, 25 patients were enrolled. Eleven patients had partial response, with an ORR of 44.0% (95% CI, 24.6–63.5%). The primary endpoint was not met, and the study failed to enter the second stage. Median progression-free survival was 4.87 months (95% CI, 2.07–7.66), with a 12-month rate of 23.2%. Median overall survival was 8.87 months (95% CI, 8.17–9.57), with 12- and 24-month rates of 40.3% and 26.9%, respectively. Two (8.0%) patients received curative resection after the study treatment. Grade ≥ 3 treatment-related adverse events occurred in 19 (76.0%) patients, with the most common being decreased lymphocyte count (13 [52.0%]), increased aspartate aminotransferase (11 [44.0%]), and increased alanine aminotransferase (seven [28.0%]).ConclusionsHepatic artery infusion of FOLFOX chemotherapy plus camrelizumab combined with oral sorafenib shows manageable safety profile but modest antitumor activity in patients with BCLC stage C advanced HCC.

Turning Waste into Treasure: Radiation Byproduct-Induced Fe(III)/Fe(II) Conversion for Efficient Ferroptosis to Improve Iodine-131-Based Transarterial Radioembolization for Liver Tumors.

Transarterial radioembolization (TARE) is a primary palliative treatment for advanced liver cancer. Nonetheless, its therapeutic efficacy is frequently hindered by resistance to tumor cell apoptosis induced by inter-radiotherapy. Induction of multiple cell death modalities provides a potential solution to this challenge. Ferroptosis, a distinct form of cell death from apoptosis, is dependent on the intracellular Fe2+-mediated Fenton reaction for the production of hydroxyl radicals (·OH) and is gaining recognition as a promising approach for cancer treatment. In this study, we synthesized a therapeutic radionuclide iodine-131 (131I)-based TARE agent by combining 131I-labeled iron-based MIL-88B(Fe) nanoparticles (NPs) (abbreviated as 131I-MIL-88B(Fe)) with Lipiodol to achieve a combined apoptosis-ferroptosis tumor therapy. Specifically, a mixture of Lipiodol and 131I-MIL-88B(Fe) NPs was injected into the liver tumors through the hepatic artery. Lipiodol blocks the arterial blood supply of the tumor, causing tumor tissue necrosis, whereas 131I inter-radiotherapy damages deoxyribonucleic acid (DNA) through direct action or indirectly via the production of ·OH through H2O radiolysis, leading to tumor cell apoptosis. Importantly, hydrated electrons (eaq-), a byproduct of H2O radiolysis, promoted the conversion of Fe3+ to Fe2+ in MIL-88B(Fe) NPs, enhancing the efficacy of the Fenton reaction and triggering ferroptosis. In vitro experiments demonstrated that compared to 131I alone, 131I-MIL-88B(Fe) NPs significantly enhanced ferroptosis-mediated tumor cell death due to 131I-induced Fe2+ production, which increased catalytic activity in the Fenton reaction. In a rat model bearing orthotopic N1S1 liver tumors, TARE with Lipiodol and 131I-MIL-88B(Fe) NPs induced tumor cell necrosis, apoptosis, and ferroptosis, resulting in improved therapeutic outcomes. This study leverages eaq- to facilitate Fe3+/Fe2+ conversion for efficient ferroptosis, turning waste into a valuable resource. This demonstrated the innovative integration of multiple treatment strategies to augment the efficacy of TARE in liver cancer therapy.

Hepatic artery infusion chemotherapy combined with camrelizumab and apatinib as conversion therapy for patients with unresectable hepatocellular carcinoma: a single-arm exploratory trial

BackgroundThe development of systemic therapy, including targeted drugs and immune checkpoint inhibitors, has significantly improved the prognosis of patients with advanced unresectable hepatocellular carcinoma (uHCC). Hepatic arterial infusion chemotherapy (HAIC) has been gradually applied to the treatment of advanced uHCC, showing good potential as conversion therapy. We aimed to investigate the efficacy and safety of HAIC combined with camrelizumab and apatinib as conversion therapy for uHCC.MethodsThis study was a single-arm exploratory trial (NCT05099848) in patients with uHCC. Eligible patients received apatinib 250 mg once daily, camrelizumab 200 mg on day 3, and HAIC with FOLFOX regimen (oxaliplatin 85 mg/m2 at hours 0–2, leucovorin 400 mg/m2 at hours 2–3, and fluorouracil 400 mg/m2 at hour 3, followed by fluorouracil 2400 mg/m2 for 46 h) on days 4–5 of each 21-day cycle for up to 8 cycles. Primary endpoints were conversion rate and margin-free (R0) resection rate.ResultsBetween March 2021 and July 2023, 19 patients were enrolled. Median follow-up was 14.9 months (interquartile range, 10.9–21.1). Disease became resectable in 14 (73.7%) of 19 patients; nine (47.4%) patients received R0 resection, while five (26.3%) refused surgery and opted for observation. Three (33.3%) of nine patients with surgery achieved major pathological response, including two (22.2%) with pathological complete response. Objective response and disease control rates were 47.4% (9/19) and 89.5% (17/19) per Response Evaluation Criteria In Solid Tumors (RECIST) version 1.1 and both 89.5% (17/19) per modified RECIST. Survival data were immature. Fourteen (73.7%) of 19 patients had grade 3 or higher treatment-related adverse events, with the most common being increased alanine aminotransferase or aspartate aminotransferase (seven [36.8%]) and increased lymphocyte count (six [31.6%]). No treatment-related deaths occurred.ConclusionsThe combination of HAIC, camrelizumab, and apatinib as conversion therapy shows promising clinical benefits and a manageable safety profile in patients with uHCC. Future randomized controlled trials are warranted.Trial registrationClinicalTrials.gov NCT05099848. Registered on October 13, 2021.

Early angiographic changes after hemostatic radiotherapy for gastric cancer bleeding, mentioning the mechanism and potential immediate effects of the treatment.

Although hemostatic radiotherapy has been reported as an effective treatment for gastric cancer bleeding, its mechanism and immediate effects remain unclear. We experienced a case of gastric cancer bleeding originating from both the whole gastric tumor and a left gastric arterial pseudoaneurysm at the tumor-associated ulcer. The patient was treated with radiotherapy for bleeding from the whole gastric tumor, followed by transcatheter arterial embolization for the left gastric arterial pseudoaneurysm. Angiography performed two hours after radiotherapy with an X-ray of 8Gy in a single fraction revealed the disappearance of both tumor vessels and tumor stain from not only the embolized left gastric artery but also both the non-embolized right gastric artery and common trunk of the left gastric and the left hepatic arteries, which indicated these angiographic changes of the non-embolized arteries were presumed to reflect an immediate effect of hemostatic radiotherapy. Following hemostatic treatments, the patient's vital signs stabilized, and hemoglobin levels did not decrease, indicating immediate hemostasis. This case suggests a link between hemostatic mechanism and early tumor vessel changes, indicating that hemostatic radiotherapy can achieve rapid bleeding control. Therefore, hemostatic radiotherapy should be considered an emergency treatment option for gastric cancer bleeding.

Validation of a CT-based model for early prediction of post pancreatectomy haemorrhage risk.

Validation of a CT-based model for early prediction of post pancreatectomy haemorrhage risk.

Interventional arterial chemotherapy versus sorafenib for advanced hepatocellular carcinoma in China: a health economic evaluation of open-label, randomised, phase 3 study.

This post hoc study aimed to evaluate the cost-effectiveness of hepatic artery infusion chemotherapy (HAIC) with fluorouracil, leucovorin and oxaliplatin (HAIC-FO) compared with sorafenib in patients with advanced hepatocellular carcinoma (HCC). The analysis was conducted from the perspective of Chinese payers. A cost-effectiveness analysis was performed using a Markov model derived from data obtained in the FOHAIC-1 trial (phase 3 randomised controlled trial; conducted 2017-2020). The study was conducted in tertiary care centres in China. The study included advanced HCC patients enrolled in the FOHAIC-1 trial. Inclusion criteria followed the trial protocols, with patients stratified by disease severity (including the presence of Vp4 portal vein tumour thrombus (PVTT) and high tumour burden). HAIC-FO (fluorouracil, leucovorin and oxaliplatin) was compared with sorafenib for cost and health outcomes. The primary outcome was the incremental cost-effectiveness ratio (ICER), calculated as the additional cost per quality-adjusted life year (QALY) gained. Sorafenib yielded 0.66 QALYs at a cost of $15 011.73, whereas HAIC-FO yielded 1.00 QALY at a cost of $18 470.98. The ICER of HAIC-FO compared with sorafenib was $10 235.56 per QALY, which was below the willingness-to-pay (WTP) threshold of $30 492.00 per QALY. Sensitivity analyses confirmed that HAIC-FO remained cost-effective across variable assumptions, with probabilistic sensitivity analysis showing a 99.9% probability of cost-effectiveness at the WTP threshold. Subgroup analyses demonstrated more favourable ICERs for patients with Vp4 PVTT ($7003.33 per QALY) and those with high tumour burden ($7382.86 per QALY). HAIC-FO is a more cost-effective treatment for advanced HCC than sorafenib from the Chinese payer's perspective, particularly in patients with Vp4 PVTT and/or high tumour burden. Further research is needed to explore long-term economic implications and real-world effectiveness data. NCT03164382.

Initial hepatic artery reperfusion for complex portal vein thrombosis in living donor liver transplantation: A case report

Initial hepatic artery reperfusion for complex portal vein thrombosis in living donor liver transplantation: A case report

FRI-095 Hepatic artery infusion chemotherapy(HAIC) combined with Lenvatinib and Camrelizumab for hepatocellular carcinoma(HCC) with portal vein tumor thrombus(PVTT): a prospective longitudinal real-world study

FRI-095 Hepatic artery infusion chemotherapy(HAIC) combined with Lenvatinib and Camrelizumab for hepatocellular carcinoma(HCC) with portal vein tumor thrombus(PVTT): a prospective longitudinal real-world study

When Infection Strikes Deep: High-stakes ICU Management of Bleeding Hepatic Artery Pseudoaneurysm in an Infective Endocarditis Patient

When Infection Strikes Deep: High-stakes ICU Management of Bleeding Hepatic Artery Pseudoaneurysm in an Infective Endocarditis Patient

Rupture of a Giant Hepatic Artery Pseudoaneurysm into Biliary Tract

Rupture of a Giant Hepatic Artery Pseudoaneurysm into Biliary Tract

Recipient right renal artery to graft hepatic artery in liver transplantation for otherwise impossible graft arterialization.

Recipient right renal artery to graft hepatic artery in liver transplantation for otherwise impossible graft arterialization.

FRI-499 Hepatic artery atherosclerosis is a risk factor for biliary strictures after liver transplantation

FRI-499 Hepatic artery atherosclerosis is a risk factor for biliary strictures after liver transplantation