Underwent Transcatheter Arterial Embolization Research Articles

Chest Compression-Associated Internal Thoracic Artery Injury During Cardiopulmonary Resuscitation: Incidence, Injury Patterns and Efficacy of Transcatheter Arterial Embolization.

To investigate the incidence and patterns of chest compression-associated internal thoracic artery injury (CAI) during cardiopulmonary resuscitation and identify the embolization techniques used to treat hemorrhage. A retrospective study was conducted in the patients who underwent transcatheter arterial embolization (TAE) for life-threatening hemorrhage caused by CAI at two tertiary care centers between May 2013 and December 2019. Data on background characteristics, imaging findings, embolization and outcomes were collected from the medical records. Among 385 patients in whom circulation returned after resuscitation, there were 9 patients (2.3%) who required TAE for CAI. Eight of 9 patients had acute myocardial infarction, and all had been started on extracorporeal membrane oxygenation before TAE. Seven patients had unilateral, and two had bilateral internal thoracic artery injuries. Main trunk injury of internal thoracic artery was seen in 27%, while branch injury in 73%. Six patients (67%) had multiple injuries in the internal thoracic artery territory, and five (56%) had injuries to other vessels. In all cases, we embolized the main trunk of the internal thoracic artery using n-butyl 2-cyanoacrylate and coils (n = 8), a gelatin sponge only (n = 2), or coils and a gelatin sponge (n = 1). TAE was technically successful in all, without any complication. The 30-day mortality rate was 44%. CAI needing hemostatic intervention occurred in 2.3% of patients after successful cardiopulmonary resuscitation. Branch injury was more common than main trunk injury, and multiple vessel injuries were common. TAE appears to be safe and effective for controlling life-threatening hemorrhage.

Utility of marking and fusion image-guided technique with cone-beam CT in kidney ruptured haemorrhage without extravascular leakage in angiography: a pilot study.

To explore the feasibility of using marking and fusion image-guided technique with cone-beam CT (CBCT) in cases of kidney ruptured haemorrhage without extravascular leakage in digital subtraction angiography (DSA) images. This is a retrospective case-control study that included 43 patients who underwent transcatheter arterial embolization for kidney ruptured haemorrhage and difficult haemostasis. The patients were divided into two groups: the CBCT group (cases without extravascular leakage observed in angiography) and the control group (cases with clearly identifiable target vessels in angiography). The baseline characteristics and clinical outcomes were collected and analysed. The results showed no statistically significant differences in the duration of the procedure and intraoperative blood transfusion between the control and CBCT groups (P > .05). The study clarified that the CBCT group had a significantly higher rate of improvement of gross haematuria compared to the control group (P < .05). The CBCT group showed a greater increase in haemoglobin and a lesser increase in creatinine. The clinical success rates were 87.5% in the control group and 90.9% in the CBCT group (P > .05). The marking and fusion image-guided technique is useful in cases of kidney ruptured haemorrhage without extravascular leakage of contrast agent. The technique is safe, feasible, and effective, and we believe it is superior to purely DSA-guidance. The use of the marking and fusion image-guided technique is recommended to overcome the challenge of undetectable target vessels during interventional procedures. This technique is considered as non-inferior to purely DSA-guided interventional procedures where the target vessels are clearly identifiable.

Improvement in Quality of Life Following Celiprolol Hydrochloride Administration in a Patient with Vascular Ehlers–Danlos Syndrome: A Case Report

A 40-year-old female, who underwent transcatheter arterial embolization due to acute bleeding from an iliolumbar artery, was subsequently genetically diagnosed with vascular Ehlers–Danlos syndrome. She experienced chronic anemia for many years due to the easy bruising of her whole body. The bruising improved with oral administration of celiprolol hydrochloride. There were no cardiac or vascular events during the 7 years following the transcatheter arterial embolization. Vascular Ehlers–Danlos syndrome requires specialized treatment that is scientifically proven to prevent a major vascular event. Proactive genetic diagnosis is recommended in patients suspected of having vascular Ehlers–Danlos syndrome after careful patient interview.

Therapeutic response and prognostic factors of 14 dogs undergoing transcatheter arterial embolization for hepatocellular masses: A retrospective study.

Information regarding the therapeutic effect and outcome of transcatheter arterial embolization (TAE) for hepatic masses is limited in veterinary medicine. To analyze the therapeutic response, outcome (overall survival), and their predictors in dogs that underwent TAE for primary hepatocellular masses. We hypothesized that larger pre-TAE tumors would be associated with worse outcomes. Fourteen client-owned dogs. Retrospective study. Medical records between 1 September 2016 and 30 April 2022 were reviewed to identify dogs treated with TAE for hepatic masses diagnosed as hepatocellular origin by cytological or histopathological examination. Computed tomography images were compared before and after TAE. The univariate Cox proportional hazards test was performed to assess the associations between variables and survival. Univariate linear regression analysis was performed to assess the associations between variables and the tumor reduction percentage: ([post-TAE volume - pre-TAE volume]/pre-TAE volume) × 100. The median survival time was 419 days (95% confidence interval, 82-474). History of intra-abdominal hemorrhage (P = .03) and pre-TAE tumor volume/body weight (P = .009) were significantly associated with overall survival. The mean reduction percentage was -51% ± 40%. Pre-TAE tumor volume/body weight ratio (cm3 /kg; P = .02, correlation coefficient = 0.704) was significantly correlated with the volume reduction percentage. History of intra-abdominal hemorrhage and large pre-TAE tumor volume/body weight ratio could be predictive factors for adverse outcomes after TAE. Pre-TAE tumor volume/body weight ratio could be a predictive factor for therapeutic effect.

Trends in Isolated Pelvic Fracture and 30-Day Survival during a Recent 15-Year Period: A Nationwide Study of the Japan Trauma Data Bank.

The epidemiology and treatment of isolated pelvic fracture in Japan are not well understood. This study evaluated epidemiological trends in isolated pelvic trauma and in-hospital survival rates during a recent 15-year period. This retrospective cohort study analyzed data from the Japan Trauma Data Bank for 2004-2018. Patients of any age with isolated pelvic fracture were grouped according to time period, as follows: 2004-2008 (Phase 1), 2009-2013 (Phase 2), and 2014-2018 (Phase 3). The main outcome was 30-day in-hospital survival rate. The data were analyzed using the chi-square, Kruskal-Wallis, and Mantel-Haenszel trend tests. We analyzed change in the main outcome over time in multiple logistic regression analysis fitted with a generalized estimating equation, accounting for within-cluster association. In total, 5,348 isolated pelvic fractures were identified during the study period. There was no significant between-phase difference in proportions of patients who underwent resuscitative balloon occlusion of the aorta or external fixation. The proportion of patients who underwent transcatheter arterial embolization significantly increased with time (p=0.003), as did the survival rate (Phase 1, 77%; Phase 2, 86%; and Phase 3, 91%; p<0.001). The 30-day in-hospital mortality rate was significantly lower in Phase 3 than in Phase 1 and Phase 2, even after adjustment for hospital clustering and other confounders (p<0.01). The 30-day in-hospital survival rate after isolated pelvic fracture improved over a 15-year period in Japan.

Resuscitative endovascular balloon occlusion of the aorta for life-threatening postpartum hemorrhage: A nationwide observational study in Japan.

Resuscitative endovascular balloon occlusion of the aorta (REBOA) is used for postpartum hemorrhage (PPH), which is one of the leading causes of maternal mortality worldwide; however, its utility in the obstetrics setting remains unclear. Thus, this study aimed to describe the characteristics, demographics, and mortality of patients with PPH who underwent REBOA. We used the Japanese Diagnosis Procedure Combination inpatient database to identify patients with PPH who underwent REBOA from April 2012 to March 2020. We examined the patients' characteristics, interventions administered, and in-hospital mortality. We identified 143 patients with PPH who underwent REBOA. The most common cause of PPH was atonic postpartum hemorrhage (52.4%), followed by disseminated intravascular coagulation (29.4%) and amniotic fluid embolism documented (11.2%). Among patients who delivered at hospitals in which REBOA was performed (n = 55), 38.2% of patients experienced preterm births, and 70.9% delivered via cesarean delivery. The proportion of patients who underwent transcatheter arterial embolization and hysterectomy was 53.8% and 16.1%, respectively. In-hospital mortality was 7.0%. The results of the present study could be helpful in clinical decision making and providing patients and families with additional treatment options for PPH. Therapeutic/Care Management; Level IV.

Comparison of clinical characteristics between sporadic gastrinoma and multiple endocrine neoplasia type 1-related gastrinoma

Objective: To compare clinical characteristics of sporadic gastrinoma and multiple endocrine neoplasia type 1 (MEN1)-related gastrinoma. Methods: A retrospective cohort study was conducted. Patients with clinical manifestations of Zollinger-Ellison syndrome, pathological diagnosis as neuroendocrine neoplasm (NEN) and complete clinical and follow-up data were enrolled. Patients with only high gastric acid secretion but without evidence of NEN, or with other concurrent non-NEN tumors were excluded. According to the above criteria, the clinicopathological data of 52 cases of gastrinoma diagnosed from April 2003 to December 2020 in the First Affiliated Hospital, Sun Yat-sen University, were collected. Patients who met the diagnostic criteria of gastrinoma and met one of the following conditions were diagnosed as MEN1-related gastrinoma: (1) the presence of pathogenic mutations in the MEN1 gene confirmed by genetic testing; (2) NENs involving two or more endocrine glands, namely, pituitary, parathyroid, thymic, pancreatic, and adrenal NENs; (3) NEN and at least one first-degree relatives diagnosed as MEN1. The remaining gastrinomas were defined as sporadic gastrinoma. Student's t test and chi-square test were used for statistical analysis. Clinicopathological characteristics, endoscopic findings, imaging characteristics, treatment, and prognosis of sporadic and MEN1-related gastrinoma were compared. Results: Among 52 patients with gastrinoma, 33 were sporadic gastrinoma and 19 were MEN1-related gastrinoma. The common symptoms of both sporadic and MEN1-related gastrinomas were diarrhea (24/33, 72.7%; 17/19, 89.5%) and abdominal pain (19/33, 57.6%; 9/19, 47.4%). Compared with sporadic gastrinoma, MEN1-related gastrinoma needed longer time for diagnosis [(7.4±4.9) years vs. (3.9±5.2) years, t=-2.355, P=0.022), were more likely multiple tumors [47.4% (9/19) vs. 15.2% (5/33), χ(2)=6.361, P=0.012], had smaller diameter [(1.7±1.0) cm vs. (3.1±1.8) cm, t=2.942, P=0.005), presented the lower tumor grade [G1: 83.3% (15/18) vs. 39.4% (13/33); G2: 11.1% (2/18) vs. 54.5% (18/33); G3: 5.6% (1/18) vs. 6.1% (2/33), Z=-2.766, P=0.006], were less likely to have serum gastrin which was 10 times higher than normal [11.8% (2/17) vs. 56.0% (14/33), χ(2)=8.396, P=0.004], had higher probability of complication with type 2 gastric neuroendocrine tumors (g-NET) [31.6% (6/19) vs. 3.0%(1/33), χ(2)=6.163, P=0.013], and had lower rate of liver metastasis [21.1% (4/19) vs. 51.5% (17/33), χ(2)=4.648, P=0.031). There was no obvious difference between sporadic gastrinomas and MEN1-related gastrinomas in endoscopic findings. Both types presented enlarged and swollen gastric mucosa under the stimulation of high gastric acid, and multiple ulcers in the stomach and duodenum could be seen. Gastrinoma with type 2 g-NET presented multiple polypoid raised lesions in the fundus and body of the stomach. (68)Ga-SSR-PET/CT scan had a 100% detection rate for both types while (18)F-FDG-PET/CT scan had a higher detection rate for sporadic gastrinoma compared with MEN1-related gastrinoma [57.9% (11/19) vs. 20.0% (3/15), χ(2)=4.970, P=0.026]. Among the patients with sporadic gastrinoma, 19 received surgical treatment, 1 underwent endoscopic submucosal dissection, 8 underwent transcatheter arterial embolization (TAE), and 5 underwent surgery combined with TAE. Among patients with MEN1-related gastrinoma, 13 received surgical treatment, and the other 6 received conservative treatment. The median follow-up of all the patients was 21.5 (1-129) months, and the 5-year survival rate was 88.4%. The 5-year survival rate of patients with sporadic and MEN1-related gastrinomas was 89.5% and 80.0% respectively (P=0.949). The 5-year survival rate of patients with and without liver metastasis was 76.2% vs. 100%, respectively (P=0.061). Conclusions: Compared with sporadic gastrinoma, MEN1-related gastrinoma has longer diagnosis delay, smaller tumor diameter, lower tumor grading, lower risk of liver metastasis, and is more likely to complicate with type 2 g-NET, while there is no difference in survival between the two tumor types.

Colonic Stenosis Caused by Transcatheter Arterial Embolization

An 82-year-old man presented to our hospital with abdominal pain and diarrhea after taking senna glycoside. He had undergone transcatheter arterial embolization (TAE) with microcoils for endoscopic hemostasis-resistant diverticular hemorrhage in the ascending colon 3 months previously (Figures A, B, arrowhead). No other colonic abnormalities were observed and he had no abdominal symptoms after the first hospital discharge until the present episode. On admission, hematology tests showed a strong inflammatory response (C-reactive protein, 17.21 mg/dL [reference range, 0.00−0.14 mg/dL]).

A Case of Locally Advanced Breast Cancer that Underwent Transcatheter Arterial Embolization for Cancerous Skin Ulcer with Persistent Bleeding

症例は54歳，女性．増大傾向を示す左乳房腫瘤から出血を伴うようになり前医を受診した．Mohs軟膏や放射線治療を行いながら外来化学療法を受けていた．化学療法中断後，往診にて緩和的治療を受けていたが，慢性的に出血が続き計6回の輸血を受けた．前医初診から1年11カ月後，比較的多量の出血が持続し局所の処置に困り，また強い倦怠感と息切れを主訴に当院に搬送された．入院にて局所の処置を行いながら輸血を行うも貧血の進行は抑制されず，入院5日目に動脈塞栓術（TAE）を施行した．TAE後は止血のみでなく浸出液や臭気も著明に改善し，亡くなるまでの21日間は穏やかな終末期を過ごすことができた．今回われわれは，制御困難な持続出血を伴う癌性皮膚潰瘍を形成した乳癌終末期患者に対してTAEを行い，良好な終末期を過ごせた1例を経験したので，若干の考察を加え報告する．

In-Hospital Mortality Risk of Transcatheter Arterial Embolization for Patients with Severe Blunt Trauma: A Nationwide Observational Study.

This study investigated the risk factors for in-hospital mortality of severe blunt trauma patients who underwent transcatheter arterial embolization (TAE). We analysed data from the Japan Trauma Data Bank from 2009 to 2018. Patients with severe blunt trauma and an Injury Severity Score (ISS) ≥ 16 who underwent TAE were enrolled. The primary analysis evaluated patient characteristics and outcomes, and variables with significant differences were included in the secondary multivariate logistic regression analysis. In total, 5800 patients (6.4%) with ISS ≥ 16 underwent TAE. There were significant differences in the proportion of male patients, transportation method, injury mechanism, injury region, Revised Trauma Score, survival probability values, and those who underwent urgent blood transfusion and additional urgent surgery. In multivariable regression analyses, higher age, urgent blood transfusion, and initial urgent surgery were significantly associated with higher in-hospital mortality risk [p < 0.001, odds ratio (OR), 95% confidence interval (CI): 1.01 (1.00–1.01); p < 0.001, 3.50 (2.55–4.79); and p = 0.001, 1.36 (1.13–1.63), respectively]. Inter-hospital transfer was significantly associated with lower in-hospital mortality risk (p < 0.001, OR = 0.56, 95% CI = 0.44–0.71). Treatment protocols for urgent intervention before and after TAE and a safe, rapid inter-hospital transport system are needed to improve mortality risks for severe blunt trauma patients.

救命救急センターに搬送された産科救急症例の検討(Clinical analysis of obstetric patients admitted to an emergency department)

要旨【目的】救命救急センターには多くの産科救急症例が搬送されるが，その経年変化や治療内容の変遷に関しては詳細な検討はなされていない。本研究では，当院高度救命救急センターに搬送された産科救急症例を調査し，治療内容の変遷や救急医の果たす役割に関して検討を行った。【対象】2013年4月から2019年3月までに当院高度救命救急センターに搬送された産科救急症例を対象として，患者数の経年変化，診断，治療および転帰を検討した。【結果】対象期間に搬送された産科救急症例は56例であった。症例数は増加傾向で，2013年度は3例であったのに対し，2018年度には15例まで増加していた。疾患群別では産後出血が最も多く56例中33例（58.9%）を占め，弛緩出血が最多であった。収縮期血圧90mmHg未満もしくはショックインデックス1.0以上のショックバイタルで搬送となった症例は21例（37.5%）であった。外科的介入を要した症例は56例中29例（51.8%）あり，12例に経カテーテル動脈塞栓術（TAE）を施行していた。死亡例はなく，子宮全摘術を行った1例を除き妊孕性の低下が判明した症例はなかった。【結語】産科救急症例の搬送数は増加傾向であり，その中でバイタル管理や出血のコントロール，産婦人科や放射線科との連携など，救急医の占める役割は大きいと考えられた。

Genicular Artery Embolization to Improve Pain and Function in Early-Stage Knee Osteoarthritis—24-Month Pilot Study Results

Ten patients with painful early-stage knee osteoarthritis underwent transcatheter arterial embolization of neoangiogenic branches from genicular arteries. At 12 months, 6 patients had responded to treatment according to study criteria. Median pain, function, and quality-of-life scores had improved by 15.4%, 21.3%, and 100%, respectively, for the 10 patients. Median 30-second chair stand test and 6-minute walk test scores had improved by 43% and 26%, respectively. No major adverse events occurred. Improvements following transcatheter arterial embolization provide evidence that embolization might be an effective treatment technique for people with early-stage knee osteoarthritis, although more rigorous evaluation is required.

Clinical features and risk factors for mortality in patients with open pelvic fracture: A retrospective study of 46 cases.

This study aimed to investigate the clinical features, current management strategies, and outcomes of open pelvic fracture patients. We performed a retrospective review of data on patients with blunt trauma and open pelvic fractures admitted to our trauma center over a 5-year period (January 2013 to December 2017). Demographic as well as clinical data including injury mechanism, injury severity score (ISS), fracture classifications, transfusion requirements, interventions, length of hospital and intensive care unit (ICU) stay, and prognosis were investigated. Univariate analysis and binary logistic regression were used to identify the risk variables of death. Finally, a brief literature review was performed to understand the current capacity of treatment and prognosis of this type of injury. Forty-six patients (36 male and 10 female) were included in this study, mean age 43.2 ± 14.2 years. The overall mortality rate was 17.4%; 43.5% of the patients were hypotensive (systolic blood pressure (SBP) <90 mmHg) on arrival. The average ISS was 31.7 ± 6.7, and the average packed red blood cell (PRBC) transfusion during the first 24 h was 9.6 ± 7.4 units. Five patients (10.9%) underwent transcatheter arterial embolization in the early stage of management. The average hospital and ICU length of stay were 53.0 ± 37.6 days and 14.3 ± 15.3 days, respectively. Statistically significant differences were found in ISS, PRBC units received with the first 24 h, SBP, lactate and base excess on admission, and mechanism of injury when comparing between the death and the survival groups (p < 0.05). ISS and lactate on admission were found to be the independent risk factors for mortality. The mortality rate of open pelvic fractures remains high. ISS and lactate on admission were the independent risk factors for mortality. Optimization of the trauma care algorithms for early identification and treatment of this injury could be the key to decreasing mortality.

Technical results, clinical efficacy and predictors of outcome of intercostal arteries embolization for hemothorax: a two-institutions' experience.

To evaluate the clinical efficacy and identify the predictors of outcome of intercostal arterial embolization for hemothorax caused by intercostal artery (ICA) injuries. A retrospective multi-institutional study was conducted. Outcomes were analyzed in 30 consecutive patients presenting with hemothorax caused by active ICA hemorrhage undergoing transcatheter arterial embolization (TAE). Clinical and procedural parameters were compared between outcomes groups. Overall technical success rate was 87% (n=26). Among the 4 failed cases, 2 underwent repeated TAE and 2 underwent additional surgery. Overall 30-day mortality rate was 23%. Low haemoglobin levels and haematocrit, hepatic comorbidities and more than one artery undergoing embolization increased technical failure rate significantly. Survival was poorer in patients with massive bleeding. ICA embolization was found to be a safe and effective method in treating hemothorax caused by active ICA haemorrhage. Careful pre-embolization evaluation may be required for patient with low haemoglobin levels and haematocrit, hepatic comorbidities and active haemorrhage from more than one artery.

Transarterial embolisation with bleomycin and N-butyl-2-cyanoacrylate –Lipiodol mixture for symptomatic polycystic liver disease: preliminary experience

To evaluate the therapeutic effect and safety of transarterial embolisation using a bleomycin-Lipiodol mixture and N-butyl-2-cyanoacrylate (NBCA)-Lipiodol mixture (BNL) for the treatment of polycystic liver disease (PLD). From June 2012 to July 2018, a total of consecutive 14 symptomatic patients (13 women and 1 man; mean age, 49.3±9.9 years) with PLD were referred and underwent transcatheter arterial embolisation (TAE) with BNL. Technical success was achieved in all cases. PLD-related severe symptoms were improved remarkably in 13 of the treated patients. The mean maximum abdominal circumference decreased significantly from 100.6±9.4 to 94.9±9.1 cm (p<0.01). The total liver volume decreased significantly compared with pre-TAE in 13 patients at 6-12 months after TAE. It decreased from 9,776±2,219 to 8,303±2,009 cm3 (p<0.01). There were no major complications associated with the procedure. TAE with the bleomycin-Lipiodol mixture and NBCA-Lipiodol mixture may be an effective method for treating symptomatic PLD patients, with improvement of symptoms and shrinkage of cyst volume.

Endoscopic side-by-side uncovered self-expandable metal stent placement for malignant hilar biliary obstruction.

Aim:To investigate outcomes of endoscopic bilateral side-by-side placement across the papilla using 10-mm-diameter uncovered self-expandable metal stents for unresectable malignant hilar biliary obstruction.Methods:We retrospectively analyzed 23 patients who underwent endoscopic biliary uncovered self-expandable metal stent placement for unresectable malignant hilar biliary obstruction between January 2015 and September 2016 at our institution. We performed endoscopic side-by-side placement across the papilla using 10-mm-diameter longer-model uncovered self-expandable metal stents. Outcomes included the technical and functional success rates, recurrent biliary obstruction rate, time to recurrent biliary obstruction, reintervention rate, and incidence of adverse events other than recurrent biliary obstruction.Results:Of the 23 patients, 10 with malignant hilar biliary obstruction underwent endoscopic side-by-side uncovered self-expandable metal stent placement across the papilla (median age, 83 years; 6 men). The locations of malignant hilar biliary obstruction were Bismuth types II (n = 3), III (n = 3), and IV (n = 4). The median common bile duct diameter was 8 mm. The technical and functional success rates were 100% and 80%, respectively. Seven patients (70%) developed recurrent biliary obstruction because of stent occlusions, including early hemobilia in two patients and late tumor ingrowth in five patients. The median time to recurrent biliary obstruction was 66 (95% confidence interval: 29–483) days. Six patients (60%) required reintervention, and 1 (10%) underwent transcatheter arterial embolization for right hepatic arterial pseudoaneurysm. Early adverse events other than recurrent biliary obstruction occurred in four patients and late adverse event in one patient.Conclusion:Endoscopic side-by-side placement across the papilla using 10-mm-diameter uncovered self-expandable metal stents was technically feasible for unresectable malignant hilar biliary obstruction; however, it might be better to avoid this method for patients with malignant hilar biliary obstruction because of high recurrent biliary obstruction rate and shorter time to recurrent biliary obstruction.

Angiographic management of percutaneous renal procedure-related bleeding: A single-center experience.

To present the radiological and clinical results of transcatheter arterial embolization in patients with active bleeding after percutaneous renal procedures. A total of 79 consecutive patients who underwent angiography for percutaneous renal procedure-related bleeding were included in the present retrospective analysis. Patient characteristics, angiographic management and clinical outcomes were analyzed. On angiography, bleeding foci were observed in 81.0% of the patients (64/79), all of whom underwent transcatheter arterial embolization. Among the 15 patients (19.0%) with negative angiographic findings, empirical transcatheter arterial embolization was carried out in six patients (40.0%). The technical success rate in 64 patients with positive angiographic findings was 100%, and the clinical success rate in 70 patients who underwent transcatheter arterial embolization was 85.7% (60/70). A total of 14.3% (10/70) of patients with clinical failure underwent repeat transcatheter arterial embolization and all achieved clinical recovery. There were no major complications. There was no statistical difference in estimated glomerular filtration rate values before the percutaneous renal procedure and those measured 7days after transcatheter arterial embolization (43.4±24.4 to 44.6±25.1mL/min/1.73m2 ; P=0.189). Clinical failure was not associated with age, sex, type of renal procedures, bleeding tendency, presence of active bleeding on angiography, latency time and embolic agents used (P>0.05). Transcatheter arterial embolization is a safe and effective method of treating percutaneous renal procedure-related bleeding without renal function deterioration.

Pharmacokinetics of continuous transarterial infusion of 5-fluorouracil in patients with advanced hepatocellular carcinoma.

Numerous studies concerning hepatic arterial infusion chemotherapy (HAIC) have been conducted by adopting regimens containing 5-fluorouracil (FU), with a favourable efficacy compared with conventional transcatheter arterial chemoembolisation (TACE) treatment; however, the detailed mechanism of HAIC remains unclear. The present study aimed to evaluate peripheral concentration time curves of 5-FU administered through the hepatic artery, which may additionally explain the mechanism of action of HAIC. A total of 10 eligible patients underwent transcatheter arterial embolization and a 2-day HAIC treatment regimen using a folinic acid, fluorouracil and oxaliplatin regimen. Peripheral venous blood sampling was performed in each patient prior to infusion, and at 0, 0.5, 1, 1.5, 2, 5, 10, 15, 22 and 23 h following the start of infusion. The blood sample at 0 h was analysed for dihydropyrimidine dehydrogenase (DPD) levels by high performance liquid chromatography, and the rest of the samples were analysed for 5-FU by optimised liquid chromatography-mass spectrometry (LC-MS). The lower limit of quantification of optimised LC-MS for 5-FU was 5 ng/ml. The steady-state plasma concentration of 5-FU administered through the hepatic artery was achieved after 15 h. This concentration largely varied, ranging from 8.64–152.00 ng/ml. Optimised LC-MS may detect low concentrations of 5-FU. The steady-state concentration of 5-FU administered through the hepatic artery was achieved after 15 h. DPD levels were analysed through determining the ratio of plasma uracil (U) and dihydrouracil (UH2) by HPLC, and the results indicated a mild DPD deficiency in the patients with HCC. These results may provide a basis for the explanation of the clinical efficacy of HAIC, and to additionally optimise its efficacy.

4:21 PM Abstract No. 110 ■ FEATURED ABSTRACT Safety and efficacy of transcatheter arterial embolization for upper gastrointestinal bleeding at a tertiary care center: a contemporary review

To evaluate the safety and efficacy of transcatheter arterial embolization in the management of nonvariceal upper gastrointestinal bleeding (UGIB). All patients who underwent transcatheter arterial embolization intervention for UGIB at a single institution from September 2011 to October 2016 were included in this retrospective study. The rates of technical and clinical success, ischemic complications, in-hospital mortality, and recurrent bleeding were determined. Technical success was defined as the absence of angiographic signs of hemorrhage at the conclusion of the procedure. Clinical success was defined as technical success without major complication or recurrent bleeding within 30 days of embolization. Additionally, the etiology of bleeding, outcomes of preprocedure endoscopic intervention, imaging concordance, and embolic material used were evaluated. 109 UGIB transcatheter arterial embolization procedures were performed on 101 patients over this time period. 61 embolizations (56%) were performed for positive angiographic findings, and 48 embolizations (44%) were performed empirically. The most commonly identified etiologies included duodenal ulcer (22%), gastric cancer (14.7%), pancreatic cancer (6.4%), and Dieulafoy lesions (7.3%). 79 cases underwent endoscopy prior to embolization. A CT angiogram was performed in 13 cases and was concordant with the angiogram performed during embolization 84.6% of the time. A nuclear medicine study was performed in 6 cases and was concordant with the angiogram performed during embolization 83.3% of the time. Embolic material used included coils only (56.9%), Gelfoam only (7.3%), particles only (6.4%), liquid embolic only (5.6%), or a combination of the above (23.9%). For all cases evaluated, the clinical success, ischemic complications, recurrent bleeding, and in-hospital mortality were 67%, 0%, 33%, and 33.7%, respectively. Modern equipment and techniques for transcatheter arterial embolization have maximized technical success rates and minimized ischemic complications, but clinical success rates remain similar to historical controls.

Can we predict delayed undesirable events after blunt injury to the torso visceral organs?

AimBlunt injuries to visceral organs have the potential to lead to delayed pseudoaneurysm formation or organ rupture, but current trauma and surgical guidelines do not recommend repetitive imaging. This study examined the incidence and timing of delayed undesirable events and established advisable timing for follow‐up imaging and appropriate observational admission.MethodsPatients with blunt splenic (S), liver (L), or kidney (K) injury treated with non‐operative management (NOM) in our institution were included and retrospectively reviewed.ResultsFrom January 2013 to January 2017, 57 patients were admitted with documented blunt visceral organ injuries and 22 patients were excluded. Of 35 patients (L, 10; S, 17; K, 6; L & S, 1; S & K, 1) treated with NOM, 14 (L, 4; S, 9; K, 1) patients underwent transcatheter arterial embolization. Delayed undesirable events occurred in four patients: three patients with splenic pseudoaneurysm on hospital day 6–7 and one patient with splenic delayed rupture on hospital day 7. The second follow‐up computed tomography scan carried out 1–2 days after admission did not show any significant findings that could help predict undesirable results of delayed events. The patients with delayed events had longer continuous abdominal pain than that of event‐free patients (P = 0.04).ConclusionsUndesirable delayed events were recognized on follow‐up computed tomography scans in 11.4% of NOM patients at hospital day 6–7 and tended to be associated with high‐grade splenic injuries and continuous symptoms. Repetitive screening of these patients 6–7 days after injury might be warranted because of the potential risk of delayed events.