Transcatheter Hepatic Arterial Embolization Research Articles

Transcatheter Hepatic Artery Embolization Versus Hepatic Artery Perfusion Chemoembolization in the Interventional Treatment of Primary Hepatocellular Carcinoma: Clinical Effect Observation

Objective: To investigate the clinical effect of transcatheter hepatic artery embolization and hepatic artery perfusion chemoembolization on the interventional treatment of primary liver cancer. Methods: Eighty-two primary hepatocellular carcinoma patients who came to the outpatient clinic for treatment from August 2020 to November 2023 were selected as the study subjects. Based on the retrospective analysis, they were divided into 45 cases in the embolization group and 37 cases in the chemoembolization group according to the difference of treatment methods. The embolization group was treated with transcatheter hepatic artery embolization, and the chemoembolization group was treated with hepatic artery perfusion chemoembolization. The clinical efficacy, survival rate, survival quality score, serum tumor markers, and incidence of adverse reactions were observed in the two groups. Results: The clinical efficacy, survival quality score, and serum tumor markers of the chemoembolization group were higher than that of the embolization group, and the incidence of adverse reactions was lower than that of the embolization group, with statistically significant differences (P < 0.05). The survival rate of the chemoembolization group was not statistically significant when compared with that of the embolization group (P > 0.05). Conclusion: In the treatment of primary hepatocellular carcinoma, hepatic artery perfusion chemoembolization is better than transcatheter hepatic artery embolization, which can effectively improve the quality of patients’ survival and reduce the incidence of adverse reactions, and it is worth further popularized in the clinic.

Effect of Transcatheter Hepatic Artery Embolization and Hepatic Artery Infusion Chemoembolization in the Treatment of Primary Liver Cancer

Effect of Transcatheter Hepatic Artery Embolization and Hepatic Artery Infusion Chemoembolization in the Treatment of Primary Liver Cancer

Hepatic Arterial Bland Embolization Increases Th17 Cell Infiltration in a Syngeneic Rat Model of Hepatocellular Carcinoma.

To determine the tumor immune cell landscape after transcatheter arterial bland embolization (TAE) in a clinically relevant rat hepatocellular carcinoma (HCC) model. Buffalo rats (n = 21) bearing syngeneic McArdle RH-7777 rat hepatoma cells implanted into the left hepatic lobe underwent TAE using 70-150µm beads (n = 9) or hepatic artery saline infusion (n = 12). HCC nodules, peritumoral margin, adjacent non-cancerous liver, and splenic parenchyma were collected and disaggregated to generate single-cell suspensions for immunological characterization 14d after treatment. Changes in tumor-infiltrating immune subsets including CD4 T cells (Th17 and Treg), CD8 cytotoxic T cells (IFNγ), and neutrophils were evaluated by multiparameter flow cytometry. Migration and colony formation assays were performed to examine the effect of IL-17, a signature cytokine of Th17 cells, on McArdle RH-7777 hepatoma cells under conditions simulating post-embolization environment (i.e., hypoxia and nutrient privation). Statistical significance was determined by the Student unpaired t test or one-way ANOVA. TAE induces increased infiltration of Th17 cells in liver tumors when compared with controls 14d after treatment (0.29 ± 0.01 vs. 0.19 ± 0.02; p = 0.02). A similar pattern was observed in the spleen (1.41 ± 0.13 vs. 0.57 ± 0.08; p < 0.001), indicating both local and systemic effect. No significant differences in the percentage of FoxP3 + Tregs, IFNγ-producing CD4 T cells, and CD8 T cells were observed between groups (p > 0.05). In vitro post-embolization assays demonstrated that IL-17 reduces McA-RH7777 cell migration at 24-48h (p = 0.003 and p = 0.002, respectively). Transcatheter hepatic arterial bland embolization induces local and systemic increased infiltration of Th17 cells and expression of their signature cytokine IL-17. In a simulated post-embolization environment, IL-17 significantly reduced McA-RH7777 cell migration.

Factors Influencing Cyst Infection in Autosomal Dominant Polycystic Kidney Disease

Background: Cyst infection is a frequent and serious complication of autosomal dominant polycystic kidney disease (ADPKD) that is often difficult to treat. However, the factors influencing cyst infection are still unknown. Therefore, we investigated clinical factors related to the duration of hospitalization and death due to cyst infection. Methods: All ADPKD patients undergoing cyst drainage or nephrectomy or partial hepatectomy at Toranomon Hospital from January 2004 to March 2016, in whom cyst fluid analysis showed bacteria or neutrophils indicating definite cyst infection, were reviewed retrospectively. Factors influencing the duration of hospitalization and death due to cyst infection were analyzed. Results: A total of 243 patients with cyst infection were enrolled, including 104 men and 139 women (mean age: 62.6 ± 10.0 years). Seventeen patients died of cyst infection. Multivariate logistic regression analysis revealed that hepatomegaly, positive cyst contents culture, and the maximum white blood cell (WBC) count were significantly associated with death from cyst infection. Death was significantly more likely if patients had massive hepatomegaly (≥5,113.2 mL) compared with mild hepatomegaly (< 1,898.7 mL; odds ratio 38.1; 95% CI 2.9–492.6, p = 0.0004). Multivariate Cox proportional hazards analysis revealed that older age, dialysis duration, hepatic transcatheter arterial embolization, maximum WBC count, and hepatomegaly were significantly associated with longer hospital stay for cyst infection, while female sex, nephrectomy, serum albumin, and serum cholinesterase were significantly associated with shorter hospital stay. Discharge alive from hospital was significantly associated with massive hepatomegaly versus mild hepatomegaly (hazard ratio 0.0072; 95% CI 0.0008–0.0659, p < 0.0001). Conclusions: Hepatomegaly was strongly associated with both death and longer hospital stay due to cyst infection.

Abstract No. 429 A case control study of percutaneous sclerotherapy versus transcatheter hepatic arterial embolization for treatment of large-volume hepatic hemangioma

To evaluate the clinical efficacy of percutaneous sclerotherapy and transcatheter hepatic artery embolization in the treatment of large volume hepatic hemangioma. Twenty-two patiens with large-volume hepatic hemangioma (diameter larger than 5 cm) were randomly divided into two groups between Jan 2015 and Aug 2017 at one single institution. Eleven cases were undergone percutaneous injection of bleomycin sclerotherapy under CT-guidance (sclerotherapy group), 11 patients were performed by DSA-guided bleomycin lipiodol emulsion transcatheter hepatic artery embolization (embolization group). The procedure time, hospital cost, postoperative outcomes, complications and QOL scales were reviewed and analyzed. The mean procedure time (15.6+6.4) min in sclerotherapy group was shorter than that in the embolization group (51.5+7.2) min. The liver dysfunction rate of sclerotherapy group (27.3%, 3/11) was much lower than that in embolization group (90.9%, 10/11). The mean hospitalization and cost of sclerotherapy group were significantly less than that of embolization group, p0.05. At 6 months follow-up post procedure, the effective rate (CR+PR) of sclerotherapy group and embolization group were (81.8%, 9/11), (92.3%, 10/11), respectively, p>0.05. Both approaches (sclerotherapy, embolization) in the treatment of large-volume hepatic hemangioma are effective and safe. Sclertotherapy is more simple, cost-effective method in the treatment of hepatic hemangioma.

131I-Labeled Copper Sulfide-Loaded Microspheres to Treat Hepatic Tumors via Hepatic Artery Embolization.

Purpose: Transcatheter hepatic artery embolization therapy is a minimally invasive alternative for treating inoperable liver cancer but recurrence is frequent. Multifunctional agents, however, offer an opportunity for tumor eradication. In this study, we were aim to synthesized poly (lactic-co-glycolic acid) (PLGA) microspheres encapsulating hollow CuS nanoparticles (HCuSNPs) and paclitaxel (PTX) that were then labeled with radioiodine-131 (131I) to produce 131I-HCuSNPs-MS-PTX. This compound combines the multi-theranostic properties of chemotherapy, radiotherapy and photothermal therapy. In addition, it can also be imaged with single photon emission computed tomography (SPECT) imaging and photoacoustic imaging.Methods: We investigated the value of therapeutic and imaging of 131I-HCuSNPs-MS-PTX in rats bearing Walker-256 tumor transplanted in the liver. After the intra-arterial (IA) injection of 131I-HCuSNPs-MS-PTX, 18F-Fluorodeoxyglucose (18F-FDG) micro-positron emission tomography/computed tomography (micro-PET/CT) imaging was used to monitor the therapeutic effect. PET/CT findings were verified by immunohistochemical analysis. SPECT/CT and photoacoustic imaging were performed to demonstrate the distribution of 131I-HCuSNPs-MS-PTX in vivo.Results: We found that embolization therapy in combination with chemotherapy, radiotherapy and photothermal therapy offered by 131I-HCuSNPs-MS-PTX completely ablated the transplanted hepatic tumors at a relatively low dose. In comparison, embolization monotherapy or combination with one or two other therapies had less effective anti-tumor efficacy. The combination of SPECT/CT and photoacoustic imaging effectively confirmed microsphere delivery to the targeted tumors in vivo and guided the near-infrared laser irradiation.Conclusion: Our study suggests that there is a clinical theranostic potential for imaging-guided arterial embolization with 131I-HCuSNPs-MS-PTX for the treatment of liver tumors.

Is Emergency Transcatheter Hepatic Arterial Embolization Suitable for Spontaneously Ruptured Hepatocellular Carcinoma in Child–Pugh C Cirrhosis?

PurposeTo evaluate the utility of emergent transcatheter arterial embolization for spontaneously ruptured hepatocellular carcinoma (HCC) in patients with Child–Pugh class C (CPC) liver cirrhosis presenting hemorrhagic shock. Materials and MethodsA study of all 94 patients was retrospectively conducted from January 2006 to January 2016. Sixty patients underwent conservative treatment (control group) and 34 underwent embolization. ResultsEmbolization provided better stabilization of hemodynamic status than conservative treatment (91.2% vs 61.7%), with greater overall survival (OS) rates at 30, 60, and 120 days (73.5%, 52.9%, and 29.4% vs 33.3%, 13.3%, and 0%, respectively). Mean follow-up duration was 51.07 days (range, 3–237 d). Median survival time was longer for the embolization group than the control group, specifically for patients with a shock index (SI) of ≥ 0.6 to < 1 (106.0 d ± 39.4 vs 34.0 d ± 4.7) or ≥ 1 (18.0 d ± 7.5 vs 11.0 d ± 3.2), those with CPC scores 10 or 11 (88.0 d ± 29.4 vs 28.0 d ± 4.5), and those with segmental (165.0 d ± 20.6 vs 34.0 d ± 9.7) or lobar (54.0 d ± 7.9 vs 26.0 d ± 3.4) portal vein tumor thrombus (PVTT). SI ≥ 1, Child–Pugh score of 12/13, tumor size ≥ 10 cm, and PVTT were independent factors in poor prognosis for OS. ConclusionsEmergent transcatheter arterial embolization is an effective intervention for ruptured HCC in patients with CPC liver function in hemorrhagic shock, particularly those with a SI ≥ 1, Child–Pugh scores of 10/11, and first- or lower-order PVTT.

Multipolar versus monopolar radiofrequency ablation for hepatocellular carcinoma in the caudate lobe: Results of a propensity score analysis.

This study aimed to compare multipolar radiofrequency ablation (RFA) with monopolar RFA as the major treatment for nodules of hepatocellular carcinoma in the caudate lobe. This retrospective study was approved by the institutional review board. Data were reviewed from 101 patients who met the Milan criteria and were treated by multipolar RFA (n = 22) or monopolar RFA (n = 79). After propensity score matching, complications and local tumor progression were compared between the two groups. Before propensity score matching (n = 101), the 2-year relapse-free survival rates for multipolar and monopolar RFA (65.1% vs. 38.8%, respectively; P = 0.064) and the local tumor progression rate (12.5% vs. 14.9%, respectively; P = 0.313) were not significantly different. There were no significant differences between the two RFA techniques by treatment efficacy of transcatheter hepatic arterial embolization, location of tumor, and puncture route. After matching (n = 44), the 2-year relapse-free survival rate for the multipolar and monopolar groups (65.1% vs. 22.7%, respectively; P = 0.004) was significantly different, and the local tumor progression rate (12.5% vs. 22.9%, respectively; P = 0.004) was significantly different. No severe complications occurred in the patients treated by multipolar RFA. Multipolar RFA appears to be a safe and effective method for hepatocellular carcinoma nodules in the caudate lobe.

经导管肝动脉栓塞技术在创伤性肝破裂出血治疗中的价值

目的：探讨经导管肝动脉栓塞技术在创伤性肝破裂出血治疗中的价值。方法：回顾性分析我院2012年4月至2015年4月收治的57例创伤性肝破裂出血患者，依据治疗方法将这些患者随机分为两组，即研究组(n = 28)和对照组(n = 29)。介入组患者为经导管肝动脉栓塞技术及腹腔引流术治疗，对两组患者的术中输血量、术后住院时间及并发症发生情况进行统计分析。结果：和开放手术组相比，介入组患者的术中输血量明显较少(P < 0.05)，术后住院时间明显较短(P < 0.05)，术后并发症发生率35.7%显著低于对照组58.6% (P < 0.05)。结论：经导管肝动脉栓塞技术在创伤性肝破裂出血治疗中具有较高的应用价值，值得在临床推广。 Objective: To investigate the value of transcatheter hepatic arterial embolization in the treatment of traumatic hepatic rupture. Methods: 57 cases of patients with liver trauma bleeding who were treated in our hospital from April 2012 to April 2015 were selected. These patients were divided into two groups according to the treatment methods, namely the interventional therapy group (n = 28) and the open surgery group (n = 29). The interventional therapy group of patients were given transcatheter hepatic arterial embolization therapy and peritoneal drainage, and then the intraoperative blood transfusion, postoperative hospital stay and complications of the two groups of patients were analyzed statistically. Results: The intraoperative blood transfusion of the interventional therapy group of patients was significantly less than that of the open surgery group (P < 0.05). Postoperative hospital stay was significantly shorter (P < 0.05). The postoperative complication rate 35.7% was significantly lower than that of the open surgery group 58.6% (P < 0.05). Conclusion: Transcatheter hepatic arterial embolization is an effective and safe method in the treatment of traumatic hepatic rupture; so it is worthy of promotion in the clinical.

A Case Study of Refractory Liver Abscesses Following Transcatheter Hepatic Arterial Embolization for an Intrahepatic Aneurysm Rupture that Occurred After Choledochojejunostomy

A Case Study of Refractory Liver Abscesses Following Transcatheter Hepatic Arterial Embolization for an Intrahepatic Aneurysm Rupture that Occurred After Choledochojejunostomy

Survival after arterial embolization therapy in patients with polycystic kidney and liver disease.

Transcatheter arterial embolization (TAE) has become a therapeutic option for symptomatic polycystic kidney disease (PKD) and polycystic liver disease (PLD). However, factors affecting survival with renal TAE remain unknown. All symptomatic patients with severe PKD and/or PLD who received renal and/or hepatic TAE at our center from October 1996 through March 2013 (n = 1,028) were followed until death. Their survival was compared with that of the general PKD population on dialysis in Japan. Factors affecting survival were analyzed using the Cox hazard model. After renal TAE, 5- and 10-year survival was, respectively, 0.78 (95% confidence interval, 0.74-0.82) and 0.56 (0.49-0.63); with hepatic TAE, 0.69 (0.58-0.77) and 0.41 (0.22-0.60); and with dual TAE (renal and hepatic), 0.82 (0.72-0.88) and 0.45 (0.31-0.59). Survival after dialysis initiation was better among patients with renal TAE than among general PKD patients. Factors affecting survival after renal TAE were age [hazard ratio (HR) 3.02 (1.44-6.33) for every 10 years] and albumin [HR 0.70 (0.55-0.89) per 0.1 g/dl]. Kidney volume was not associated with patient death after TAE. The main causes of death among patients after renal TAE were similar to those of the general PKD population on dialysis whereas, after hepatic TAE, the main cause was cyst infection with liver failure (12.5% with PLD and 5.9% with PKD, p < 0.01). Survival after renal TAE with severe PKD was better than for the general PKD population on dialysis, suggesting that renal TAE could overcome the disadvantage due to huge organ size.

Intravascular Embolization Therapy in Patients With Enlarged Polycystic Liver

Hepatic transcatheter arterial embolization (TAE) has become an accepted treatment option for patients with symptomatic autosomal dominant polycystic kidney disease (ADPKD) who also have polycystic liver disease and who are not good candidates for surgery. However, indications for TAE and long-term outcome with it are still unclear. Retrospective cohort study. Symptomatic patients with ADPKD with polycystic liver disease who underwent hepatic TAE, June 2001 to December 2012, at Toranomon Hospital and whose liver volume data were available were studied (N=244; 56% on dialysis therapy, none with kidney transplants). Mean age was 55 ± 9 (SD) years, and mean liver volumes were 8,353 ± 2,807 and 6,626 ± 2,485 cm(3) in men and women, respectively. Target arteries were embolized from the periphery using platinum microcoils. Sex-specific quartiles (6,433, 8,142, and 9,574 cm(3) in men and 4,638, 6,078, and 8,181 cm(3) in women) of total liver volume pretreatment. All causes of mortality were obtained from medical records, followed up until July 31, 2013. Laboratory values were measured before TAE and 1, 3, 6, and 12 months after. Organ volumes were measured pretreatment, then 6 and 12 months after, by summing the products of the organ areas traced in each computed tomographic image. Liver/cyst volume decreased to 94.7% (95% CI, 93.5%-95.8%) at 6 months and 90.8% (95% CI, 88.7%-92.9%) at 12 months of pretreatment volumes. Serum protein and hematocrit values improved significantly without liver damage. Survival was significantly better for patients with liver volume ≤ 9,574 cm(3) (men) and ≤ 8,181 cm(3) (women) than for those with larger livers (5-year survival, 69% and 48%; P=0.02). Infection and liver failure caused most deaths, especially in patients with larger livers. Referral bias and lack of control group. Hepatic TAE appears to be a safe and less invasive option for patients with symptomatic polycystic liver, especially those contraindicated for surgical treatment (eg, with malnutrition or on dialysis therapy), improving both hepatic volume and nutrition.

A Case of Giant Hemangioma of the Liver Presenting with Fever and Cough

Hemangioma of the liver is usually asymptomatic and incidentally discovered. However, giant hemangioma of the liver may be symptomatic, which is an indication for treatment. A 31-year-old female was admitted with a fever and 1-month history of a nonproductive cough. Her blood test results revealed thrombocytopenia, anemia, and mild coagulopathy. A giant hemangioma of the liver was the cause of her symptoms and signs, and was too large for surgical treatment. Therefore, we performed two sessions of transcatheter hepatic arterial embolization (TAE). The patient has been doing well without fever for 1 year following the second TAE procedure. Surgical resection and enucleation are the traditional treatments of choice for symptomatic giant hemangioma of the liver. However, the signs and symptoms of giant hemangioma of the liver improved by TAE in the present case. We herein report a case of complicated giant hemangioma of the liver that was partially treated by TAE and conservative management. (Korean J Med 2014;87:505-509)

Infantile hepatic hemangioendothelioma in an 11-year-old child: A case report and review of literature

Infantile hepatic hemangioendothelioma (IHH) is a rare benign mesenchymal tumor. As the name implies, it is commonly seen in infancy and has variable clinical presentation and outcome. This tumor can spontaneously regress or can have expansile growth replacing whole of the liver. In very large tumors, there may be extensive arteriovenous shunting within the lesion, resulting congestive heart failure (CHF) in a significant number of patients with poor outcome. Since there is no tumor marker for this tumor, the diagnosis can only be suspected on the basis of clinical features and radiological investigations from among the various mass occupying lesions of the liver in this age group, which includes hepatoblastoma, mesenchymal hamartoma or hepatocellular carcinoma. As a result, the management strategy cannot be defined and in the literature also there are isolated reports with diverse treatment protocols. The medical management includes corticosteroid, interferon, cytotoxic agents and irradiation or even the radical interventions such as hepatic artery ligation, transcatheter hepatic artery embolization. The surgical options are biopsy, complete resection of the lesion or even liver transplantation. We are reporting a case of IHH who was managed with surgical resection and postoperative corticosteroid. However, the patient had recurrence of the tumor and developed CHF, which led to the demise of the patient. The idea of reporting this case is that this patient was 11-year-old child who very unusual for this tumor at this age, and the surgical resection of this lesion should be radical rather than just excision biopsy as was done in the present case.

Non-cirrhotic Portal Hypertension from Chemotherapy-induced Intrahepatic Non-tumorous Arterioportal Fistula

Purpose: Intrahepatic arterioportal fistulas (APF) are rare, are mostly caused by trauma or malignancy, and can cause presinusoidal portal hypertension. We report a case of chemotherapy-induced non-tumoral intrahepatic APF (CI-APF) presenting with non-cirrhotic portal hypertension (NCPH). A 57-year-old white man presented with chronic abdominal pain and abnormal liver tests for one year (3/13). He underwent right hemicolectomy for cecal adenocarcinoma (2/12), and received adjuvant chemotherapy with FOLFOX (4/12-9/12). His laboratory data showed thrombocytopenia and fluctuating liver tests (AST 43-90 U/L; ALT 49-91U/L; alkaline phosphatase 173-280U/L, and total bilirubin 0.4-1.7mg/dL). Viral and autoimmune hepatitis were excluded. Physical exam was normal. Upper endoscopy showed new trace esophageal varices. Abdominal magnetic resonance imaging reported a large APF in both lobes of the liver, with hyperarterial vascularity perfusing the right hepatic lobe, early shunting to the portal vein, moderate atrophy of right lobe of the liver, distension of the portal vein, and splenomegaly with otherwise patent hepatic vasculature (A). Trans-jugular liver biopsy with wedge pressure and hepatic arteriography showed hepatic vein pressure gradient of 3 mmHg and hepatic arterial to portal vein shunting (B). Liver biopsy was notable for focal sinusoidal dilatation, unremarkable bile ducts, portal tracts, and hepatocytes, with no fibrosis. Prior imaging showed normal hepatic anatomy (2/2012, 6/2012) and fatty infiltration of the liver without vascular abnormalities (11/2012). The occurrence of APF with presinusoidal portal hypertension and the temporal relationship with chemotherapy led to the final diagnosis of NCPH from CI-APF. Several cases of NCPH in patients undergoing chemotherapy for metastatic colorectal cancer have been reported. It is believed that severe hepatic injury from chemotherapy results in benign transformation of the hepatic parenchyma into nodular regenerative hyperplasia (NRH). In our case, the presence of pre-sinusoidal portal hypertension is more supportive of obliterative portal venopathy leading to APF, rather than NRH. Shunt reduction with minimally invasive techniques such as transcatheter hepatic artery embolization have been successfully performed without severe complications.Figure

Treatment of symptomatic polycystic liver disease: transcatheter super-selective hepatic arterial embolization using a mixture of NBCA and iodized oil

Surgical therapy for symptomatic polycystic liver disease (PLD) is effective but has substantial mortality and morbidity. Minimally invasive options such as laparoscopic fenestration, percutaneous cyst aspiration with or without injection of a sclerosing solution have had disappointing results. Because the hepatic cysts in autosomal dominant polycystic kidney disease (ADPKD) patients are mostly supplied from hepatic arteries but not from portal veins, therefore, transcatheter arterial embolization (TAE) of the hepatic artery branches that supply major hepatic cysts can lead to shrinkage of the cyst and liver size. The purpose of this study was to evaluate the safety and effectiveness of TAE using a mixture of N-butyl-2-cyanoacrylate (NBCA) and iodized oil for massive PLD in ADPKD patients. From February 2007 to March 2011, a total of 21 patients with symptomatic PLD underwent super-selective hepatic TAE with the mixture of NBCA and iodized oil. The patients consisted of 17 women and 4 men (age range 36-64years, average age 48.8years). All patients underwent contrast-enhanced computed tomography (CT) of the liver before TAE, and at every 3months for the first year after TAE and at 6-monthly intervals thereafter. Laboratory data, including routine blood tests and liver enzymes, were collected before and 1, 3, 7, and 14days, 1, 3, 6, and 12months after TAE. Technical success was achieved in all cases. No serious complications were experienced. The mean follow-up period was 34±20months (range 12-60months). At follow-up of 6-12months, symptoms notably improved in 18 (85.7%) of 21 patients, and these patients experienced further relief of the symptoms during the follow-up period. TAE failed to benefit in 3 patients (14.3%). No patient complained of worsening of the symptoms after the procedure. At follow-up CT, the total liver volume and total intra-hepatic cyst volume decreased significantly (p<0.001) compared with pre-TAE in 18 (85.7%) of 21 patients at 12months after TAE. The total liver volume decreased from 8270±3016 to 6120±2680cm(3) and the total intra-hepatic cyst volume decreased from 7120±3070 to 4530±2600cm(3). Mild elevation of the liver enzymes was shown in patients at 1-14days after TAE but returned to the normal range within 1month. The mixture of NBCA and iodized oil is an acceptable embolic agent for embolization of the hepatic artery branches that supply the hepatic cysts in ADPKD patients. This technique is an option for patient with highly symptomatic PLD who are not candidates for surgical treatment.

Effect of interval between transcatheter hepatic arterial embolization and radiofrequency ablation on ablated lesion size in a swine model

The aim of the study was to clarify the effect of the interval between transcatheter hepatic arterial embolization (TAE) with Lipiodol plus gelatin sponge particles and radiofrequency (RF) ablation on the extent of ablation. Eight healthy swine were divided into four groups: RF ablation (ablation only), RF ablation immediately after TAE (immediate ablation), RF ablation 3 days after TAE (3-day ablation), and RF ablation 6 days after TAE (6-day ablation). Five ablated lesions were created in each swine (10 per group). A 2-cm expandable LeVeen needle electrode was used for RF ablation. Ablated lesions are composed of an outer reddish zone and an inner whitish zone. The average longest length of the major, intermediate, and minor axes and the volume in the immediate ablation, 3-day ablation, and 6-day ablation groups were significant longer and greater (1.52 and 1.52, 1.46 and 1.50, and 1.37 and 1.35 times greater in the red zone and the whitish area, respectively) than those in the ablation-only group (P < 0.05/3). Accumulation of Lipiodol was still noted in the hepatic sinusoids in the 3-day and 6-day ablation groups. RF ablation delayed to 6 days following TAE produced larger ablation volumes than did RF ablation alone.

Development of a Large Animal Model of Cirrhosis and Portal Hypertension Using Hepatic Transarterial Embolization: A Study in Swine

Purpose To develop a clinically relevant porcine model of liver cirrhosis with portal hypertension by means of hepatic transarterial embolization. Materials and Methods Institutional animal care and use committee approval was obtained for all experiments. Pigs received transcatheter arterial infusion of a 3:1 mixture of iodized oil and ethanol into the hepatic artery in volumes of 16 mL in group 1 (n = 4), 28 mL in group 2 (n = 4), and 40 mL in group 3 (n = 4) with intent of bilobar distribution. Hepatic venous pressure gradient (HVPG) measurement, liver function tests, and volumetry were performed at baseline, at 2 weeks, and before necropsy. Results Cirrhosis was successfully induced in three animals that received 16 mL of the embolic mixture and in all four animals that received 28 mL. The animals in the 40-mL group did not recover from the procedure and were euthanized within 48 h. Increases in HVPG after 6–8 weeks versus baseline reached statistical significance ( P < .05). Correlation between degree of fibrosis and volume of embolic agent did not reach statistical significance, but there was a trend toward increased fibrosis in the 28-mL group compared with the 16-mL group. Conclusions Transcatheter hepatic arterial embolization can be used to create a reliable and reproducible porcine model of liver cirrhosis and portal hypertension.

Prolonged recurrence-free survival following OK432-stimulated dendritic cell transfer into hepatocellular carcinoma during transarterial embolization

Despite curative locoregional treatments for hepatocellular carcinoma (HCC), tumour recurrence rates remain high. The current study was designed to assess the safety and bioactivity of infusion of dendritic cells (DCs) stimulated with OK432, a streptococcus-derived anti-cancer immunotherapeutic agent, into tumour tissues following transcatheter hepatic arterial embolization (TAE) treatment in patients with HCC. DCs were derived from peripheral blood monocytes of patients with hepatitis C virus-related cirrhosis and HCC in the presence of interleukin (IL)-4 and granulocyte-macrophage colony-stimulating factor and stimulated with 0·1 KE/ml OK432 for 2 days. Thirteen patients were administered with 5 × 10⁶ of DCs through arterial catheter during the procedures of TAE treatment on day 7. The immunomodulatory effects and clinical responses were evaluated in comparison with a group of 22 historical controls treated with TAE but without DC transfer. OK432 stimulation of immature DCs promoted their maturation towards cells with activated phenotypes, high expression of a homing receptor, fairly well-preserved phagocytic capacity, greatly enhanced cytokine production and effective tumoricidal activity. Administration of OK432-stimulated DCs to patients was found to be feasible and safe. Kaplan-Meier analysis revealed prolonged recurrence-free survival of patients treated in this manner compared with the historical controls (P = 0·046, log-rank test). The bioactivity of the transferred DCs was reflected in higher serum concentrations of the cytokines IL-9, IL-15 and tumour necrosis factor-α and the chemokines CCL4 and CCL11. Collectively, this study suggests that a DC-based, active immunotherapeutic strategy in combination with locoregional treatments exerts beneficial anti-tumour effects against liver cancer.

A Case of Painful Erythema on Upper Abdominal Wall after Hepatic Transcatheter Arterial Embolization

A Case of Painful Erythema on Upper Abdominal Wall after Hepatic Transcatheter Arterial Embolization