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HPB : the Official Journal of the... Jan 2015Liver metastasis from a neuroendocrine tumour (NET) represents a significant clinical entity. A multidisciplinary group of experts was convened to develop... (Review)
Review
OBJECTIVES
Liver metastasis from a neuroendocrine tumour (NET) represents a significant clinical entity. A multidisciplinary group of experts was convened to develop state-of-the-art recommendations for its management.
METHODS
Peer-reviewed published reports on intra-arterial therapies for NET hepatic metastases were reviewed and the findings presented to a jury of peers. The therapies reviewed included transarterial embolization (TAE), transarterial chemoembolization (TACE) and radioembolization (RE). Two systems were used to evaluate the level of evidence in each publication: (i) the US National Cancer Institute (NCI) system, and (ii) the GRADE system.
RESULTS
Eighteen publications were reviewed. These comprised 11 reports on TAE or TACE and seven on RE. Four questions posed to the panel were answered and recommendations offered.
CONCLUSIONS
Studies of moderate quality support the use of TAE, TACE and RE in hepatic metastases of NETs. The quality and strength of the reports available do not allow any modality to be determined as superior in terms of imaging response, symptomatic response or impact on survival. Radioembolization may have advantages over TAE and TACE because it causes fewer side-effects and requires fewer treatments. Based on current European Neuroendocrine Tumor Society (ENETS) Consensus Guidelines, RE can be substituted for TAE or TACE in patients with either liver-only disease or those with limited extrahepatic metastases.
Topics: Chemoembolization, Therapeutic; Embolization, Therapeutic; Hepatic Artery; Humans; Liver Neoplasms; Neuroendocrine Tumors; Patient Selection; Radiopharmaceuticals; Risk Assessment; Risk Factors; Time Factors; Treatment Outcome
PubMed: 25186181
DOI: 10.1111/hpb.12326 -
RoFo : Fortschritte Auf Dem Gebiete Der... Nov 2019Segmental arterial mediolysis (SAM) is a rare non-atherosclerotic, non-inflammatory, non-infectious arteriopathy in middle-aged patients that tends to affect...
AIM
Segmental arterial mediolysis (SAM) is a rare non-atherosclerotic, non-inflammatory, non-infectious arteriopathy in middle-aged patients that tends to affect medium-sized splanchnic arteries typically leading to dissecting aneurysms which in case of rupture have a high mortality. Treatment options include watchful waiting and endovascular or surgical intervention. There are no official treatment guidelines and to the best of our knowledge, there has not been any report of extensive exclusion of multiple splanchnic vessel regions in affected patients to date.
MATERIALS AND METHODS
We retrospectively examined the outcome of extensive splanchnic embolization in four patients suffering from SAM between 2011 and 2016 with follow-up periods of up to 7 years.
RESULTS
One patient presented with abdominal pain due to rupture of aneurysms of the pancreaticoduodenal arcade, one with abdominal pain due to dissection, and two were clinically asymptomatic but displayed rapidly progressing disease over the course of 12 months. All patients were treated with complete exclusion of the diseased vessel segments by coiling all branches to and from the diseased segment. In three cases the main hepatic artery was excluded completely. In one case, the complete vascular bed of the celiac axis was excluded by coiling the distal vessel branches and placing a stent graft over the orifice of the celiac trunk. During a follow-up period of a minimum of 2 and a maximum of 7 years after intervention, there were no immediate or long-term complications except for a temporary arterio-portal fistula. Interestingly, no new diseased areas of SAM were detected afterwards.
CONCLUSION
Extensive endovascular exclusion of the entire diseased arterial segment with coils seems to be a safe and effective treatment option in patients with SAM presenting with ruptured or rapidly growing aneurysms. Provided that patients have normal liver function and proper portal venous flow, risk of hepatobiliary complications seems to be low even after extensive embolization.
KEY POINTS
· An asymptomatic SAM can be followed up.. · In case of disease progression or suspicion of aneurysm rupture, an endovascular approach is indicated where the whole pathological vessel bed should be excluded with coils.. · It seems that exclusion of even extensive vessel areas is tolerated..
CITATION FORMAT
· Najafi A, Sheikh GT, Binkert C. Extensive Embolization of Splanchnic Artery Aneurysms due to Segmental Arterial Mediolysis. Fortschr Röntgenstr 2019; 191: 1010 - 1014.
Topics: Abdominal Pain; Aged; Aged, 80 and over; Aneurysm; Aortic Dissection; Aneurysm, Ruptured; Disease Progression; Embolization, Therapeutic; Endovascular Procedures; Female; Follow-Up Studies; Humans; Male; Mesenteric Arteries; Middle Aged; Retrospective Studies; Treatment Outcome; Tunica Media
PubMed: 30947350
DOI: 10.1055/a-0855-4198 -
Saudi Journal of Gastroenterology :... Nov 2016
Topics: Embolization, Therapeutic; Esophageal and Gastric Varices; Gastrointestinal Hemorrhage; Humans; Splenic Artery; Treatment Outcome
PubMed: 27976633
DOI: 10.4103/1319-3767.195557 -
HPB : the Official Journal of the... Mar 2022To evaluate liver venous deprivation (LVD) outcomes in patients with colorectal liver metastasis (CRLM) heavily pretreated with systemic and hepatic arterial infusion...
BACKGROUND
To evaluate liver venous deprivation (LVD) outcomes in patients with colorectal liver metastasis (CRLM) heavily pretreated with systemic and hepatic arterial infusion pump (HAIP) chemotherapies that had an anticipated insufficient future liver remnant (FLR) hypertrophy after portal vein embolization (PVE).
METHODS
PVE was performed with liquid embolics using a transsplenic or ipsilateral transhepatic approach. Simultaneously and via a trans-jugular approach, the right hepatic vein was embolized with vascular plugs. Liver volumetry was assessed on computed tomography before and 3-6 weeks after LVD.
RESULTS
Twelve consecutive CRLM patients that underwent LVD before right hepatectomy or trisectionectomy were included, all previously treated with systemic chemotherapy for a mean of 11.9 months. Six patients had additional HAIP. After embolization, FLR ratio increased from 28.7% ± 5.9 to 42.2% ± 9.0 (P < 0.01). Mean kinetic growth rate (KGR) was 3.56%/week ± 2.3, with a degree of hypertrophy (DH) of 13.8% ± 7.1. In the HAIP subgroup, mean KGR and DH were respectively 3.58%/week ± 2.8 and 14.3% ± 8.7. No severe complications occurred. Ten patients reached surgery after 39 days ± 7.5.
CONCLUSION
In heavily pretreated patients, LVD safely stimulated a rapid and effective FLR hypertrophy, with a resultant high rate of resection.
Topics: Colonic Neoplasms; Embolization, Therapeutic; Hepatectomy; Hepatic Veins; Humans; Liver; Liver Neoplasms; Portal Vein; Treatment Outcome
PubMed: 34452833
DOI: 10.1016/j.hpb.2021.08.816 -
Beijing Da Xue Xue Bao. Yi Xue Ban =... Dec 2018To prepare ion exchange doxorubicin-loaded poly (acrylic acid) microspheres (DPMs) and evaluate the properties of these chemoembolic agents.
OBJECTIVE
To prepare ion exchange doxorubicin-loaded poly (acrylic acid) microspheres (DPMs) and evaluate the properties of these chemoembolic agents.
METHODS
Poly (acrylic acid) microspheres (PMs) without drug were prepared by inverse suspension polymerization method and then doxorubicin was loaded by ion exchange mechanism to prepare DPMs. Optical microscope was used to investigate the morphology and particle size distribution of PMs and DPMs; fluorescence microscope and confocal microscope were used to observe the distribution of doxorubicin after drug loading. Elasticities of both the microspheres were evaluated by texture analyzer. High performance liquid chromatography (HPLC) method was established to determine the drug loading behavior of PMs and releasing behavior of DPMs. The in vivo embolic property was evaluated by embolizing the hepatic artery of a rabbit with 0.1 mL of DPMs.
RESULTS
PMs and DPMs were both spherical in shape, smooth in surface and dispersed well. Doxorubicin was mainly in the outer area inside of DPMs and distributed evenly. The average particle size of PMs and DPMs were (283±136) μm and (248±149) μm, respectively. PMs and DPMs both had good compression ability with the Young's modulus of (62.63±1.65) kPa and (93.94±1.10) kPa separately. PMs reached the drug loading balance at 12 h, and the entrapment efficiency was greater than 99%. Drug loading of PMs in doxorubicin solution at the concentration of 5.0 g/L and 12.5 g/L was (19.78±0.27) g/L and (49.45±0.37) g/L, respectively. Doxorubicin released slowly from DPMs in PBS and the accumulative release percentages of DPMs with corresponding drug loading were 6.82%±0.02% and 2.83%±0.10% after 24 h, respectively. Arterial angiograms showed that the hepatic artery of the rabbit was successfully embolized with DPMs.
CONCLUSION
DPMs with good performance of loading doxorubicin could be a potential embolic agent for transcatheter arterial chemoembolization.
Topics: Acrylates; Animals; Doxorubicin; Embolization, Therapeutic; Microspheres; Particle Size; Rabbits
PubMed: 30562784
DOI: No ID Found -
Cardiovascular and Interventional... Jun 2018To evaluate the usefulness of hydrogel-coated coils for preventing recanalization after coil embolization of pulmonary arteriovenous malformations (PAVMs).
PURPOSE
To evaluate the usefulness of hydrogel-coated coils for preventing recanalization after coil embolization of pulmonary arteriovenous malformations (PAVMs).
MATERIALS AND METHODS
Thirty-seven consecutive patients with 57 untreated PAVMs underwent coil embolization with hydrogel-coated coils between January 2013 and Jun 2017. The mean age was 49 years (range 9-83 years), and there were seven male patients and 30 female patients. The median size of the feeding artery was 3.7 mm (range 1.5-6.1 mm), and the median size of the venous sac was 9.3 mm (range 2.6-36.6 mm). For all PAVM, embolization was attempted using 0.018-in. hydrogel-coated coils with or without other coils (0.0135-0.018-in. bare platinum coils and fibered platinum coils). Technical success rate, recanalization rate, and complications were evaluated. Technical success was defined as completion of embolization using hydrogel-coated coils. Recanalization was evaluated with time-resolved magnetic resonance angiography and/or pulmonary angiography.
RESULTS
In 56 of 57 PAVMs, embolization was successfully performed with hydrogel-coated coils. Therefore, the technical success rate was 98% (56/57). The number of PAVMs at risk was 56, 42, 18, and 12 at 0, 12, 24, and 36 months, respectively. There was no recanalization with a mean follow-up period of 19 months (range 2-47 months) in 56 PAVMs embolized with hydrogel-coated coils. There were no major complications. As a minor complication, local pain was observed in 8 of 43 sessions (19%) after embolization.
CONCLUSIONS
Hydrogel-coated coils may be useful for preventing recanalization after the embolization of PAVMs.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Arteriovenous Fistula; Blood Vessel Prosthesis; Child; Embolization, Therapeutic; Female; Humans; Hydrogels; Magnetic Resonance Angiography; Male; Middle Aged; Pulmonary Artery; Pulmonary Veins; Retrospective Studies; Treatment Outcome; Young Adult
PubMed: 29344712
DOI: 10.1007/s00270-018-1876-5 -
Cardiovascular and Interventional... Jun 2022To describe the technique and document utility of adjunctive cone-beam CT (CBCT) in patients undergoing bronchial artery embolization (BAE) or chemoinfusion (BAC).
PURPOSE
To describe the technique and document utility of adjunctive cone-beam CT (CBCT) in patients undergoing bronchial artery embolization (BAE) or chemoinfusion (BAC).
MATERIALS AND METHODS
Between August 2010 and February 2021, 26 patients (62 bronchial arteries) were evaluated with CBCT in addition to the usual digital subtraction angiography (DSA) during BAE or BAC. 19 patients (43 arteries) underwent BAE for hemoptysis; 7 patients (19 arteries) had BAC for palliation of lung malignancy. Retrospective review of procedural reports and the archived DSA and CBCT images was assessed for (1) whether CBCT findings added unique diagnostic information prior to treatment of target arteries compared to DSA alone; and (2) whether these unique CBCT findings led to modification of embolization or chemoinfusion technique.
RESULTS
In 61 of 62 (98%) interrogated bronchial arteries, CBCT provided additional unique diagnostic information over planar DSA, primarily cross-sectional assessment of the spinal canal for spinal arteries. In 46/62 (74%) of the bronchial arteries the unique information did not lead to a change in therapeutic technique. In 15 bronchial arteries (24%), the added information from CBCT led to change in embolization and/or chemoinfusion technique. Embolization of one small unrecognized spinal artery branch (1.6%), which was missed intra-procedurally but retrospectively seen on CBCT led to transient spinal cord ischemia.
CONCLUSIONS
These results suggest that adjunctive use of CBCT technique may improve diagnostic confidence from information provided by DSA in nearly all cases of BAE and BAC leading to improved therapeutic targeting or change in technique of embolization or chemoinfusion.
Topics: Bronchial Arteries; Cone-Beam Computed Tomography; Cross-Sectional Studies; Embolization, Therapeutic; Hemoptysis; Humans; Retrospective Studies
PubMed: 35441243
DOI: 10.1007/s00270-022-03148-5 -
PloS One 2018The present study compared standard computed tomography (CT) and histopathological findings after endovascular embolization using a prototype of inherently radiopaque...
Computed tomography and histopathological findings after embolization with inherently radiopaque 40μm-microspheres, standard 40μm-microspheres and iodized oil in a porcine liver model.
PURPOSE
The present study compared standard computed tomography (CT) and histopathological findings after endovascular embolization using a prototype of inherently radiopaque 40μm-microspheres with both standard 40μm-microspheres and iodized oil in a porcine liver model.
MATERIALS AND METHODS
Twelve pigs were divided into six study groups, of two pigs each. Four pigs were embolized with iodized oil alone and four with radiopaque microspheres; two animals in each group were sacrificed at 2 hours and two at 7 days. Two pigs were embolized with radiopaque microspheres and heparin and sacrificed at 7 days. Two pigs were embolized with standard microspheres and sacrificed at 2 hours. CT was performed before and after segmental embolization and before sacrifice at 7 days. The distribution of embolic agent, inflammatory response and tissue necrosis were assessed histopathologically.
RESULTS
Radiopaque microspheres and iodized oil were visible on standard CT 2 hours and 7 days after embolization, showing qualitatively comparable arterial and parenchymal enhancement. Quantitatively, the enhancement was more intense for iodized oil. Standard microspheres, delivered without contrast, were not visible by imaging. Radiopaque and standard microspheres similarly occluded subsegmental and interlobular arteries and, to a lesser extent, sinusoids. Iodized oil resulted in the deepest penetration into sinusoids. Necrosis was always observed after embolization with microspheres, but never after embolization with iodized oil. The inflammatory response was mild to moderate for microspheres and moderate to severe for iodized oil.
CONCLUSION
Radiopaque 40μm-microspheres are visible on standard CT with qualitatively similar but quantitatively less intense enhancement compared to iodized oil, and with a tendency towards less of an inflammatory reaction than iodized oil. These microspheres also result in tissue necrosis, which was not observed after embolization with iodized oil. Both radiopaque and standard 40μm-microspheres are found within subsegmental and interlobar arteries, as well as in hepatic sinusoids.
Topics: Animals; Contrast Media; Embolization, Therapeutic; Hepatic Artery; Inflammation; Iodine Radioisotopes; Iodized Oil; Liver; Microspheres; Models, Animal; Necrosis; Swine; Tomography, Emission-Computed
PubMed: 29985928
DOI: 10.1371/journal.pone.0198911 -
BMJ Case Reports Feb 2020Spontaneous rupture of an intercostal artery is exceptionally rare. It can be complicated by haemothorax, haematoma and/or retroperitoneal haemorrhage, which contributes...
Spontaneous rupture of an intercostal artery is exceptionally rare. It can be complicated by haemothorax, haematoma and/or retroperitoneal haemorrhage, which contributes to its morbidity and mortality. The authors report a case of a 76-year-old patient who was referred to the emergency department for pain associated with the appearance of a mass with progressive growth for 2 days in the right subscapular region. The patient had no previous history of trauma, ecchymosis or noticeable skin changes. History included the use of acetylsalicylic acid and a history of heart failure, as well as haemodialysis due to stage 5 chronic renal disease. CT scan showed an active haemorrhage from an artery in the fifth intercostal space. Embolisation was performed with microspheres and microcoils. No complications or recurrent bleeding was observed. Spontaneous rupture of an intercostal artery is rare, but it is an emergency requiring immediate diagnosis and intervention.
Topics: Aged; Computed Tomography Angiography; Embolization, Therapeutic; Hematoma; Hemorrhage; Hemothorax; Humans; Male; Microspheres; Rupture, Spontaneous; Thoracic Arteries; Treatment Outcome; Vascular Diseases
PubMed: 32060114
DOI: 10.1136/bcr-2019-233242 -
Journal of the American College of... Nov 2020Obesity is well-appreciated to result in poor cardiovascular and metabolic outcomes. Dietary and medical weight loss strategies are frequently unsuccessful and... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
Obesity is well-appreciated to result in poor cardiovascular and metabolic outcomes. Dietary and medical weight loss strategies are frequently unsuccessful and unsustainable. Bariatric surgery is quite effective, but is reserved for the most obese patients because of the associated intraoperative/post-operative risks. In preclinical and early clinical case series, a novel therapy, transcatheter bariatric embolotherapy (TBE) of the left gastric artery, has been reported to promote weight loss by reducing ghrelin, an appetite-stimulating hormone secreted from the gastric fundus.
OBJECTIVES
The purpose of this study was to examine TBE in a single-blind, sham procedure randomized trial.
METHODS
Obese subjects (body mass index 35 to 55 kg/m) were randomized 1:1 to either sham or TBE targeting the left gastric artery using an occlusion balloon microcatheter to administer 300- to 500-μm embolic beads. All patients entered a lifestyle counseling program. Patients and physicians performing follow-up were blind to the allocated therapy. Endoscopy was performed at baseline and 1-week post-procedure. The primary endpoint was 6-month total body weight loss (TBWL).
RESULTS
Eligible subjects (n = 44; age 45.5 ± 9.4 years; 8 men/36 women; body mass index 39.6 ± 3.8 kg/m) were randomized to undergo the sham or TBE procedure with no device-related complications and 1 vascular complication. Patients reported mild nausea and vomiting, and endoscopy revealed only minor self-limiting ulcers in 5 patients. At 6 months, in both the intention-to-treat and per-protocol populations, the TBWL was greater with TBE (7.4 kg/6.4% and 9.4 kg/8.3% loss, respectively) than sham (3.0 kg/2.8% and 1.9 kg/1.8%, respectively; p = 0.034/0.052 and p = 0.0002/0.0011, respectively). The TBWL was maintained with TBE at 12 months (intention-to-treat 7.8 kg/6.5% loss, per-protocol 9.3 kg/9.3% loss; p = 0.0011/0.0008, p = 0.0005/0.0005, respectively).
CONCLUSIONS
In this randomized pilot trial, we have established the proof-of-principle that transcatheter bariatric embolotherapy of the left gastric artery is well-tolerated and promotes clinically significant weight loss over a sham procedure.(The Lowering Weight in Severe Obesity by Embolization of the Gastric Artery Trial [LOSEIT]; NCT03185949).
Topics: Adult; Embolization, Therapeutic; Female; Gastric Artery; Ghrelin; Humans; Hunger; Hypertension; Male; Middle Aged; Obesity; Quality of Life; Satiety Response
PubMed: 33183504
DOI: 10.1016/j.jacc.2020.09.550