Brief report
Temporary Balloon Occlusion of the Common Hepatic Artery for Administration of Yttrium-90 Resin Microspheres in a Patient with Patent Hepatoenteric Collaterals

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Abstract

The most common serious complication of yttrium-90 (90Y) therapy is gastrointestinal ulceration caused by extrahepatic microsphere dispersion. The authors describe the use of a balloon catheter for temporary occlusion of the common hepatic artery to reverse hepatoenteric flow for lobar administration of resin microspheres when coil embolization of a retroportal artery was impossible. At 9 months after treatment, the patient had no gastrointestinal side effects and showed a partial response.

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

References (9)

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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.

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