Transcatheter Hepatic Arterial Embolization Research Articles

Bile duct necrosis:Complication of transcatheter hepatic arterial embolization

Bile duct necrosis:Complication of transcatheter hepatic arterial embolization

Spontaneous rupture of hemangioma of the liver: Treatment with transcatheter hepatic arterial embolization : T. Yamamoto, Y. Kawarada, T. Yano, et al. Am J Gastroenterol 86:1645–1649, (November), 1991

Spontaneous rupture of hemangioma of the liver: Treatment with transcatheter hepatic arterial embolization : T. Yamamoto, Y. Kawarada, T. Yano, et al. Am J Gastroenterol 86:1645–1649, (November), 1991

Transcatheter hepatic arterial embolization with avitene in dogs

The hepatic arteries in 36 dogs were embolized with microfibrillar collagen (Avitene) to evaluate the effects on the liver parenchyma. Serial examinations were then conducted over 4 weeks. The dogs were divided into 3 groups: Group 1 received Avitene soaked in saline, Group 2 received decanted Avitene, and Group 3 received Avitene decanted and filtered through gauze. Coagulation necrosis and degeneration of the liver parenchyma was noted in all 3 groups, but was least in Group 3. These results in dogs suggest that gauze filtration of Avitene prior to arterial embolization may also reduce damage to liver parenchyma.

Bile duct necrosis after partial hepatectomy and transcatheter hepatic arterial embolization.

Bile duct necrosis after partial hepatectomy and transcatheter hepatic arterial embolization.M Gotoh, M Monden, M Sakon, T Kanai, K Umeshita, W Endoh, J Okamura, K Wakasa, M Sakurai and T MarukawaAudio Available | Share

Transcatheter hepatic segmental arterial embolization using lipiodol mixed with an anticancer drug and gelfoam particles for hepatocellular carcinoma

Transcatheter hepatic segmental arterial chemoembolization using Lipiodol mixed with an anticancer drug followed by the injection of Gelfoam particles, introduced into the tumor-bearing hepatic segment as the target area (segmental Lipiodol-TAE), was carried out in 54 patients with hepatocellular carcinoma (HCC), 7 of whom were later resected. In 5 of the resected 7 cases, complete necrosis was histologically verified. No death due to HCC was encountered in 47 nonoperated cases, and better therapeutic results were obtained with segmental Lipiodol-TAE. It was concluded that this technique does not adversely affect normal tissues, and it does reinforce the effect of TAE.

Hepatic transcatheter arterial embolization with gastroduodenal artery blocking by finger compression.

Hepatic transcatheter arterial embolization was performed in two patients by blocking the gastroduodenal artery with finger compression on the abdominal surface. The embolizing material, which was injected into the common hepatic artery, did not enter the gastroduodenal artery. No postoperative complications were experienced. This method may be useful for patients in whom superselective catheterization of the proper hepatic artery is not feasible.

Hepatic artery embolization for inoperable hepatocellular carcinoma; prognosis and Risk Factors

During a 7-year period in our hospital, 69 patients with inoperable hepatocellular carcinoma (HCC) underwent 111 courses of transcatheter hepatic artery embolization (TAE) and/or chemoinfusion with lipiodol. Patient survival was 0.5-37 months following therapy and the factors affecting prognosis were evaluated. Survival rates at 1, 2 and 3 years after TAE were 53%, 24% and 15%, respectively. Survival rates at 1, 2 and 3 years in relation to tumor size were 100%, 100% and 100% in 5 patients (tumor size less than 2 cm in diameter), 81%, 33% and 16% in 23 patients (2.1-5.0 cm), and 35%, 9% and 0% in 41 patients (greater than 5.1 cm). An analysis of prognostic factors showed that the size of the main tumor significantly influenced the prognosis following TAE (P less than 0.01), whereas the frequency of TAE, intrahepatic metastasis and the degree of liver dysfunction showed a slight correlation (P less than 0.1). These results suggest that TAE has a significant potential for becoming the first choice of treatment for patients with small multiple HCCs (less than 2 cm), provided that neither severe hepatic dysfunction nor a tumor thrombus in the main portal vein is present.

Effect of caerulein on abdominal pain following transcatheter hepatic arterial embolization in malignant liver cancer patients

The severity of pain occurring in the right hypochondrium after transcatheter hepatic arterial embolization carried out in the treatment of malignant hepatic tumors was compared between a caerulein-treated group and a non-caerulein-treated group. The caerulein-treated group and the non-treated group each comprised nine patients Gelfoam powder was used as an occlusive agent. Even though there were no statistically significant differences between the two groups, the caerulein-treated group tended to demonstrate milder pain in the right hypochondricus, less incidence of tenderness and needed fewer administrations of analgesic than did the non-treated group. None of the three patients showing cystic artery contraction after the caerulein administration developed right hypochondricus pain or tenderness, or required the administration of analgesic. It was concluded that caerulein is useful in relieving right hypochondricus pain occurring after transcatheter hepatic arterial embolization.

Splenic infarction in transcatheter hepatic arterial embolization: angiographic findings for predisposing factors

Splenic infarction in transcatheter hepatic arterial embolization: angiographic findings for predisposing factors

Transcatheter hepatic arterial embolization of ruptured hepatoma with massive intraperitoneal bleeding

Transcatheter hepatic arterial embolization of ruptured hepatoma with massive intraperitoneal bleeding

GALL BLADDER INFARCTION FOLLOWING TRANSCATHETER HEPATIC ARTERY EMBOLIZATION

Fifty-eight patients who underwent transcatheter hepatic artery embolization (TAE) were divided into two groups. Patients who had cholecystectomy before TAE were placed in group A (8 patients), and those without cholecystectomy in group B (50 patients). The two groups were compared for changes in liver function and complaints following TAE, in order to investigate the relation between side effects and gallbladder infarction. No differences in GOT, GPT and LDH following TAE were found between the two groups. In group B, γ-GTP and Al-p were elevated after TAE in 16 (32%) and 9 (18%) patients, respectively. Elevation of the two enzymes was not observed in any of the patients in group A. Patients in both groups showed high fever after TAE at a considerable frequency. Many patients in group B felt abdominal pain after TAE, but only one patient in group A felt abdominal pain. Eight patients in group A underwent cholecystectomy when curative operations were done after TAE, and six of them were found to have gallbladder infarction. A correlation between elevated serum γ-GTP and Al-p and gall-bladder infarction was supposed to exist. Preceding cholecystectomy seems to be useful in preventing complaints following TAE.

Portal venous hemodynamics in hepatocellular carcinoma: Effects of hepatic artery embolization

Portal hemodynamics were studied in 55 patients with hepatocellular carcinoma in comparison with 41 normal subjects, using the duplex system that consists of an electronic sector scanner and a pulsed Doppler velocitometer. Changes of portal hemodynamics after transcatheter hepatic artery embolization were also investigated in 15 of the patients with hepatocellular carcinoma. The duplex system showed that 9 of the 55 had no Doppler signal in the portal trunk, suggesting portal vein thrombosis, 2 had hepatofugal flow in the portal trunk indicative of arterioportal shunts, and 44 had hepatopetal flow in the portal trunk. One of the 9 patients with no significant portal venous flow showed hepatopetal flow in collateral veins at the porta hepatis, suggesting cavernous transformation of the portal vein. All of these ultrasound findings were confirmed by subsequent celiac-mesenteric angiography. In 44 of the 55 patients there was no tumor invasion in the portal trunk, and portal venous flow was found to be close to that of normal subjects regardless of the stage or size of tumor, and tumor invasion into relatively large portal branches. After transcatheter hepatic artery embolization, portal venous flow was increased, even on the next day, and it remained increased for at least 2 wk. Thus, the duplex system is useful to study qualitative and quantitative changes of portal hemodynamics in hepatocellular carcinoma. Our observations suggest that the portal venous flow is kept relatively constant by some homeostatic mechanism even in advanced hepatocellular carcinoma until the tumor invades into the portal trunk, and that it increases when hepatic arterial flow is occluded.

Histologic assessment of resected hepatocellular carcinoma after transcatheter hepatic arterial embolization

Ten cases of large hepatocellular carcinoma (HCC) (largest diameter, 6.5-15 cm) were surgically resected from 3 to 19 days after transcatheter hepatic arterial embolization (TAE) for histologic assessment of the effectiveness. Another two patients, including one with a small HCC (3.5 X 3 X 3 cm) who died of complications, were also studied. The patients' ages ranged from 20 to 64 years, 11 were men and 1 was a woman, and all positive for serum hepatitis B surface antigen. All 11 cases with large HCC were symptomatic before the HCC was clinically diagnosed. Alpha-fetoprotein levels were elevated in ten cases but immediately dropped to normal levels after TAE and resection in eight cases. An effective massive tumor coagulative necrosis of 99% already occurred 3 days after TAE. A necrosis involving more than 95% of the whole tumor mass was demonstrated in eight cases: one was a large HCC taken from an autopsy specimen, and TAE was done three times. This strongly indicates the effectiveness of TAE on the destruction of HCC. However, the presence of viable residual tumors in 11 cases also strongly argues for the necessity for surgical resection whenever it is possible. The failure of a complete necrosis was related to the extracapsular extension, liver invasion, satellite nodules, and portal vein involvement, and probably related to collateral and portal vein blood supply.

Short-Term Changes in Blood Ketone Body Ratios in the Phase Immediately After Hepatic Artery Embolization: Their Clinical Significance

Changes in arterial and hepatic venous blood ketone bodies were investigated following transcatheter hepatic artery embolization (THAE) in patients with hepatocellular carcinoma. Acetoacetate/ beta-hydroxybutyrate ratio (ketone body ratio) in arterial blood was positively correlated with those of hepatic venous blood (r = 0.960, p less than 0.001), which reflects the mitochondrial redox potential in the embolized lobe. Nine cirrhotic patients were classified into three groups according to the changes in arterial blood ketone body ratio following THAE: Type A without decrease to below 0.7; Type B with a transient decrease to below 0.7, followed by its restoration within 5 hours; and Type C with decrease to below 0.7 without recovery within 5 hours. There were no serious complications in Type A and B patients. By contrast, severe sepsis and hepatic failure developed in Type C patients, possibly due to the extended embolization of both lobes. It is suggested that THAE can be successfully performed even in severely cirrhotic patients, as long as the embolized area is restricted to one lobe. In addition, changes in arterial blood ketone body ratios can give early information about the likely consequences of the THAE procedure just performed.

Serial changes in sonographic appearance after transcatheter hepatic arterial embolization.

Serial changes in sonographic appearance after transcatheter hepatic arterial embolization (TAE) were studied in 22 patients who had hepatoma and one patient who had a hepatoblastoma. These changes were classified into three types. In cases of type 1, the internal echo of the entire tumor became remarkably echogenic with or without an acoustic shadow. In cases of type 2, echogenic areas or scattered echogenic spots with or without acoustic shadows were observed. In Type 3 cases, no changes in sonographic appearance were observed. Tumor diameters in all of the type 1 cases were less than 4.9 cm. Various size tumors were observed in the cases of type 2 and type 3. Transcatheter arterial embolization was completely effective or effective in 89 per cent of the type 1 and type 2 cases, but was not effective in 75 per cent of the type 3 cases. The sonographic changes correlated well with the effectiveness of TAE.

Hepatic embolization from the common hepatic artery using balloon occlusion technique.

Transcatheter hepatic artery embolization has been established as an effective treatment method for hepatic tumors [1 , 2]. In order to safely accomplish hepatic embolization while protecting gastroduodenal flow, the catheter must be advanced into the proper hepatic artery or a more peripheral artery superselectively through the common hepatic artery. However, this catheter technique is not possible in all cases. We investigated a new method of hepatic embolization via the common hepatic artery, using a balloon catheter to reverse gastroduodenal flow direction.

Transcatheter hepatic artery embolization of liver cancer

Transcatheter hepatic artery embolization of liver cancer

Gallbladder necrosis after transcatheter hepatic arterial embolization: a technique to avoid this complication.

We present a technique used to avoid unnecessary embolization of the cystic artery in the treatment of hepatoma by transcatheter arterial embolization. A special long tapering catheter that is flexible and soft enough to be inserted into the distal small branches of the heptic artery is used. Embolic material ( Oxycel , absorbable cellulose) was mixed with Mitocin -C (mitomycin) and contrast material. This mixture will help to avoid reflux.

Arteriographic Management of Hepatic Hemorrhage

To the Editor. —The recent report Artery Ligation for Delayed Hepatic Hemorrhage (Archives115:92, 1980) invites comment. The authors justly note that selective hepatic arterial ligation is an effective method for controlling acute and delayed hepatic hemorrhage and that it is usually well tolerated because of the excellent collateral vascular potential. Furthermore, they advocate preoperative arteriography to localize such bleeding and to identify hepatic arterial variations. Arteriography, however, may aid not only in the diagnostic evaluation but also in the treatment of these patients. Indeed, selective transcatheter hepatic arterial embolization can be an alternative in such cases, as has recently been demonstrated through the control of intrahepatic and intraperitoneal hepatic hemorrhage, as well as of hemobilia. 1,2 Embolization therapy has also proved useful in instances of aberrant hepatic vascular supply of the type that the authors encountered. 1 Considering the frequency of hepatic injury in abdominal trauma, the occasional limitations

Transcatheter arterial embolization of normal livers and experimental hepatic tumours in the rat.

Transcatheter hepatic arterial embolization with Spongostan (99.3% gelatin) was performed in a group of normal rats. By repeat angiography could be demonstrated that arterial occlusions lasted for at least 1 to 8 days in most rats. Microscopy of these normal livers gave no evidence of parenchymatous liver injury. At postembolization angiography in a group of rats with experimental liver tumours it could be demonstrated that arterial supply of these tumours was temporarily completely arrested. Microscopy of some of these neoplasms revealed extensive necroses. The eventual future clinical applications of this procedure as an alternative to hepatic artery ligation is discussed.