Limits...
Selective internal radiation therapy of hepatic tumors: procedural implications of a patent hepatic falciform artery.

Schelhorn J, Ertle J, Schlaak JF, Mueller S, Bockisch A, Schlosser T, Lauenstein T - Springerplus (2014)

Bottom Line: Initial coil embolization of the HFA succeeded only in three of 11 patients.Out of the eight remaining patients four had no abdominal wall (99m)Tc-HSAM accumulation.In patients with abdominal wall (99m)Tc-HSAM accumulation HFA embolization or ice pack administration seems to prevent complications.

View Article: PubMed Central - PubMed

Affiliation: Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Hufelandstrasse 55, 45147 Essen, Germany.

ABSTRACT
Selective internal radiation therapy (SIRT) using 90-yttrium is a local therapy for unresectable liver malignancies. Non-targeted 90-yttrium diversion via a patent hepatic falciform artery (HFA) is seen as risk for periprocedural complications. Therefore, this study aimed to evaluate the impact of a patent HFA on SIRT. 606 patients with SIRT between 2006 and 2012 were evaluated retrospectively. SIRT preparation was performed by digital subtraction angiography including (99m)Tc-HSAM administration and subsequent SPECT/CT. Patients with an angiographically patent HFA were analyzed for procedural consequences and complications. 19 of 606 patients (3%) with an angiographically patent HFA were identified. Only 11 of these 19 patients received 90-yttrium in the hepatic vessel bed containing the HFA. Initial coil embolization of the HFA succeeded only in three of 11 patients. Out of the eight remaining patients four had no abdominal wall (99m)Tc-HSAM accumulation. The other four patients presented with an abdominal wall (99m)Tc-HSAM accumulation, for those a reattempt of HFA embolization was performed or ice packs were administered on the abdominal wall during SIRT. In summary, all patients tolerated SIRT well. A patent HFA should not be considered a SIRT contraindication. In patients with abdominal wall (99m)Tc-HSAM accumulation HFA embolization or ice pack administration seems to prevent complications.

No MeSH data available.


Related in: MedlinePlus

Example of a coilable, but subsequently partially recanalized hepatic falciform artery (HFA). Patent HFA visible in the DSA (A) which initially was coil embolized (B) but which proofed partially recanalized in the therapeutic DSA (C). Subsequently it was reoccluded using gelfoam (D) prior to the 90-yttrium administration.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC4197194&req=5

Fig2: Example of a coilable, but subsequently partially recanalized hepatic falciform artery (HFA). Patent HFA visible in the DSA (A) which initially was coil embolized (B) but which proofed partially recanalized in the therapeutic DSA (C). Subsequently it was reoccluded using gelfoam (D) prior to the 90-yttrium administration.

Mentions: Eight of these 19 patients did not receive 90-yttrium in the hepatic vessel bed containing the HFA due to clinical deterioration (n = 4), persistent duodenal shunting (n = 1), insufficient tumor 99mTc-HSAM accumulation (n = 1), or because the liver tumor was located exclusively in the contralateral liver lobe (n = 2). Hence, only 11 patients received 90-yttrium in the hepatic artery from which the HFA arose. In three of these 11 patients the HFA could initially be coil embolized. None of these patients showed any 99mTc-HSAM accumulation in the ventral abdominal wall or the falciform ligament (Figure 1A-C). In two of these three patients a partial reopening of the HFA was discovered during subsequent therapeutic DSA. Thus, the HFA was reoccluded with gelfoam prior to the 90-yttrium administration (Figure 2A-D). All three patients tolerated SIRT well without any complications.Figure 1


Selective internal radiation therapy of hepatic tumors: procedural implications of a patent hepatic falciform artery.

Schelhorn J, Ertle J, Schlaak JF, Mueller S, Bockisch A, Schlosser T, Lauenstein T - Springerplus (2014)

Example of a coilable, but subsequently partially recanalized hepatic falciform artery (HFA). Patent HFA visible in the DSA (A) which initially was coil embolized (B) but which proofed partially recanalized in the therapeutic DSA (C). Subsequently it was reoccluded using gelfoam (D) prior to the 90-yttrium administration.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4197194&req=5

Fig2: Example of a coilable, but subsequently partially recanalized hepatic falciform artery (HFA). Patent HFA visible in the DSA (A) which initially was coil embolized (B) but which proofed partially recanalized in the therapeutic DSA (C). Subsequently it was reoccluded using gelfoam (D) prior to the 90-yttrium administration.
Mentions: Eight of these 19 patients did not receive 90-yttrium in the hepatic vessel bed containing the HFA due to clinical deterioration (n = 4), persistent duodenal shunting (n = 1), insufficient tumor 99mTc-HSAM accumulation (n = 1), or because the liver tumor was located exclusively in the contralateral liver lobe (n = 2). Hence, only 11 patients received 90-yttrium in the hepatic artery from which the HFA arose. In three of these 11 patients the HFA could initially be coil embolized. None of these patients showed any 99mTc-HSAM accumulation in the ventral abdominal wall or the falciform ligament (Figure 1A-C). In two of these three patients a partial reopening of the HFA was discovered during subsequent therapeutic DSA. Thus, the HFA was reoccluded with gelfoam prior to the 90-yttrium administration (Figure 2A-D). All three patients tolerated SIRT well without any complications.Figure 1

Bottom Line: Initial coil embolization of the HFA succeeded only in three of 11 patients.Out of the eight remaining patients four had no abdominal wall (99m)Tc-HSAM accumulation.In patients with abdominal wall (99m)Tc-HSAM accumulation HFA embolization or ice pack administration seems to prevent complications.

View Article: PubMed Central - PubMed

Affiliation: Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Hufelandstrasse 55, 45147 Essen, Germany.

ABSTRACT
Selective internal radiation therapy (SIRT) using 90-yttrium is a local therapy for unresectable liver malignancies. Non-targeted 90-yttrium diversion via a patent hepatic falciform artery (HFA) is seen as risk for periprocedural complications. Therefore, this study aimed to evaluate the impact of a patent HFA on SIRT. 606 patients with SIRT between 2006 and 2012 were evaluated retrospectively. SIRT preparation was performed by digital subtraction angiography including (99m)Tc-HSAM administration and subsequent SPECT/CT. Patients with an angiographically patent HFA were analyzed for procedural consequences and complications. 19 of 606 patients (3%) with an angiographically patent HFA were identified. Only 11 of these 19 patients received 90-yttrium in the hepatic vessel bed containing the HFA. Initial coil embolization of the HFA succeeded only in three of 11 patients. Out of the eight remaining patients four had no abdominal wall (99m)Tc-HSAM accumulation. The other four patients presented with an abdominal wall (99m)Tc-HSAM accumulation, for those a reattempt of HFA embolization was performed or ice packs were administered on the abdominal wall during SIRT. In summary, all patients tolerated SIRT well. A patent HFA should not be considered a SIRT contraindication. In patients with abdominal wall (99m)Tc-HSAM accumulation HFA embolization or ice pack administration seems to prevent complications.

No MeSH data available.


Related in: MedlinePlus