Arterial injury during transcatheter arterial chemoembolization for hepatocellular carcinoma: predictors of risk and outcome

Long-Term Suitability of Left Gastric Artery Inflow for Arterial Perfusion of Living Donor Right Lobe Grafts

Poorer than expected, living donor liver transplant outcomes are observed after recipient graft artery thrombosis. At grafting, the risk for later thrombosis is high if a dissected hepatic artery is used for standard reconstruction. Surgeon diagnosis of dissection requires nonstandard management with alternative technique in addition to microvascular expertise. Intimal flap repair with standard reconstruction is contingent on basis of a redo anastomosis. It is a suboptimal choice for living donor transplantation. Achieving goal graft arterial perfusion at first revascularization is crucial for superior outcomes. Managing dissection at grafting with nonstandard left gastric artery reconstruction is unreported. Our experience is limited, but this is our preferred alternative technique to standard hepatic artery reconstruction complicated by dissection. Here, we describe our two-case experience with left gastric arterialized grafts for management of dissection. Our living donor graft recipients with alternatively arterialized grafts are now 6- and 2-years posttransplant.

Safety and efficacy of drug-eluting microspheres chemoembolization under cone beam computed tomography control in patients with early and intermediate stage hepatocellular carcinoma

BACKGROUND

Drug-eluting microsphere transarterial chemoembolization (DEM-TACE) is the standard of care in patients with intermediate-stage hepatocellular carcinoma and ensures targeted and controlled cytotoxic and ischemic effects. Proper patient selection and optimized treatment techniques are associated with longer median survival. The aim of this single-institution retrospective study was to evaluate safety and efficacy of DEM-TACE under cone beam computed tomography (CBCT) control in patients with early and intermediate stage hepatocellular carcinoma.

PATIENTS AND METHODS

A total of 144 patients (mean age 67.9 ± 8.0 years, 127 males and 17 females) between February 2010 and December 2018 were studied. Microparticles of different dimensions according to two manufacturers (diameter of 70-150 μm, 100-300 μm or 300-500 μm and 40-μm, 75-μm or 100-μm) were used and loaded with 50-150 mg of doxorubicin. The objective tumour response according to the modified Response Evaluation Criteria in Solid Tumours (mRECIST), the time to progression, adverse events and overall survival were (OS) evaluated.

RESULTS

In total, 452 procedures were performed (median, 3 per patient). Four (0.9% of all procedures) major complications were noted. Postembolization syndrome occurred after 35% of procedures. At the first imaging follow-up 2-3 months after first treatment, 91% of patients achieved an objective response. The median time to progression was 10.2 months (95% CI: 8.3-12.1 months). OS rates at 1, 2, 3, 4, and 5 years were 85%, 53%, 33%, 20% and 14%, respectively. The median survival time was 25.8 months (95% CI: 22.1-29.5 months).

CONCLUSIONS

DEM-TACE under CBCT control in patients with early and intermediate stage hepatocellular carcinoma is a safe and effective method of treatment with high objective tumour response and survival rates.

Iatrogenic celiac and hepatic artery dissections during intra-arterial regional tumor therapies: a 16-year retrospective review

PURPOSE

To identify the incidence and outcomes of iatrogenic celiac and hepatic artery dissections during transarterial therapies, including bland embolization, chemoembolization, radioembolization (TARE), and pre-TARE scintigraphic mapping.

METHODS

The institution's quality assessment database, electronic medical record, and picture archiving and communication system were reviewed to identify all patients who underwent transarterial locoregional therapy from 1/2001 to 7/2017 and to determine the incidence of iatrogenic dissection, to assess patency of the arteries after dissection, and to assess the ability to complete therapy.

RESULTS

2253 patients underwent 3776 transarterial hepatic oncology procedures. Among 3776 procedures, 40 (1.1%) were associated with dissection of the visceral vasculature, affecting 39 patients (1.7%). The incidence of flow-limiting dissections was 0.3% (13/3776) and non-flow-limiting dissections was 0.7% (27/3776). After dissection, 68% (27/40) of treatments were completed the same day. Among the 13 aborted treatments, 8 (62%) were completed on a subsequent encounter. Follow-up imaging was obtained in 26 of 40 cases at median time of 63 days. Complete resolution of the dissection was seen in 15/26 cases (58%), near complete resolution (< 30% luminal narrowing) in 3/26 (12%), unchanged appearance of a non-flow-limiting dissection in 4/26 (15%), progressive luminal narrowing in 3/26 (12%), and complete occlusion in 1/26 (4%).

CONCLUSION

Iatrogenic dissections of visceral arteries rarely occur during tumor embolization procedures. 35/39 (90%) of patients underwent successful treatment despite the dissection.

Changes of serum vascular endothelial growth factor and perfusion parameters in hepatocellular carcinoma after anti-angiogenic therapy

BACKGROUND

Vascular targeting drugs are one of the major advances in the treatment of liver tumors, especially for patients with advanced hepatocellular carcinoma (HCC) which cannot be resected surgically. Contrast-enhanced ultrasound is a non-invasive method for displaying perfusion. It can dynamically reflect microcirculation perfusion of tumor tissue in real time and provide hemodynamic information for clinical evaluation of anti-angiogenic effect on HCC.

AIM

To investigate the value of contrast-enhanced ultrasound in evaluating the effect of anti-angiogenic therapy in HCC.

METHODS

Seventy-two patients with HCC (72 lesions) confirmed by pathology were randomly divided into either group A (36 cases) or group B (36 cases). Group A received transcatheter arterial chemoembolization (TACE). Group B received TACE combined with thalidomide. All patients were examined by contrast-enhanced ultrasound before treatment and 12 weeks after treatment. The parameters of blood perfusion including area under curve (AUC) and peak intensity (PI) were measured. Meanwhile, the levels of serum vascular endothelial growth factor (VEGF) were measured and compared.

RESULTS

The AUC, PI, and serum levels of VEGF after treatment were significantly lower than those before treatment in both groups A and B (P < 0.05), and these parameters after treatment were significantly lower in group B than in group A (P < 0.05).

CONCLUSION

Contrast-enhanced ultrasound can quantitatively analyze the changes of blood flow perfusion after anti-angiogenic therapy of HCC and effectively evaluate the effect of anti-angiogenic therapy in this malignancy.

Identification of the feeding arteries of hepatocellular carcinomas by performing dual arterial phase CT during pre-transarterial chemoembolization angiography

PURPOSE

This study evaluated the usefulness of performing dual arterial phase computed tomography (CT) during pre-transarterial chemoembolization (TACE) angiography for identifying the feeding arteries of hepatocellular carcinomas (HCC).

MATERIALS AND METHODS

Dual arterial phase CT was performed during pre-TACE angiography in 73 patients with 139 HCC. Ten HCC underwent this procedure twice, so the total number of examined HCC was 149. Early and late arterial phase images were obtained 6 seconds after injection of an iodinated contrast material serially during a single breath-hold. The feeding artery was defined as the branch of the hepatic artery that was connected to the enhanced areas of the tumor. For HCC that could not be visualized on the early arterial phase images, fusion images superimposing the early and late arterial phase images were constructed. Furthermore, technical success defined as successful catheterization of the subsegmental or more distal feeding artery was evaluated.

RESULTS

The feeding artery was correctly identified on dual arterial phase CT in 146 of the 149 tumors (98.0%). In two HCC, the feeding arteries could not be identified due to severe motion artifacts, and in one, due to the presence of anastomosis between the right and left hepatic arteries. Catheterization of the subsegmental feeding artery was successful in all TACE procedures (technical success rate: 100%).

CONCLUSION

Performing dual arterial phase CT during angiography appears to be useful for identifying the feeding arteries of HCC.