Brief reportTemporary Balloon Occlusion of the Common Hepatic Artery for Administration of Yttrium-90 Resin Microspheres in a Patient with Patent Hepatoenteric Collaterals
Section snippets
Case Report
Approval for a single patient report is not required by our institutional review board. A 75-year-old white woman with liver dominant metastatic carcinoid was referred for 90Y resin radioembolotherapy after hepatic progression following somatostatin analogue treatment. A therapy-planning angiogram showed multifocal, bilobar, hypervascular lesions predominantly in the right lobe. A retroportal artery with hepatofugal flow was identified at the bifurcation of the anterior and posterior sectorial
Discussion
Nontarget embolization is a potential complication of all transarterial therapies. It can occur in the setting of unrecognized variant or collateral circulation or as a result of changes in flow dynamics during infusion (7). In a large retrospective analysis involving > 1,100 patients, the risk of nontarget administration of 90Y microspheres causing gastrointestinal ulceration was reported to be 0%–20% (3). Key aspects of hepatic 90Y microsphere delivery further increase the risk of
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Transcatheter therapy for hepatic malignancy: Standardization of terminology and reporting criteria
2016, Journal of Vascular and Interventional RadiologyCitation Excerpt :This may simply be repositioning of a catheter on the basis of physician experience or imaging findings, or it could eventually include integration of corollary techniques such as C-arm cone-beam CT scanning (5) or optical imaging (46). This term would also include embolization of nontarget vessels such as the gastroduodenal or right gastric arteries during radioembolization, particle embolization to decrease arterioportal shunting during chemoembolization of a hepatocellular carcinoma (HCC), use of an antireflux catheter (47,48), or other techniques (49) to ensure appropriate therapeutic agent dissemination. Imaging used to assess treatment outcomes after a single treatment or treatment cycle is discussed in a subsequent section as “radiologic response assessment” (14,50,51).
Radioembolization with yttrium-90 microspheres work up: Practical approach and literature review
2015, Diagnostic and Interventional ImagingCitation Excerpt :When they are visible and identified, however, embolization may be required [3]. When they are not easy to catheterize, temporary occlusion of the CHA with a remodeling balloon redistributes local hemodynamics, reversing the flow in the GDA and therefore the flow in these small arteries and avoiding adverse effects due to particle introduction [18,55]. The existence of extrahepatic arterial supply to neoplastic liver lesions and particularly hepatocellular carcinoma (HCC) is well documented in the literature and affects 17 to 30.8% of liver tumors [50,51,56–58].
Radioembolization and the cystic artery
2014, Journal of Vascular and Interventional RadiologyQuantification and reduction of reflux during embolotherapy using an antireflux catheter and tantalum microspheres: Ex vivo analysis
2013, Journal of Vascular and Interventional RadiologyCitation Excerpt :However, in the experimental side, with the same dose delivered, use of an antireflux microcatheter resulted in 99.9%±1.0 of the dose delivered into the target vessel, with 0.1% reflux. Therefore, we have been able to confirm in an animal study that reflux can be visibly eliminated with use of an antireflux catheter without the use of a balloon occlusion catheter (18,19). Consequently, the rapid hemodynamic redistribution that occurs during embolotherapy may be mitigated with the use of an antireflux catheter.
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R.M. received honoraria from SIRTEX Medical and MDS Nordion, the manufacturers of the resin and glass radioactive microsphere products. None of the other authors have identified a conflict of interest.