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Seminars in Interventional Radiology Mar 2015Intranodal lymphangiography (IL) has supplanted pedal lymphangiography (PL) as an easier and more practical approach to opacifying lymphatic vessels for interventional... (Review)
Review
Intranodal lymphangiography (IL) has supplanted pedal lymphangiography (PL) as an easier and more practical approach to opacifying lymphatic vessels for interventional radiologists treating refractory chyle leaks. As more interventional radiologists-many of who are not trained in or have not performed PL-incorporate IL into their practice, it is imperative that they be familiar with the risks of lymphangiography, including pulmonary and systemic embolization of oily contrast material. Herein, the authors report a devastating case of cerebral embolization of ethiodized oil following IL and review the literature regarding systemic embolization following lymphangiography.
PubMed: 25762841
DOI: 10.1055/s-0034-1396957 -
Diagnostics (Basel, Switzerland) Sep 2021There is a sparsity of data on the use of ethiodized poppy seed oil (EPO) contrast agent (Lipiodol) in patients. We investigated the safety of EPO in children,...
BACKGROUND
There is a sparsity of data on the use of ethiodized poppy seed oil (EPO) contrast agent (Lipiodol) in patients. We investigated the safety of EPO in children, adolescents, and some adults for diagnostic and therapeutic interventions.
METHODS
All patients who underwent procedures with EPO between 1995 and 2014 were retrospectively included. Demographic characteristics, diagnosis, dose, route of administration, preparation of EPO in combination with other agents, and complications were recorded.
RESULTS
In 1422 procedures, EPO was used for diagnostic or treatment purposes performed in 683 patients. The mean patient age was 13.4 years (range: 2 months-50 years); 58% of patients were female. Venous malformations ( = 402, 58.9%) and arteriovenous malformations ( = 60, 8.8%) were the most common diagnosis. Combined vascular anomalies included capillary-lymphatic-venous malformations, fibroadipose vascular anomalies ( = 54, 7.9%), central conducting lymphatic anomalies ( = 31, 4.5%), lymphatic malformations ( = 24, 3.5%), aneurysmal bone cysts ( = 22, 3.2%), and vascularized tumors ( = 11, 1.6%). In 1384 procedures (96%), EPO was used in various combinations with sclerosing and embolization agents, including sodium tetradecyl sulfate, ethanol, and glue. The mean volume of EPO used in interventions was 3.85 mL (range: 0.1-25 mL) per procedure with a mean patient weight of 45.9 kg (range: 3.7-122.6 kg) and a weight-adjusted dose of 0.12 mL/kg (range: 0.001-1.73 mL/kg). In 56 procedures (4%), EPO was used as a single agent for diagnostic lymphangiography. The mean volume was 4.8 mL (range: 0.3-13 mL) per procedure with a mean patient weight of 27.4 kg (range: 2.4-79.3 kg) and a weight-adjusted dose of 0.2 mL/kg (range: 0.04-0.54 mL/kg). Procedural-related complications occurred in 25 (1.8%) procedures. The 20 minor and 5 major complications were related to the primary treatment agents. None of them were directly related to EPO. No allergic reactions were noted.
CONCLUSION
The use of an ethiodized poppy seed oil contrast agent in children, adolescents, and adults for diagnostic or therapeutic purposes is safe.
PubMed: 34679474
DOI: 10.3390/diagnostics11101776 -
Fertility and Sterility Jul 2020
Topics: Contrast Media; Ethiodized Oil; Female; Humans; Hysterosalpingography; Infertility; Water
PubMed: 32532493
DOI: 10.1016/j.fertnstert.2020.04.034 -
Radiography (London, England : 1995) Oct 2023Hysterosalpingography is widely used as a first-line investigation for infertility, and may also be therapeutic, increasing pregnancy rates. Aqueous and oil-based... (Review)
Review
INTRODUCTION
Hysterosalpingography is widely used as a first-line investigation for infertility, and may also be therapeutic, increasing pregnancy rates. Aqueous and oil-based contrast agents can be used. Some studies suggest Lipiodol hysterosalpingography has a greater therapeutic effect on fertility than aqueous contrast, though this is contentious. There are additionally safety concerns surrounding Lipiodol hysterosalpingography. This review summarises the adverse effects associated with Lipiodol hysterosalpingography, particularly on thyroid function.
KEY FINDINGS
331 articles were identified. Of these, 46 met inclusion criteria. 3 further articles were identified from reference lists. Complications typically cited in the literature include pain, intravasation, life-threatening oil embolism, and lipogranuloma formation. Emerging evidence suggests that Lipiodol hysterosalpingography may also impact maternal and neonatal thyroid function. Women may develop hypo- or hyperthyroidism. Thyroid dysfunction is clinically significant as even subclinical hypothyroidism reduces fertility, increases the risk of pregnancy complications including miscarriage, pre-eclampsia and perinatal mortality, and adversely impacts foetal neurodevelopment. One study suggested a possible link with neonatal congenital hypothyroidism.
CONCLUSION
There is emerging evidence to suggest that Lipiodol hysterosalpingography can cause hypo- or hyperthyroidism, in addition to known adverse effects of pain, intravasation, oil embolism, and lipogranuloma formation.
IMPLICATIONS FOR PRACTICE
Given the significance of these risks, and contention surrounding whether Lipiodol truly increases pregnancy rates compared to aqueous mediums, careful consideration is required in the selection of contrast agent. In particular, Lipiodol hysterosalpingography may not be suitable for women with pre-existing thyroid dysfunction.
Topics: Pregnancy; Infant, Newborn; Female; Humans; Ethiodized Oil; Hysterosalpingography; Contrast Media; Embolism; Hyperthyroidism; Pain
PubMed: 37714068
DOI: 10.1016/j.radi.2023.08.008 -
Liver Cancer Sep 2022With the advent of effective systemic therapy, transarterial chemoembolization (TACE) is established as a highly effective locoregional treatment modality for carefully...
INTRODUCTION
With the advent of effective systemic therapy, transarterial chemoembolization (TACE) is established as a highly effective locoregional treatment modality for carefully selected patients with hepatocellular carcinoma (HCC). This randomized controlled trial was conducted to clarify whether selective TACE with drug-eluting beads (DEB-TACE) loaded with epirubicin or selective conventional TACE (cTACE) with epirubicin-ethiodized oil might be more effective for obtaining complete response(CR) in patients with HCC.
METHODS
Between March 2016 and May 2019, Child-Pugh class A or B patients with unresectable HCC who were scheduled to receive selective TACE were randomly assigned at a 1:1 ratio to the DEB-TACE arm or the cTACE arm. The primary endpoint was the CR rate at 3 months, as evaluated according to the modified Response Evaluation Criteria in Solid Tumors by an independent review committee, and the secondary endpoints were the CR rate at 1 month and incidences of adverse events.
RESULTS
A total of 200 patients (DEB-TACE, 99 patients; cTACE, 101 patients) were enrolled in the study. The CR rates at 3 months and 1 month were significantly higher in the cTACE arm (75.2%, 84.2%) as compared with the DEB-TACE arm (27.6%, 35.7%). However, the frequencies of adverse events of any grade, including pyrexia (DEB-TACE vs. cTACE, 19.4% vs. 45.5%, = 0.0001), fatigue (5.1% vs. 15.8%, = 0.0194), malaise (11.1% vs. 25.7%, = 0.0103), appetite loss (12.1% vs. 28.7%, = 0.0048), abdominal pain (12.1% vs. 23.8%, = 0.0423), increased serum bilirubin (22.2% vs. 48.5%, = 0.0002), hypoalbuminemia (43.4% vs. 60.3%, = 0.0154), increased serum aspartate aminotransferase (35.7% vs. 81.2%, < 0.0001), and increased serum alanine aminotransferase (35.7% vs. 77.2%, < 0.0001), were also significantly higher in the cTACE arm than in the DEB-TACE arm.
CONCLUSIONS
Selective cTACE appeared to have higher CR rates for local tumor control as compared to selective DEB-TACE for HCC. However, the frequency of postembolization syndrome was also significantly higher in the cTACE group than in the DEB-TACE group. Thus, to achieve CR, cTACE may be selected over DEB-TACE in patients who can be expected to tolerate postembolization syndrome.
PubMed: 36158586
DOI: 10.1159/000525500 -
Cardiovascular and Interventional... Oct 2022Several publications show that superselective conventional TransArterial ChemoEmbolization (cTACE), meaning cTACE performed selectively with a microcatheter positioned... (Review)
Review
Several publications show that superselective conventional TransArterial ChemoEmbolization (cTACE), meaning cTACE performed selectively with a microcatheter positioned as close as possible to the tumor, improves outcomes, maximizing the anti-tumoral effect and minimizing the collateral damages of the surrounding liver parenchyma. Recent recommendations coming from the European Association for the Study of the Liver (EASL) and European Society of Medical Oncology (ESMO) highlighted that TACE must be used in Hepatocellular Carcinoma (HCC) "selectively targetable" and "accessible to supraselective catheterization." The goal of the manuscript is to better define such population and to standardize superselective cTACE (ss-cTACE) technique. An expert panel with extensive clinical-procedural experience in TACE, have come together in a virtual meeting to generate recommendations and express their consensus. Experts recommend that anytime cTACE is proposed, it should be ss-cTACE, preferably with a 1.5-2.0 Fr microcatheter. Ideally, ss-cTACE should be proposed to patients with less than five lesions and a maximum number of two segments involved, with largest tumor smaller than 5 cm. Angio Cone-Beam Computed Tomography (CBCT) should be used to detect enhancing tumors, tumor feeders and guide tumor targeting. Whole tumor volume should be covered to obtain the best response. Adding peritumoral margins is encouraged but not mandatory. The treatment should involve a water-in-oil emulsion, whose quality is assessable with the "drop test." Additional particulate embolization should be systematically performed, as per definition of cTACE procedure. Non-contrast CBCT or Multi-Detector Computed Tomography (MDCT) combined with angiography has been considered the gold standard for imaging during TACE, and should be used to assess tumor coverage during the procedure. Experts convene that superselectivity decreases incidence of adverse effects and improves tolerance. Experts recommend contrast-enhanced Computed Tomography (CT) as initial imaging on first follow-up after ss-cTACE, and Magnetic Resonance Imaging (MRI) if remaining tumor viability cannot be confidently assessed on CT. If no response is obtained after two ss-cTACE sessions within six months, patient must be considered unsuitable for TACE and proposed for alternative therapy. Patients are best served by multidisciplinary decision-making, and Interventional Radiologists should take an active role in patient selection, treatment allocation, and post-procedural care.
Topics: Carcinoma, Hepatocellular; Chemoembolization, Therapeutic; Emulsions; Ethiodized Oil; Humans; Liver Neoplasms; Retrospective Studies; Water
PubMed: 35978174
DOI: 10.1007/s00270-022-03233-9 -
Journal of Biomaterials Applications Apr 2021Ultra-high molecular weight polyethylene (UHMWPE) can be made radiopaque for medical imaging applications through the diffusion of an iodised oil-based contrast agent...
Ultra-high molecular weight polyethylene (UHMWPE) can be made radiopaque for medical imaging applications through the diffusion of an iodised oil-based contrast agent (Lipiodol Ultra Fluid). A similar process is used for Vitamin E incorporated polyethylene which provides antioxidant properties. This study aimed to investigate the critical long-term properties of oil-infused medical polyethylene after 4 weeks of accelerated thermal ageing. Samples treated with an oil (Vitamin E or Lipiodol) had a higher oxidation stability than currently used medical grade polyethylene, indicated by a smaller increase in oxidation index after ageing (Vitamin E + 36%, Lipiodol +40%, Untreated +136%, Thermally treated +164%). The tensile properties of oil treated polyethylene after ageing were significantly higher than the Untreated and Thermally treated controls (p<0.05) indicating less mechanical degradation. There was also no alteration in the percentage crystallinity of oil treated samples after ageing, though the radiopacity of the Lipiodol treated samples reduced by 54% after ageing. The leaching of oil with time was also investigated; the leaching of Lipiodol and Vitamin E followed the same trend and reached a steady state by two weeks. Overall, it can be concluded that the diffusion of an oil-based fluid into polyethylene not only increases the oxidative and chemical stability of polyethylene but also adds additional functionality (e.g. radiopacity) providing a more suitable material for long-term medical applications.
Topics: Antioxidants; Biocompatible Materials; Calorimetry, Differential Scanning; Contrast Media; Ethiodized Oil; Oxidation-Reduction; Polyethylenes; Spectroscopy, Fourier Transform Infrared; Temperature; Tensile Strength; Time Factors; Vitamin E; X-Ray Microtomography
PubMed: 33356787
DOI: 10.1177/0885328220977353 -
Annals of Hepatology 2021Conventional transarterial chemoembolization (cTACE) has several limitations due to the lack of standardization. The aim of this study was to evaluate the chemical and...
INTRODUCTION AND OBJECTIVES
Conventional transarterial chemoembolization (cTACE) has several limitations due to the lack of standardization. The aim of this study was to evaluate the chemical and physical characteristics and behaviors over time of emulsions for cTACE and to assess intra- and inter-operator variabilities in the preparation processes.
MATERIALS AND METHODS
This in vitro study involved evaluation of emulsions for cTACE prepared using two methods: water-in-oil (WiO) and chemotherapeutic-in-oil (CiO). Three emulsions were prepared with each method and obtained after 20, 50, and 100 pumping exchanges. A drop from each final mixture was analyzed via light microscopy (time 1) and after 5, 10, 15, and 20min since the end of preparation. After 20min, all preparations were re-mixed and new drops were re-evaluated. The intra- and inter-operator variabilities were analyzed.
RESULTS
The mean droplet diameter decreased non-significantly when the number of pumping exchanges increased and increased significantly over time for both WiO and CiO. The droplets returned to their initial diameters after re-mixing. There were no significant differences in the intra- and inter-operator variabilities (P>0.01).
CONCLUSIONS
Any interventional radiologist, regardless of their experience, may prepare these emulsions. These data may represent a set of instructions to standardize cTACE.
Topics: Antineoplastic Agents; Carcinoma, Hepatocellular; Chemoembolization, Therapeutic; Contrast Media; Drug Compounding; Emulsions; Epirubicin; Ethiodized Oil; Humans; Iopamidol; Liver Neoplasms
PubMed: 33129978
DOI: 10.1016/j.aohep.2020.10.006 -
Journal of Endourology Case Reports 2018To report the approach, technical success, clinical outcomes, complications, and follow-up of ethiodized oil intranodal lymphangiography with cyanoacrylate glue...
Endolymphatic Ethiodized Oil Intranodal Lymphangiography and Cyanoacrylate Glue Embolization for the Treatment of Postoperative Lymphatic Leak After Robot-Assisted Laparoscopic Pelvic Resection.
To report the approach, technical success, clinical outcomes, complications, and follow-up of ethiodized oil intranodal lymphangiography with cyanoacrylate glue embolization for the treatment of lymphatic leak after robot-assisted laparoscopic pelvic resection. Four men with mean age 68.7 ± 14.3 years were treated with ethiodized oil intranodal lymphangiography with cyanoacrylate embolization for postoperative lymphatic leak. Patients underwent either (1) cystoprostatectomy with ileal conduit and bilateral extensive pelvic lymph node dissection for muscle-invasive urothelial carcinoma and presented with postoperative lymphatic ascites ( = 2) or (2) prostatectomy with bilateral standard pelvic lymph node dissection for prostate carcinoma and presented with postoperative pelvic lymphoceles ( = 2). Intranodal lymphangiography and embolization procedural details, technical success, clinical outcomes, and follow-up were recorded. In four patients, a total of six ethiodized oil intranodal lymphangiograms were performed, two procedures being repeated interventions. Inguinal lymph node catheterization and ethiodized oil lymphangiography was technically effective in all procedures. A mean of 5.2 ± 2.0 mL of ethiodized oil was used for lymphatic opacification. Cyanoacrylate was diluted to 24.2% with ethiodized oil and 0.44 mL of cyanoacrylate was instilled during first time interventions. On repeat procedures, cyanoacrylate was diluted to 51.7%, and 0.52 mL was instilled. The primary clinical success rate was 50% ( = 2/4). Clinical success was achieved in all patients after two interventions ( = 4; 100%). No complications were reported at mean follow-up of 134.7 ± 79.2 days (range: 59-248 days). Ethiodized oil intranodal lymphangiography with direct cyanoacrylate glue embolization is a minimally invasive treatment option for lymphatic leak after pelvic resection.
PubMed: 29789814
DOI: 10.1089/cren.2018.0026 -
Future Oncology (London, England) Nov 2018Transarterial chemoembolization (TACE) combines intra-arterial delivery of a chemotherapeutic agent with selective embolization to obtain a synergistic effect. TACE is... (Review)
Review
Transarterial chemoembolization (TACE) combines intra-arterial delivery of a chemotherapeutic agent with selective embolization to obtain a synergistic effect. TACE is recognized as the standard treatment of hepatocellular carcinoma patients at an intermediate stage. If conventional TACE, defined as the injection of an emulsion of a drug with ethiodized oil, still has a role to play, the development of drug-eluting beads has allowed many improvements and optimization of the technique. TANDEM microspheres are second-generation drug-loadable microspheres. This device raised a special interest due to its tightly calibrated spherical microspheres, with small sizes down to 40 μm available. In this review, we describe the technical characteristics of these microspheres, analyze the scientific literature and hypothesize on the future perspectives.
Topics: Antineoplastic Combined Chemotherapy Protocols; Carcinoma, Hepatocellular; Chemoembolization, Therapeutic; Doxorubicin; Drug Carriers; Drug Liberation; Humans; Idarubicin; Liver; Liver Neoplasms; Microspheres; Particle Size; Randomized Controlled Trials as Topic; Tomography, X-Ray Computed; Treatment Outcome
PubMed: 29953255
DOI: 10.2217/fon-2018-0237