Embolisation of the Gastroduodenal Artery is Not Necessary in the Presence of Reversed Flow Before Yttrium-90 Radioembolisation
Tóm tắt
The gastroduodenal artery (GDA) is usually embolised to avoid nontarget dispersal before yttrium-90 (Y90) radioembolisation to treat liver metastases. In a minority of patients, there is retrograde flow in the GDA. The purpose of this study was to determine if there is any increased risk from maintaining a patent GDA in patients with reversed flow. A retrospective review was performed of all patients undergoing Y90 radioembolisation at our institution. The incidence of toxicities arising from nontarget radioembolisation by way of the GDA (gastric/duodenal ulceration, gastric/duodenal bleeding, and pancreatitis) and death occurring within 2 months of treatment were compared between the reversed and the antegrade GDA groups. Ninety-two patients underwent preliminary angiography. Reversed GDA flow was found on angiography in 14.1% of cases; the GDA was not embolised in these patients. The GDA was coiled in 55.7% of patients with antegrade GDA flow to prevent inadvertent dispersal of radioembolic material. There was no increased toxicity related to nontarget dispersal by way of the GDA, or increased early mortality, in patients with reversed GDA flow (P > 0.05). In patients with reversed GDA flow, maintenance of a patent GDA before administration of Y90 radioembolisation does not increase the risk of toxicity from nontarget dispersal. Therapeutic injection, with careful monitoring to identify early vascular stasis, may be safely performed beyond the origin of the patent GDA. A patent GDA with reversed flow provides forward drive for infused particles and may allow alternative access to the hepatic circulation.
Tài liệu tham khảo
Salem R, Thurston KG (2006) Radioembolization with 90yttrium microspheres: a state-of-the-art brachytherapy treatment for primary and secondary liver malignancies. Part 1: technical and methodologic considerations. J Vasc Interv Radiol 17(8):1251–1278
Salem R, Thurston KG (2006) Radioembolization with 90yttrium microspheres: a state-of-the-art brachytherapy treatment for primary and secondary liver malignancies, Part 2: special topics. J Vasc Interv Radiol 17(9):1425–1439
Salem R, Thurston KG (2006) Radioembolization with yttrium-90 microspheres: a state-of-the-art brachytherapy treatment for primary and secondary liver malignancies, Part 3: comprehensive literature review and future direction. J Vasc Interv Radiol 17(10):1571–1593
Khodjibekova M, Szyszko T, Singh A et al (2007) Treatment of primary and secondary liver tumours with selective internal radiation therapy. J Exp Clin Cancer Res 26(4):561–570
Liu DM, Salem R, Bui JT et al (2005) Angiographic considerations in patients undergoing liver-directed therapy. J Vasc Interv Radiol 16(7):911–935
Kwon JW, Chung JW, Song SY et al (2002) Transcatheter arterial chemoembolization for hepatocellular carcinomas in patients with celiac axis occlusion. J Vasc Interv Radiol 13(7):689–694
Haydar AA, Wasan H, Wilson T et al (2010) 90Y radioembolization: embolization of the gastroduodenal artery is not always appropriate. Cardiovasc Interv Radiol 33(5):1069–1071
Becker C, Waggershauser T, Tiling R et al (2011) C-arm computed tomography compared with positron emission tomography/computed tomography for treatment planning before radioembolization. Cardiovasc Interv Radiol 34(3):550–556
Karunanithy N, Gordon F, Hodolic M et al (2011) Embolization of hepatic arterial branches to simplify hepatic blood flow before yttrium 90 radioembolization: a useful technique in the presence of challenging anatomy. Cardiovasc Interv Radiol 34(2):287–294
Bilbao JI, Garrastachu P, Herráiz MJ et al (2010) Safety and efficacy assessment of flow redistribution by occlusion of intrahepatic vessels before radioembolization in the treatment of liver tumors. Cardiovasc Interv Radiol 33(3):523–531