BACKGROUND Middle meningeal artery embolization(MMAE)is emerging as a promising treatment for chronic subdural hematoma(CSDH),serving both as an adjunct to surgery and as a primary therapeutic option depending on pati...BACKGROUND Middle meningeal artery embolization(MMAE)is emerging as a promising treatment for chronic subdural hematoma(CSDH),serving both as an adjunct to surgery and as a primary therapeutic option depending on patient presentation.Due to its low recurrence rate and minimal complications,MMAE has gained increasing acceptance among clinicians in recent years.This report presents a case of diplopia following MMAE due to the presence of a potential anastomotic artery,aiming to enhance awareness of this complication.CASE SUMMARY A 60-year-old male patient presented with a headache following head trauma,and cranial computed tomography revealed a left-sided CSDH.The patient underwent left MMAE;however,polyvinyl alcohol particles inadvertently flowed into the lacrimal artery through an anastomotic artery,resulting in diplopia due to impaired abduction of the left eye.The diplopia resolved by postoperative day 40.The patient’s headache resolved by postoperative day 7,and the hematoma completely resolved by postoperative day 108.CONCLUSION Potential anastomotic arteries in the middle meningeal artery(MMA)can lead to serious complications.Superselective angiography of the MMA or its branches prior to embolization is essential.Performing embolization distal to potential anastomotic sites can reduce risks,and the presence of an anastomosis may warrant coil embolization or termination of the procedure.展开更多
Middle meningeal artery embolization(MMAE)has revolutionized chronic subdural hematoma management,yet procedural risks persist due to anatomical variability.We analyze a case report by Zhao et al describing transient ...Middle meningeal artery embolization(MMAE)has revolutionized chronic subdural hematoma management,yet procedural risks persist due to anatomical variability.We analyze a case report by Zhao et al describing transient diplopia caused by inadvertent embolization of the lacrimal artery via a dynamic middle meningeal–ophthalmic anastomosis.This correspondence advances three critical innovations in MMAE safety.First,intraoperative anastomotic unmasking—exposing occult middle meningeal-ophthalmic collaterals during particle injection—reveals dynamic vascular behavior missed by preoperative angiography,underscoring the need for adaptive imaging protocols.Second,hybrid embolization(liquid agents for proximal occlusion+particles for distal control)balances precision and safety,reducing reflux risks compared to monotherapy.Third,a 108-day follow-up establishes a benchmark for functional recovery,challenging assumptions about irreversible cranial nerve injuries and emphasizing structured postprocedural care.Collectively,these findings advocate for procedural agility,multimodal embolic strategies,and sustained rehabilitation to optimize MMAE outcomes while minimizing iatrogenic harm.展开更多
The Kakinuma et al’s case report shows that non-pregnancy-related arterial pseudoaneurysm is a relatively rare,little known by some gynecologists,endo-scopists,surgeons or radiologists,which can cause massive bleedin...The Kakinuma et al’s case report shows that non-pregnancy-related arterial pseudoaneurysm is a relatively rare,little known by some gynecologists,endo-scopists,surgeons or radiologists,which can cause massive bleeding.Arterial pseudoaneurysm is a condition in which the wall of a blood vessel collapses due to some invasive event,and the resulting leaked blood is engulfed by soft tissues,forming a cavity that is in communication with the vessel.It is a potentially life-threatening complication that could occurs after some deliveries and some gynecological invasive procedures.Remarkably,an undetermined percentage of pseudoaneurysms are asymptomatic,and in an asymptomatic patient it is difficult to predict the risk of haemorrhage and the attitude to follow,which depends on several factors,such as,the size and location of the vessel involved,changes in the size of the pseudoaneurysm,or the available therapeutic resources to be offered to patients,among others circumstances.The management of abdominal arterial pseudoaneurysm does not have consistent scientific evidence,but it seems that,regardless of the associated circumstances,the pseudoaneurysm could be treated at least initially,and mainly,through endovascular procedures,as done by Kakinuma et al.展开更多
BACKGROUND Acute cholecystitis due to unintended cystic artery embolism is an uncommon and mostly self-limiting complication after transarterial chemoembolization procedure for treatment of hepatocellular carcinoma.Us...BACKGROUND Acute cholecystitis due to unintended cystic artery embolism is an uncommon and mostly self-limiting complication after transarterial chemoembolization procedure for treatment of hepatocellular carcinoma.Usually,conservative management is sufficient for complete recovery of patients who develop this complication.If conservative treatment is ineffective,urgent surgical inter-vention may be required to prevent the progression of complications.CASE SUMMARY This article reports a rare and serious case of acute cholecystitis complicated by gallbladder necrosis and biliary peritonitis,which was initially treated conservatively but eventually necessitated emergency laparotomy.The patient initially presented with equivocal symptoms of fever and upper abdominal pain and distention,which worsened at the two weeks mark along with emergence of signs of peritonitis.This was managed by emergency laparotomy and cholecystostomy,allowing rapid symptom relief.The patient ultimately discharged and succumbed to advanced liver cancer 11 months after diagnosis.CONCLUSION After cholecystostomy,the patient showed symptom relief and was discharged,surviving 11 months post-stage IIIB liver cancer diagnosis.展开更多
BACKGROUND Hepatic encephalopathy(HE)affects more than 30%of patients with cirrhosis.Extrahepatic portosystemic shunt(EHPSS)has been suggested to be a contributing factor to HE recurrence and mortality.Therefore,early...BACKGROUND Hepatic encephalopathy(HE)affects more than 30%of patients with cirrhosis.Extrahepatic portosystemic shunt(EHPSS)has been suggested to be a contributing factor to HE recurrence and mortality.Therefore,early detection and intervention in EHPSS may improve patient outcomes.AIM To evaluate the effects of shunt embolization on mortality and HE recurrence.METHODS In this retrospective case-control study,16 cirrhotic patients with HE treated at a tertiary care center from January 2012 to August 2022 were included.Outcomes in eight patients who underwent embolization of EHPSS were compared with those in eight patients receiving standard care without embolization.Data on baseline characteristics,HE recurrence,and overall survival were collected and analyzed using Kaplan-Meier and log-rank tests.RESULTS Baseline characteristics were comparable between the groups.The 1-year overall survival rate was significantly higher in the treatment group(0.50)than in the control group(0.33).The HE recurrence-free rate was also higher in the treatment group(1.00)than in the control group(0.17).The median survival duration was longer in the treatment group{not reached[95%confidence interval(CI):23.84 to not available(NA)]}than in the control group[15.02 months(95%CI:9.86 to NA)](P=0.006).Similarly,the recurrence-free duration was longer in the treatment group[63.09 months(95%CI:63.09 to NA)]than in the control group[9.21 months(95%CI:4.47 to NA)](P=0.006).EHPSS embolization significantly reduced 1-year HE recurrence(hazard ratio=0.09;95%CI:0.01-0.75;P=0.026).CONCLUSION EHPSS embolization significantly improves 1-year survival and prevents recurrence of HE in cirrhotic patients.Routine computed tomography and early embolization are clinically beneficial.展开更多
Transcatheter arterial embolization(TAE)is the mainstay for treating advanced hepatocellular carcinoma(HCC),and the performance of the embolization material is crucial in TAE.With the development of medical imaging an...Transcatheter arterial embolization(TAE)is the mainstay for treating advanced hepatocellular carcinoma(HCC),and the performance of the embolization material is crucial in TAE.With the development of medical imaging and the birth of“X-ray-free”technologies,we designed a new dual-mode imaging material of dimethoxy tetraphenyl ethylene(DMTPE)via emulsification by mixing poly(N-isopropylacrylamide-co-acrylic acid)(PNA)with lipiodol and fluorocarbons,which was evaluated for temperature sensitivity,stability,and dual-mode visualization in vitro.Additionally,blood vessel casting embolization and renal artery imaging were assessed in healthy rabbits.In a rabbit model with a VX2 tumor,the effectiveness of TAE for treating HCC was examined,with an emphasis on evaluating long-term outcomes of embolization and its effects on tumor growth,necrosis,and proliferation through imaging techniques.In vitro experiments confirmed that the temperature-sensitive dual-oil-phase Pickering emulsion had good flow,stable contrast,and embolism when the oil-to-oil ratio and water-to-oil ratio were both 7:3(v/v)and stabilized with 8%PNA.Similarly,in vivo,arterial embolization confirmed the excellent properties of DMTPE prepared at the abovementioned ratios.It was observed that DMTPE not only has an antitumor effect but can also achieve dual imaging using X-rays and ultrasound,making it a promising excellent vascular embolization material for TAE in tumor treatment.展开更多
BACKGROUND Hemorrhage following pancreaticobiliary surgery is a high-risk complication,with a mortality rate of 16%-38%.At present,minimally invasive endovascular intervention comprising superselective arterial emboli...BACKGROUND Hemorrhage following pancreaticobiliary surgery is a high-risk complication,with a mortality rate of 16%-38%.At present,minimally invasive endovascular intervention comprising superselective arterial embolization(SAE)and covered stent implantation(CSI)is the treatment of choice.However,in certain cases,both SAE and CSI become infeasible.AIM To evaluate the effectiveness of coil-assisted N-butyl cyanoacrylate(NBCA)embolization in comparison with that of CSI in managing delayed hemorrhage after hepatobiliary–pancreatic surgery when SAE is infeasible.METHODS Ninety-eight continuous patients(n=105 cases;mean age,58.4 years)with delayed massive hemorrhage who were treated with coil-assisted NBCA embolization(NBCA group,n=45)and/or CSI(CSI group,n=60)were retrospectively evaluated between March 2014 and December 2023.Data on technical and clinical success,30-day mortality,and severe intervention-related adverse events were collected and analyzed.RESULTS The technical and clinical success rates in the NBCA group(100%and 93.3%,respectively)were significantly higher than those in the CSI group(88.3%and 73.3%,respectively),with a statistically significant difference between the two groups(P=0.019 and 0.010,respectively).The 30-day mortality rates and major intervention-related complications were 17.8%and 0%,respectively,in the NBCA group and 18.3%and 1.7%in the CSI group,respectively,with no statistically significant difference between the two groups.CONCLUSION In terms of technical and clinical success,coil-assisted NBCA embolization was more effective than CSI for managing delayed hemorrhage after hepatobiliary–pancreatic surgery when SAE was not feasible.展开更多
Endoscopic ultrasound(EUS)guided vascular interventions have expanded the reach of therapeutic endoscopy to include vascular pathology previously inaccessible by endoscopists.Gastric variceal bleeding comprises 20%of ...Endoscopic ultrasound(EUS)guided vascular interventions have expanded the reach of therapeutic endoscopy to include vascular pathology previously inaccessible by endoscopists.Gastric variceal bleeding comprises 20%of all variceal bleeding and is associated with high morbidity and mortality.Historically,endoscopic injection of thrombosis-inducing agents such as glue has been used.However,glue injection carries potential risks including systemic embolization,damage to the endoscope,and recurrent bleeding.The introduction of hemostatic coils has revolutionized the endoscopic approach,with EUS-guided coil embolization emerging as an effective and safe modality for the management of gastric varices(GVs).When compared with conventional glue injection,EUSguided embolization is associated with improved visualization,higher efficacy,and better safety profile.Despite its expanding adoption,the standardization of EUS guided embolization remains a challenge.High-quality studies are needed to standardize this promising technique and define its role in clinical practice.In this review,we will discuss the indications,efficacy,techniques,and various approaches for EUS-guided embolization of GVs.展开更多
Traumatic carotid-cavernous arteriovenous fistula(TCCAVF)is a rare but severe cerebrovascular disorder,often resulting from head trauma with temporal bone fractures.The pathogenesis involves vessel wall injury due to ...Traumatic carotid-cavernous arteriovenous fistula(TCCAVF)is a rare but severe cerebrovascular disorder,often resulting from head trauma with temporal bone fractures.The pathogenesis involves vessel wall injury due to traction,frequently associated with fractures near the middle meningeal artery.This case highlights the typical clinical presentation,diagnostic approaches,and therapeutic management of TCCAVF,emphasizing the challenges in treating this condition.Transcatheter embolization proved effective in occluding the fistula,underscoring its role as a key intervention for traumatic meningeal arteriovenous fistulas.展开更多
BACKGROUND Post-operative infection is a common and serious complication following drugeluting trans arterial chemo embolization(D-TACE)in patients with hepatocellular carcinoma(HCC),potentially compromising treatment...BACKGROUND Post-operative infection is a common and serious complication following drugeluting trans arterial chemo embolization(D-TACE)in patients with hepatocellular carcinoma(HCC),potentially compromising treatment efficacy and increasing morbidity.AIM To investigate the risk factors associated with post-operative infection in HCC patients undergoing D-TACE,and to provide evidence for clinical prevention and targeted intervention strategies.METHODS Clinical data of 77 primary HCC patients who underwent D-TACE in our hospital from January 2022 to December 2023 were retrospectively analyzed.Patient demographics,laboratory test results,tumor characteristics,and surgery-related parameters were collected.Univariate and multivariate logistic regression analyses were performed to identify risk factors for post-operative infection.RESULTS Post-operative infection occurred in 20 cases(25.97%)among the 77 patients.Univariate analysis showed that age≥65 years,Child-Pugh grade B,tumor diameter≥5 cm,operation time≥120 minutes,preoperative albumin<35 g/L,and comorbid diabetes were significantly associated with post-operative infection(P<0.05).Multivariate logistic regression analysis identified Child-Pugh grade B(OR=2.851,95%CI:1.426-5.698),operation time≥120 minutes(OR=2.367,95%CI:1.238-4.523),and preoperative albumin<35 g/L(OR=2.156,95%CI:1.147-4.052)as independent risk factors for post-operative infection.CONCLUSION Liver function status,operation time,and preoperative albumin level are significant factors affecting post-operative infection in HCC patients undergoing D-TACE.For high-risk patients,enhanced perioperative management,appropriate timing of surgery,and active improvement of nutritional status should be implemented to reduce the risk of post-operative infection.展开更多
Objective Tumour cells in a hypoxic state are more invasive,have stronger self-renewal capabilities,and are difficult to treat because of their ability to promote tumour recurrence and metastasis.The glycolysis inhibi...Objective Tumour cells in a hypoxic state are more invasive,have stronger self-renewal capabilities,and are difficult to treat because of their ability to promote tumour recurrence and metastasis.The glycolysis inhibitor 3-bromopyruvic acid(3-BrPA)can completely inactivate glycolytic enzymes at extremely low drug concentrations,thereby exerting a strong inhibitory effect on the glucose energy metabolism of tumor cells.Therefore,we tested the inhibitory effect of 3-BrPA on hepatocellular carcinoma cells(HepG2)in vitro;then,we used the VX2 liver cancer model to study the antitumour effect of 3-BrPA combined with interventional embolization on liver cancer.Methods In vitro,a CCK-8 assay was used to detect the inhibitory effect of different concentrations of 3-BrPA on HepG2 cells,and light microscopy confirmed that the HepG2 cells were completely dead.Western blotting was used to detect the expression of key proteins involved in apoptosis.A total of 30 New Zealand white rabbits were used to establish a liver cancer model and were randomly divided into 3 groups 2 weeks after tumor establishment:the control group was perfused with saline in the hepatic artery;the transcatheter arterial embolization(TAE)group was given TAE;and the experimental group was perfused with 3-BrPA combined with TAE.The tumor-bearing rabbits were killed one week after surgery.The tumor volume and tumor necrosis ratio were calculated via the histopathological examination.Results In vitro,the inhibitory effect of 3-BrPA on HepG2 cells increased with increasing concentration.3-BrPA(100μmol/L)could induce the necrosis of HepG2 cells.Stimulation with 50μmol/L 3-BrPA could activate the tumor cell apoptosis pathway.3-BrPA combined with TAE treatment could significantly inhibit tumor growth and cause more complete tumor necrosis.Conclusion 3-BrPA not only has antitumour effects in vitro but can also significantly improve antitumour effects in the hypoxic microenvironment after embolization in vivo.展开更多
Hemoptysis is defined as bleeding originating from the respiratory tract distal to the larynx and is associated with a wide spectrum of underlying conditions,including bronchiectasis,pulmonary malignancies,tuberculosi...Hemoptysis is defined as bleeding originating from the respiratory tract distal to the larynx and is associated with a wide spectrum of underlying conditions,including bronchiectasis,pulmonary malignancies,tuberculosis,aspergillosis,and vascular malformations.^([1-3]) A metaanalysis involving patients with massive hemoptysis reported a mortality rate of 3.5%.^([4])This underscores the critical importance of prompt and eff ective embolization of the responsible artery to improve outcomes,particularly in patients presenting with life-threatening hemoptysis.展开更多
BACKGROUND Although transarterial chemoembolization(TACE)is an effective treatment for liver cancer,clinical practice has shown that many patients experience significant psychological distress following the procedure,...BACKGROUND Although transarterial chemoembolization(TACE)is an effective treatment for liver cancer,clinical practice has shown that many patients experience significant psychological distress following the procedure,which can hinder postoperative recovery and prognosis.Therefore,effective and evidence-based interventions are urgently needed to address this issue.AIM To evaluate the impact of nursing quality-sensitive indicators combined with mindfulness-based stress reduction(MBSR)interventions in patients undergoing TACE.METHODS A total of 84 patients who underwent TACE from June 2022 to March 2024 were enrolled in the study.They were randomly assigned to either the observation group(n=42),which received nursing quality-sensitive indicator-based care combined with MBSR intervention,or the control group(n=42),which received routine care combined with MBSR intervention.Psychological stress response levels[assessed using the Trait Meta-Mood Scale(TMMS)],coping strategies[measured with the Jalowiec Coping Scale(JCS)],quality of care[evaluated using the Perceived Nursing Service Quality(PNSQ)scale],and overall patient satisfaction were compared between the two groups.RESULTS After 4 weeks,the observation group demonstrated significantly higher TMMS scores,as well as increased optimism,support-seeking,bravery,PNSQ scores,and satisfaction(P<0.05).In contrast,scores for selfdependence,conservatism,resignation,and avoidance in the JCS were significantly lower in the observation group than in the control group(P<0.05).CONCLUSION The combination of nursing quality-sensitive indicators and MBSR intervention in TACE patients not only reduces psychological stress and encourages a more positive attitude toward illness but also enhances nursing quality and improves the overall patient experience.展开更多
Aortic saddle embolism(ASE)is a rare but catastrophic vascular emergency characterized by acute occlusion of the aortic bifurcation,leading to bilateral lower limb ischemia and multiorgan dysfunction.Despite advances ...Aortic saddle embolism(ASE)is a rare but catastrophic vascular emergency characterized by acute occlusion of the aortic bifurcation,leading to bilateral lower limb ischemia and multiorgan dysfunction.Despite advances in imaging and surgical techniques,ASE has high morbidity and mortality rates,particularly when diagnosis or intervention is delayed.Here,we report two patients admitted to our center to increase awareness among emergency physicians.展开更多
This study explored the therapeutic targets and molecular mechanisms of Huangqi Guizhi Decoction (HGD) in alleviatingpulmonary embolism (PE) by employing network pharmacology and molecular docking techniques. Firstly,...This study explored the therapeutic targets and molecular mechanisms of Huangqi Guizhi Decoction (HGD) in alleviatingpulmonary embolism (PE) by employing network pharmacology and molecular docking techniques. Firstly, the effective activecomponents of the Chinese herbs in HGD were retrieved from the Traditional Chinese Medicine Systems Pharmacology Database(TCMSP), and their potential therapeutic targets were predicted using the Swiss Target Prediction platform. Subsequently, PErelatedtarget genes were obtained from the Online Mendelian Inheritance in Man (OMIM) database and GeneCards database.Then, the Wei Sheng Xin tool was used to generate a Venn diagram for identifying the common targets between the herb-relatedtargets and PE-related targets. After screening these common targets, a “drug-component-target network” and a protein-proteininteraction (PPI) network were constructed. Furthermore, Gene Ontology (GO) enrichment analysis and Kyoto Encyclopedia ofGenes and Genomes (KEGG) enrichment analysis were conducted on the intersecting targets, and molecular docking verificationwas performed using AutoDockTools and PyMol software. Finally, 20 active components were screened from Astragali Radix, 7from Cinnamomi Ramulus, 13 from Paeoniae Radix Alba, 5 from Zingiberis Rhizoma Recens, and 29 from Jujubae Fructus, witha total of 983 therapeutic targets. Among these targets, 134 were associated with PE, and protein kinase B1 (AKT1), mitogenactivatedprotein kinase 1 (MAPK1), and transformation-related protein 53 (TP53) served as the core targets. The results of GOand KEGG enrichment analyses indicated that the alleviation of PE by HGD is mainly related to pathways including immuneresponse, regulation of gene expression, atherosclerosis, and tumorigenesis. Molecular docking results showed that the keyactive components in HGD could bind to the core targets spontaneously and stably. This study revealed that HGD may alleviatesymptoms in PE patients by regulating signaling pathways, modulating platelet function to exert anticoagulant effects, andregulating the expression of anti-inflammatory genes, which provided a direction for subsequent experimental research.展开更多
Objective： To evaluate the clinical application of superselective transcatheter arterial embolization （TAE） in nasopharyngeal angiofibroma before operation. Methods： Superselective angiography was done via femoral...Objective： To evaluate the clinical application of superselective transcatheter arterial embolization （TAE） in nasopharyngeal angiofibroma before operation. Methods： Superselective angiography was done via femoral. TAE with polyvinyl alcohol particles and/or gelfoam （GF） was performed in 12 patients with nasopharyngeal angiofibroma. All patients underwent surgical removal of devascularized tumors in 3 to 7 days after TAE. Results： During digital subtraction angiography, tumor staining was seen in 12 patients. Embolization of maxillary artery was performed in 12 cases and additional embolization of ascending pharyngeal artery in 8 cases. Conclusion： Superselective angiographic diagnosis, embolization and appropriate embolic particle size are important for successful treatment of nasopharyngeal angiofibroma. TAE is safe and effective in decreasing haemorrhage during surgical operation for nasopharyngeal angiofibroma.展开更多
Herein,the orthogonal test was used to optimize the preparation conditions and technique of mitoxantrone ethylcellulose microsphere fDHAQ-EC-MS)for liver arterial embolization.The dynamic dialysis method was used to s...Herein,the orthogonal test was used to optimize the preparation conditions and technique of mitoxantrone ethylcellulose microsphere fDHAQ-EC-MS)for liver arterial embolization.The dynamic dialysis method was used to study the drug release characteristics ofthe DRAQ-EC-MS.The suspension of DHAQ-EC-MS for clinical liver arterial embolization was prepared.The results show that the DHAQ-EC-MS is regular in morphology with a mean diameter of 110.24 ± 38.19μm and 86.5% of them within the range of 40-150μm,The drug loading is 12.5% and the embedding ratio is 55.6%. The release characteristics were in accordance with the single exponential model.The drug release equation is log(Y∞-Y)=-0.116t-1.198 × 10￣(-3)(r=0.9992,t(50)=2.6h).The suspension is ofstable physical and chemical properties and is suitable for clinical use.展开更多
AIMS To study the histopathological changes in hepatocellular carcinoma (HCC) after transcatheter arterial embolization (TAE). METHODS Histopathological analysis was made in 39 cases of liver neoplasms after TAE an...AIMS To study the histopathological changes in hepatocellular carcinoma (HCC) after transcatheter arterial embolization (TAE). METHODS Histopathological analysis was made in 39 cases of liver neoplasms after TAE and 11 cases of liver neoplasms after digital selective angiography (DSA), including pathological type, histological grade, necrotic degree, capsule, times of treatment, injured vessel and lymphocyte infiltration. RESULTS Six cases with 100% necrosis, 14 cases with 30% 95% necrosis, 19 cases with 0% 5% necrosis after TAE and 11 cases without necrosis after DSA were found histologically. The necrosis was related to the pathological type, capsule, injured vessels, but not to the histological grade, time of treatment and lymphocyte infiltration of the liver neoplasms. CONCLUSIONS TAE is an effective therapy for the late stage HCC. The encapsulated HCC is a preferable indicator for TAE.展开更多
Transarterial chemoembolization(TACE)is the first line treatment for patients with intermediate stage hepatocellular carcinoma but is also increasingly being used for patients on the transplant waiting list to prevent...Transarterial chemoembolization(TACE)is the first line treatment for patients with intermediate stage hepatocellular carcinoma but is also increasingly being used for patients on the transplant waiting list to prevent further tumor growth.Despite its widespread use,TACE remains an unstandardized procedure,with variation in type and size of embolizing particles,type and dose of chemotherapy and interval between therapies.Existing evidence from randomized controlled trials suggest that bland transarterial embolization(TAE)has the same efficacy with TACE.In the current article,we review the use of TACE and TAE for hepatocellular carcinoma and we focus on the evidence for their use.展开更多
AIM: To evaluate clinical outcomes of patients that underwent surgery, transarterial embolization (TAE), or supportive care for spontaneously ruptured hepatocellular carcinoma (HCC). METHODS: A consecutive 54 patients...AIM: To evaluate clinical outcomes of patients that underwent surgery, transarterial embolization (TAE), or supportive care for spontaneously ruptured hepatocellular carcinoma (HCC). METHODS: A consecutive 54 patients who diagnosed as spontaneously ruptured HCC at our institution between 2003 and 2012 were retrospectively enrolled. HCC was diagnosed based on the diagnostic guidelines issued by the 2005 American Association for the Study of Liver Diseases. HCC rupture was defined as disruption of the peritumoral liver capsule with enhanced fluid collection in the perihepatic area adjacent to the HCC by dynamic liver computed tomography, and when abdominal paracentesis showed an ascitic red blood cell count of > 50000 mm 3 /mL in bloody fluid. RESULTS: Of the 54 patients, 6 (11.1%) underwent surgery, 25 (46.3%) TAE, and 23 (42.6%) supportive care. The 2-, 4and 6-mo cumulative survival rates at 2, 4 and 6 mo were significantly higher in the surgery (60%, 60% and 60%) or TAE (36%, 20% and 20%) groups than in the supportive care group (8.7%, 0% and 0%), respectively (each, P < 0.01), and tended to be higher in the surgical group than in the TAE group. Multivariate analysis showed that serum bilirubin (HR = 1.09, P < 0.01), creatinine (HR = 1.46, P = 0.04), and vasopressor requirement (HR = 2.37, P = 0.02) were significantly associated with post-treatment mortality, whereas surgery (HR = 0.41, P < 0.01), and TAE (HR = 0.13, P = 0.01) were inversely associated with posttreatment mortality. CONCLUSION: Post-treatment survival after surgery or TAE was found to be better than after supportive care, and surgery tended to provide better survival benefit than TAE.展开更多
文摘BACKGROUND Middle meningeal artery embolization(MMAE)is emerging as a promising treatment for chronic subdural hematoma(CSDH),serving both as an adjunct to surgery and as a primary therapeutic option depending on patient presentation.Due to its low recurrence rate and minimal complications,MMAE has gained increasing acceptance among clinicians in recent years.This report presents a case of diplopia following MMAE due to the presence of a potential anastomotic artery,aiming to enhance awareness of this complication.CASE SUMMARY A 60-year-old male patient presented with a headache following head trauma,and cranial computed tomography revealed a left-sided CSDH.The patient underwent left MMAE;however,polyvinyl alcohol particles inadvertently flowed into the lacrimal artery through an anastomotic artery,resulting in diplopia due to impaired abduction of the left eye.The diplopia resolved by postoperative day 40.The patient’s headache resolved by postoperative day 7,and the hematoma completely resolved by postoperative day 108.CONCLUSION Potential anastomotic arteries in the middle meningeal artery(MMA)can lead to serious complications.Superselective angiography of the MMA or its branches prior to embolization is essential.Performing embolization distal to potential anastomotic sites can reduce risks,and the presence of an anastomosis may warrant coil embolization or termination of the procedure.
文摘Middle meningeal artery embolization(MMAE)has revolutionized chronic subdural hematoma management,yet procedural risks persist due to anatomical variability.We analyze a case report by Zhao et al describing transient diplopia caused by inadvertent embolization of the lacrimal artery via a dynamic middle meningeal–ophthalmic anastomosis.This correspondence advances three critical innovations in MMAE safety.First,intraoperative anastomotic unmasking—exposing occult middle meningeal-ophthalmic collaterals during particle injection—reveals dynamic vascular behavior missed by preoperative angiography,underscoring the need for adaptive imaging protocols.Second,hybrid embolization(liquid agents for proximal occlusion+particles for distal control)balances precision and safety,reducing reflux risks compared to monotherapy.Third,a 108-day follow-up establishes a benchmark for functional recovery,challenging assumptions about irreversible cranial nerve injuries and emphasizing structured postprocedural care.Collectively,these findings advocate for procedural agility,multimodal embolic strategies,and sustained rehabilitation to optimize MMAE outcomes while minimizing iatrogenic harm.
文摘The Kakinuma et al’s case report shows that non-pregnancy-related arterial pseudoaneurysm is a relatively rare,little known by some gynecologists,endo-scopists,surgeons or radiologists,which can cause massive bleeding.Arterial pseudoaneurysm is a condition in which the wall of a blood vessel collapses due to some invasive event,and the resulting leaked blood is engulfed by soft tissues,forming a cavity that is in communication with the vessel.It is a potentially life-threatening complication that could occurs after some deliveries and some gynecological invasive procedures.Remarkably,an undetermined percentage of pseudoaneurysms are asymptomatic,and in an asymptomatic patient it is difficult to predict the risk of haemorrhage and the attitude to follow,which depends on several factors,such as,the size and location of the vessel involved,changes in the size of the pseudoaneurysm,or the available therapeutic resources to be offered to patients,among others circumstances.The management of abdominal arterial pseudoaneurysm does not have consistent scientific evidence,but it seems that,regardless of the associated circumstances,the pseudoaneurysm could be treated at least initially,and mainly,through endovascular procedures,as done by Kakinuma et al.
基金National Natural Science Foundation of China,No.82200686Shaanxi Provincial People's Hospital Incubation Project,No.2022YJY-14.
文摘BACKGROUND Acute cholecystitis due to unintended cystic artery embolism is an uncommon and mostly self-limiting complication after transarterial chemoembolization procedure for treatment of hepatocellular carcinoma.Usually,conservative management is sufficient for complete recovery of patients who develop this complication.If conservative treatment is ineffective,urgent surgical inter-vention may be required to prevent the progression of complications.CASE SUMMARY This article reports a rare and serious case of acute cholecystitis complicated by gallbladder necrosis and biliary peritonitis,which was initially treated conservatively but eventually necessitated emergency laparotomy.The patient initially presented with equivocal symptoms of fever and upper abdominal pain and distention,which worsened at the two weeks mark along with emergence of signs of peritonitis.This was managed by emergency laparotomy and cholecystostomy,allowing rapid symptom relief.The patient ultimately discharged and succumbed to advanced liver cancer 11 months after diagnosis.CONCLUSION After cholecystostomy,the patient showed symptom relief and was discharged,surviving 11 months post-stage IIIB liver cancer diagnosis.
基金approved by Chungbuk National University Hospital Institutional Review Board in Cheongju,Chugbuk,South Korea(No.CBNUH2022-09-013-HE001).
文摘BACKGROUND Hepatic encephalopathy(HE)affects more than 30%of patients with cirrhosis.Extrahepatic portosystemic shunt(EHPSS)has been suggested to be a contributing factor to HE recurrence and mortality.Therefore,early detection and intervention in EHPSS may improve patient outcomes.AIM To evaluate the effects of shunt embolization on mortality and HE recurrence.METHODS In this retrospective case-control study,16 cirrhotic patients with HE treated at a tertiary care center from January 2012 to August 2022 were included.Outcomes in eight patients who underwent embolization of EHPSS were compared with those in eight patients receiving standard care without embolization.Data on baseline characteristics,HE recurrence,and overall survival were collected and analyzed using Kaplan-Meier and log-rank tests.RESULTS Baseline characteristics were comparable between the groups.The 1-year overall survival rate was significantly higher in the treatment group(0.50)than in the control group(0.33).The HE recurrence-free rate was also higher in the treatment group(1.00)than in the control group(0.17).The median survival duration was longer in the treatment group{not reached[95%confidence interval(CI):23.84 to not available(NA)]}than in the control group[15.02 months(95%CI:9.86 to NA)](P=0.006).Similarly,the recurrence-free duration was longer in the treatment group[63.09 months(95%CI:63.09 to NA)]than in the control group[9.21 months(95%CI:4.47 to NA)](P=0.006).EHPSS embolization significantly reduced 1-year HE recurrence(hazard ratio=0.09;95%CI:0.01-0.75;P=0.026).CONCLUSION EHPSS embolization significantly improves 1-year survival and prevents recurrence of HE in cirrhotic patients.Routine computed tomography and early embolization are clinically beneficial.
基金supported by the Hubei Province Nature Science Foundation of China(Grant No.:2023AFB1077)the National Natural Science Foundation of China(Grant No.:82003308)+2 种基金the Doctoral Start-up Fund Project of Hubei University of Science and Technology,China(Grant No.:BK202118)the Innovation team and Medical research program of Hubei University of Science and Technology,China(Grant Nos.:2023T10 and 2022YKY05)the Hubei Province Key R&D Plan Big Health Local Special Project,China(Grant No.:2022BCE042).
文摘Transcatheter arterial embolization(TAE)is the mainstay for treating advanced hepatocellular carcinoma(HCC),and the performance of the embolization material is crucial in TAE.With the development of medical imaging and the birth of“X-ray-free”technologies,we designed a new dual-mode imaging material of dimethoxy tetraphenyl ethylene(DMTPE)via emulsification by mixing poly(N-isopropylacrylamide-co-acrylic acid)(PNA)with lipiodol and fluorocarbons,which was evaluated for temperature sensitivity,stability,and dual-mode visualization in vitro.Additionally,blood vessel casting embolization and renal artery imaging were assessed in healthy rabbits.In a rabbit model with a VX2 tumor,the effectiveness of TAE for treating HCC was examined,with an emphasis on evaluating long-term outcomes of embolization and its effects on tumor growth,necrosis,and proliferation through imaging techniques.In vitro experiments confirmed that the temperature-sensitive dual-oil-phase Pickering emulsion had good flow,stable contrast,and embolism when the oil-to-oil ratio and water-to-oil ratio were both 7:3(v/v)and stabilized with 8%PNA.Similarly,in vivo,arterial embolization confirmed the excellent properties of DMTPE prepared at the abovementioned ratios.It was observed that DMTPE not only has an antitumor effect but can also achieve dual imaging using X-rays and ultrasound,making it a promising excellent vascular embolization material for TAE in tumor treatment.
基金Supported by Tengfei Project of Third Affiliated Hospital of the Naval Medical University,No.TF2024TJYQ02.
文摘BACKGROUND Hemorrhage following pancreaticobiliary surgery is a high-risk complication,with a mortality rate of 16%-38%.At present,minimally invasive endovascular intervention comprising superselective arterial embolization(SAE)and covered stent implantation(CSI)is the treatment of choice.However,in certain cases,both SAE and CSI become infeasible.AIM To evaluate the effectiveness of coil-assisted N-butyl cyanoacrylate(NBCA)embolization in comparison with that of CSI in managing delayed hemorrhage after hepatobiliary–pancreatic surgery when SAE is infeasible.METHODS Ninety-eight continuous patients(n=105 cases;mean age,58.4 years)with delayed massive hemorrhage who were treated with coil-assisted NBCA embolization(NBCA group,n=45)and/or CSI(CSI group,n=60)were retrospectively evaluated between March 2014 and December 2023.Data on technical and clinical success,30-day mortality,and severe intervention-related adverse events were collected and analyzed.RESULTS The technical and clinical success rates in the NBCA group(100%and 93.3%,respectively)were significantly higher than those in the CSI group(88.3%and 73.3%,respectively),with a statistically significant difference between the two groups(P=0.019 and 0.010,respectively).The 30-day mortality rates and major intervention-related complications were 17.8%and 0%,respectively,in the NBCA group and 18.3%and 1.7%in the CSI group,respectively,with no statistically significant difference between the two groups.CONCLUSION In terms of technical and clinical success,coil-assisted NBCA embolization was more effective than CSI for managing delayed hemorrhage after hepatobiliary–pancreatic surgery when SAE was not feasible.
文摘Endoscopic ultrasound(EUS)guided vascular interventions have expanded the reach of therapeutic endoscopy to include vascular pathology previously inaccessible by endoscopists.Gastric variceal bleeding comprises 20%of all variceal bleeding and is associated with high morbidity and mortality.Historically,endoscopic injection of thrombosis-inducing agents such as glue has been used.However,glue injection carries potential risks including systemic embolization,damage to the endoscope,and recurrent bleeding.The introduction of hemostatic coils has revolutionized the endoscopic approach,with EUS-guided coil embolization emerging as an effective and safe modality for the management of gastric varices(GVs).When compared with conventional glue injection,EUSguided embolization is associated with improved visualization,higher efficacy,and better safety profile.Despite its expanding adoption,the standardization of EUS guided embolization remains a challenge.High-quality studies are needed to standardize this promising technique and define its role in clinical practice.In this review,we will discuss the indications,efficacy,techniques,and various approaches for EUS-guided embolization of GVs.
文摘Traumatic carotid-cavernous arteriovenous fistula(TCCAVF)is a rare but severe cerebrovascular disorder,often resulting from head trauma with temporal bone fractures.The pathogenesis involves vessel wall injury due to traction,frequently associated with fractures near the middle meningeal artery.This case highlights the typical clinical presentation,diagnostic approaches,and therapeutic management of TCCAVF,emphasizing the challenges in treating this condition.Transcatheter embolization proved effective in occluding the fistula,underscoring its role as a key intervention for traumatic meningeal arteriovenous fistulas.
文摘BACKGROUND Post-operative infection is a common and serious complication following drugeluting trans arterial chemo embolization(D-TACE)in patients with hepatocellular carcinoma(HCC),potentially compromising treatment efficacy and increasing morbidity.AIM To investigate the risk factors associated with post-operative infection in HCC patients undergoing D-TACE,and to provide evidence for clinical prevention and targeted intervention strategies.METHODS Clinical data of 77 primary HCC patients who underwent D-TACE in our hospital from January 2022 to December 2023 were retrospectively analyzed.Patient demographics,laboratory test results,tumor characteristics,and surgery-related parameters were collected.Univariate and multivariate logistic regression analyses were performed to identify risk factors for post-operative infection.RESULTS Post-operative infection occurred in 20 cases(25.97%)among the 77 patients.Univariate analysis showed that age≥65 years,Child-Pugh grade B,tumor diameter≥5 cm,operation time≥120 minutes,preoperative albumin<35 g/L,and comorbid diabetes were significantly associated with post-operative infection(P<0.05).Multivariate logistic regression analysis identified Child-Pugh grade B(OR=2.851,95%CI:1.426-5.698),operation time≥120 minutes(OR=2.367,95%CI:1.238-4.523),and preoperative albumin<35 g/L(OR=2.156,95%CI:1.147-4.052)as independent risk factors for post-operative infection.CONCLUSION Liver function status,operation time,and preoperative albumin level are significant factors affecting post-operative infection in HCC patients undergoing D-TACE.For high-risk patients,enhanced perioperative management,appropriate timing of surgery,and active improvement of nutritional status should be implemented to reduce the risk of post-operative infection.
基金National Natural Science Foundation of China(No.82202281)for the funding support,and Yu-miao Wei for his review of the manuscript.
文摘Objective Tumour cells in a hypoxic state are more invasive,have stronger self-renewal capabilities,and are difficult to treat because of their ability to promote tumour recurrence and metastasis.The glycolysis inhibitor 3-bromopyruvic acid(3-BrPA)can completely inactivate glycolytic enzymes at extremely low drug concentrations,thereby exerting a strong inhibitory effect on the glucose energy metabolism of tumor cells.Therefore,we tested the inhibitory effect of 3-BrPA on hepatocellular carcinoma cells(HepG2)in vitro;then,we used the VX2 liver cancer model to study the antitumour effect of 3-BrPA combined with interventional embolization on liver cancer.Methods In vitro,a CCK-8 assay was used to detect the inhibitory effect of different concentrations of 3-BrPA on HepG2 cells,and light microscopy confirmed that the HepG2 cells were completely dead.Western blotting was used to detect the expression of key proteins involved in apoptosis.A total of 30 New Zealand white rabbits were used to establish a liver cancer model and were randomly divided into 3 groups 2 weeks after tumor establishment:the control group was perfused with saline in the hepatic artery;the transcatheter arterial embolization(TAE)group was given TAE;and the experimental group was perfused with 3-BrPA combined with TAE.The tumor-bearing rabbits were killed one week after surgery.The tumor volume and tumor necrosis ratio were calculated via the histopathological examination.Results In vitro,the inhibitory effect of 3-BrPA on HepG2 cells increased with increasing concentration.3-BrPA(100μmol/L)could induce the necrosis of HepG2 cells.Stimulation with 50μmol/L 3-BrPA could activate the tumor cell apoptosis pathway.3-BrPA combined with TAE treatment could significantly inhibit tumor growth and cause more complete tumor necrosis.Conclusion 3-BrPA not only has antitumour effects in vitro but can also significantly improve antitumour effects in the hypoxic microenvironment after embolization in vivo.
文摘Hemoptysis is defined as bleeding originating from the respiratory tract distal to the larynx and is associated with a wide spectrum of underlying conditions,including bronchiectasis,pulmonary malignancies,tuberculosis,aspergillosis,and vascular malformations.^([1-3]) A metaanalysis involving patients with massive hemoptysis reported a mortality rate of 3.5%.^([4])This underscores the critical importance of prompt and eff ective embolization of the responsible artery to improve outcomes,particularly in patients presenting with life-threatening hemoptysis.
文摘BACKGROUND Although transarterial chemoembolization(TACE)is an effective treatment for liver cancer,clinical practice has shown that many patients experience significant psychological distress following the procedure,which can hinder postoperative recovery and prognosis.Therefore,effective and evidence-based interventions are urgently needed to address this issue.AIM To evaluate the impact of nursing quality-sensitive indicators combined with mindfulness-based stress reduction(MBSR)interventions in patients undergoing TACE.METHODS A total of 84 patients who underwent TACE from June 2022 to March 2024 were enrolled in the study.They were randomly assigned to either the observation group(n=42),which received nursing quality-sensitive indicator-based care combined with MBSR intervention,or the control group(n=42),which received routine care combined with MBSR intervention.Psychological stress response levels[assessed using the Trait Meta-Mood Scale(TMMS)],coping strategies[measured with the Jalowiec Coping Scale(JCS)],quality of care[evaluated using the Perceived Nursing Service Quality(PNSQ)scale],and overall patient satisfaction were compared between the two groups.RESULTS After 4 weeks,the observation group demonstrated significantly higher TMMS scores,as well as increased optimism,support-seeking,bravery,PNSQ scores,and satisfaction(P<0.05).In contrast,scores for selfdependence,conservatism,resignation,and avoidance in the JCS were significantly lower in the observation group than in the control group(P<0.05).CONCLUSION The combination of nursing quality-sensitive indicators and MBSR intervention in TACE patients not only reduces psychological stress and encourages a more positive attitude toward illness but also enhances nursing quality and improves the overall patient experience.
文摘Aortic saddle embolism(ASE)is a rare but catastrophic vascular emergency characterized by acute occlusion of the aortic bifurcation,leading to bilateral lower limb ischemia and multiorgan dysfunction.Despite advances in imaging and surgical techniques,ASE has high morbidity and mortality rates,particularly when diagnosis or intervention is delayed.Here,we report two patients admitted to our center to increase awareness among emergency physicians.
基金supported by Research Project on Traditional Chinese Medicine in Heilongjiang Province in 2025(Research on the pharmacological substance basis of Huangqi Guizhi decoction in improving acute pulmonary embolism and lung injury based on the theory of“Diaphoresis and expanding meridian”No.ZHY2025-043).
文摘This study explored the therapeutic targets and molecular mechanisms of Huangqi Guizhi Decoction (HGD) in alleviatingpulmonary embolism (PE) by employing network pharmacology and molecular docking techniques. Firstly, the effective activecomponents of the Chinese herbs in HGD were retrieved from the Traditional Chinese Medicine Systems Pharmacology Database(TCMSP), and their potential therapeutic targets were predicted using the Swiss Target Prediction platform. Subsequently, PErelatedtarget genes were obtained from the Online Mendelian Inheritance in Man (OMIM) database and GeneCards database.Then, the Wei Sheng Xin tool was used to generate a Venn diagram for identifying the common targets between the herb-relatedtargets and PE-related targets. After screening these common targets, a “drug-component-target network” and a protein-proteininteraction (PPI) network were constructed. Furthermore, Gene Ontology (GO) enrichment analysis and Kyoto Encyclopedia ofGenes and Genomes (KEGG) enrichment analysis were conducted on the intersecting targets, and molecular docking verificationwas performed using AutoDockTools and PyMol software. Finally, 20 active components were screened from Astragali Radix, 7from Cinnamomi Ramulus, 13 from Paeoniae Radix Alba, 5 from Zingiberis Rhizoma Recens, and 29 from Jujubae Fructus, witha total of 983 therapeutic targets. Among these targets, 134 were associated with PE, and protein kinase B1 (AKT1), mitogenactivatedprotein kinase 1 (MAPK1), and transformation-related protein 53 (TP53) served as the core targets. The results of GOand KEGG enrichment analyses indicated that the alleviation of PE by HGD is mainly related to pathways including immuneresponse, regulation of gene expression, atherosclerosis, and tumorigenesis. Molecular docking results showed that the keyactive components in HGD could bind to the core targets spontaneously and stably. This study revealed that HGD may alleviatesymptoms in PE patients by regulating signaling pathways, modulating platelet function to exert anticoagulant effects, andregulating the expression of anti-inflammatory genes, which provided a direction for subsequent experimental research.
文摘Objective： To evaluate the clinical application of superselective transcatheter arterial embolization （TAE） in nasopharyngeal angiofibroma before operation. Methods： Superselective angiography was done via femoral. TAE with polyvinyl alcohol particles and/or gelfoam （GF） was performed in 12 patients with nasopharyngeal angiofibroma. All patients underwent surgical removal of devascularized tumors in 3 to 7 days after TAE. Results： During digital subtraction angiography, tumor staining was seen in 12 patients. Embolization of maxillary artery was performed in 12 cases and additional embolization of ascending pharyngeal artery in 8 cases. Conclusion： Superselective angiographic diagnosis, embolization and appropriate embolic particle size are important for successful treatment of nasopharyngeal angiofibroma. TAE is safe and effective in decreasing haemorrhage during surgical operation for nasopharyngeal angiofibroma.
文摘Herein,the orthogonal test was used to optimize the preparation conditions and technique of mitoxantrone ethylcellulose microsphere fDHAQ-EC-MS)for liver arterial embolization.The dynamic dialysis method was used to study the drug release characteristics ofthe DRAQ-EC-MS.The suspension of DHAQ-EC-MS for clinical liver arterial embolization was prepared.The results show that the DHAQ-EC-MS is regular in morphology with a mean diameter of 110.24 ± 38.19μm and 86.5% of them within the range of 40-150μm,The drug loading is 12.5% and the embedding ratio is 55.6%. The release characteristics were in accordance with the single exponential model.The drug release equation is log(Y∞-Y)=-0.116t-1.198 × 10￣(-3)(r=0.9992,t(50)=2.6h).The suspension is ofstable physical and chemical properties and is suitable for clinical use.
文摘AIMS To study the histopathological changes in hepatocellular carcinoma (HCC) after transcatheter arterial embolization (TAE). METHODS Histopathological analysis was made in 39 cases of liver neoplasms after TAE and 11 cases of liver neoplasms after digital selective angiography (DSA), including pathological type, histological grade, necrotic degree, capsule, times of treatment, injured vessel and lymphocyte infiltration. RESULTS Six cases with 100% necrosis, 14 cases with 30% 95% necrosis, 19 cases with 0% 5% necrosis after TAE and 11 cases without necrosis after DSA were found histologically. The necrosis was related to the pathological type, capsule, injured vessels, but not to the histological grade, time of treatment and lymphocyte infiltration of the liver neoplasms. CONCLUSIONS TAE is an effective therapy for the late stage HCC. The encapsulated HCC is a preferable indicator for TAE.
文摘Transarterial chemoembolization(TACE)is the first line treatment for patients with intermediate stage hepatocellular carcinoma but is also increasingly being used for patients on the transplant waiting list to prevent further tumor growth.Despite its widespread use,TACE remains an unstandardized procedure,with variation in type and size of embolizing particles,type and dose of chemotherapy and interval between therapies.Existing evidence from randomized controlled trials suggest that bland transarterial embolization(TAE)has the same efficacy with TACE.In the current article,we review the use of TACE and TAE for hepatocellular carcinoma and we focus on the evidence for their use.
文摘AIM: To evaluate clinical outcomes of patients that underwent surgery, transarterial embolization (TAE), or supportive care for spontaneously ruptured hepatocellular carcinoma (HCC). METHODS: A consecutive 54 patients who diagnosed as spontaneously ruptured HCC at our institution between 2003 and 2012 were retrospectively enrolled. HCC was diagnosed based on the diagnostic guidelines issued by the 2005 American Association for the Study of Liver Diseases. HCC rupture was defined as disruption of the peritumoral liver capsule with enhanced fluid collection in the perihepatic area adjacent to the HCC by dynamic liver computed tomography, and when abdominal paracentesis showed an ascitic red blood cell count of > 50000 mm 3 /mL in bloody fluid. RESULTS: Of the 54 patients, 6 (11.1%) underwent surgery, 25 (46.3%) TAE, and 23 (42.6%) supportive care. The 2-, 4and 6-mo cumulative survival rates at 2, 4 and 6 mo were significantly higher in the surgery (60%, 60% and 60%) or TAE (36%, 20% and 20%) groups than in the supportive care group (8.7%, 0% and 0%), respectively (each, P < 0.01), and tended to be higher in the surgical group than in the TAE group. Multivariate analysis showed that serum bilirubin (HR = 1.09, P < 0.01), creatinine (HR = 1.46, P = 0.04), and vasopressor requirement (HR = 2.37, P = 0.02) were significantly associated with post-treatment mortality, whereas surgery (HR = 0.41, P < 0.01), and TAE (HR = 0.13, P = 0.01) were inversely associated with posttreatment mortality. CONCLUSION: Post-treatment survival after surgery or TAE was found to be better than after supportive care, and surgery tended to provide better survival benefit than TAE.
