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
Portal vein embolization(PVE)is currently considered the standard of care to improve the volume of an inadequate future remnant liver(FRL)and decrease the risk of post-hepatectomy liver failure(PHLF).PHLF remains a si...Portal vein embolization(PVE)is currently considered the standard of care to improve the volume of an inadequate future remnant liver(FRL)and decrease the risk of post-hepatectomy liver failure(PHLF).PHLF remains a significant limitation in performing major liver surgery and is the main cause of mortality after resection.The degree of hypertrophy obtained after PVE is variable and depends on multiple factors.Up to 20%of patients fail to undergo the planned surgery because of either an inadequate FRL growth or tumor progression after the PVE procedure(usually 6-8 wk are needed before surgery).The management of PVE failure is still debated,with a lack of consensus regarding the best clinical strategy.Different additional techniques have been proposed,such as sequential transarterial chemoembolization followed by PVE,segment 4 PVE,intra-portal administration of stem cells,dietary supplementation,and hepatic vein embolization.The aim of this review is to summarize the up-to-date strategies to overcome such difficult situations and discuss future perspectives on improving FRL hypertrophy.展开更多
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
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
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
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 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
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
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 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
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
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
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
Objective:The aim of this study was to evaluate the predictor of unsuccessful outcome of renal angioembolization(RAE).Knowing those predictors may help in avoiding unnecessary RAE procedures and their associated side ...Objective:The aim of this study was to evaluate the predictor of unsuccessful outcome of renal angioembolization(RAE).Knowing those predictors may help in avoiding unnecessary RAE procedures and their associated side effects,while helping to prepare for an alternate procedure and improving patient's overall satisfaction.Methods:A retrospective analysis between January 2006 and December 2018 was performed,and the indications for RAE were classified into post-traumatic,iatrogenic,renal tumors,and spontaneous.Patients who underwent RAE prior to nephrectomy were eliminated.Computed tomography angiography was performed in patients with normal renal function and those who had no contrast allergy,otherwise magnetic resonance angiography was performed.For the purpose of statistical analysis,we stratified patients into two main categories based on the final outcome—successful or failed.Results:Of 180 patients,32 with negative angiography were eliminated,leaving 148 patients;136(91%)had successful outcomes after one or more trials and 12 had unsuccessful outcomes.The mean age was 45±15 years,and 105(71%)were male.Neither gender,side of the lesion,presence of hematuria,indication for RAE,nor the type of lesion affected the outcome.On the other hand,renal anatomy with presence of accessory artery was the only predictor to failed RAE(p=0.001).Failed RAE trial was a predictor for nephrectomy as a secondary procedure(p=0.03).Conclusion:No pre-procedural predictors could anticipate the RAE outcome,and different indications can be scheduled to RAE,which is equally effective.The presence of accessory renal artery on diagnostic angiography is the only factor that may predict the failure of the procedure.展开更多
AIM: To prospectively evaluate the effi cacy and safety of partial splenic embolization (PSE) combined with transcatheter hepatic arterial chemoembolization (TACE) in treatment of hepatocellular carcinoma (HCC). METHO...AIM: To prospectively evaluate the effi cacy and safety of partial splenic embolization (PSE) combined with transcatheter hepatic arterial chemoembolization (TACE) in treatment of hepatocellular carcinoma (HCC). METHODS: Fifty patients suffering from primary HCC associated with hypersplenism caused by cirrhosis were randomly assigned to 2 groups: group A receiving PSE combined with TACE (n = 26) and group B receiving TACE alone (n = 24). Follow-up examinations included calculation of peripheral blood cells (leukcytes, platelets and red blood cells) and treatment-associated complications. RESULTS: Prior to treatment, there was no signifi cant difference in sex, age, Child-Pugh grade, tumor diameter, mass pathology type and peripheral blood cell counts between the 2 groups. After treatment, leukocyte and platelet counts were significantly higher in group A during the 3-mo follow-up period (P < 0.05), but lower in group B (P < 0.05). Severe complications occurred in 3 patients (11.5%) of group A and in 19 patients (79.2%) of group B (P < 0.05), and there was no significant difference in symptoms of post-embolization syndrome, including abdominal pain, fever, mild nausea and vomiting between the 2 groups (P > 0.05). CONCLUSION: PSE combined with TACE is more effective and safe than TACE alone for patients with HCC associated with hypersplenism caused by cirrhosis.展开更多
Objective：Transcatheter arterial chemoembolization （TACE） is a standard treatment for hepatocellular carcinoma （HCC） and/or some unresectable liver metastasis tumors.Hypervascular liver metastatic lesions such as...Objective：Transcatheter arterial chemoembolization （TACE） is a standard treatment for hepatocellular carcinoma （HCC） and/or some unresectable liver metastasis tumors.Hypervascular liver metastatic lesions such as metastasis from gastrointestinal stromal tumor （GIST） are an indication for transcatheter arterial embolization （TAE）.The purpose of this study was to evaluate the efficacy and safety of Embosphere（㊣）-TAE （Embo-TAE） in comparison with conventional TACE （cTACE） for the treatment of liver metastasis from GIST.Methods：A total of 45 patients who underwent TACE between Aug 2008 and Feb 2013 were enrolled.Patients with GIST who underwent TAE with Embosphere（㊣） （n=19） were compared with controls who received cTACE （n=26）.The primary end points were treatment response and treatment-related adverse events.The secondary end points were progression-free survival （PFS） and overall survival （OS）.Results：The treatment response of Embo-TAE group was significandy higher than that of the cTACE group （P＜0.001）.The PFS was significandy better in the Embosphere（㊣）-group than in the cTACE group （56.6 and 42.1 weeks,respectively; P=0.003）.However,there was no statistically significant difference in liver toxicity between the two groups （P＞0.05）.The median OS in the Embo-TAE group was longer than that in the cTACE group （74.0 weeks,95％ CI：68.2-79.8 vs.61.7 weeks,95％ CI：56.2-67.2 weeks） （unadjusted P=0.045）.The use of Embo-TAE significantly reduced the risk of death in patients with GIST with liver metastases according to the Cox proportonal hazards regression model [hazard ratio （HR）：0.149; 95％ CI：0.064-0.475].Conclusions：TAE with Embosphcre（㊣） showed better treatment response and delayed tumor progression compared with cTACE.There was no significant difference in treatment-related hepatic toxicities.EmboTAE thus appears to be a feasible and promising approach in the treatment of liver metastasis from GIST.展开更多
Background:Recent studies showed that sequential selective transcatheter arterial chemoembolization(TACE)and portal vein embolization(PVE)provided better future liver remnant(FLR)regeneration rate and disease-free sur...Background:Recent studies showed that sequential selective transcatheter arterial chemoembolization(TACE)and portal vein embolization(PVE)provided better future liver remnant(FLR)regeneration rate and disease-free survival following surgery compared with PVE alone.The present study aimed to clarify whether preoperative sequential TACE and PVE before right hemihepatectomy can reduce postoperative hepatocellular carcinoma(HCC)recurrence and improve long-term disease-free and overall survival.Methods:Recurrence and survival outcomes were retrospectively evaluated in 205 patients with HCC who underwent right hemihepatectomy by a single surgeon from November 1993 to November 2017.Patients were divided into four groups according to the procedure performed before the surgery:sequential TACE and PVE(TACE-PVE),PVE-only,TACE-only,or na?ve control groups.The baseline patient and tumor characteristics,postoperative outcomes,recurrence-free survival and overall survival were analyzed.Results:Baseline patient and tumor characteristics upon diagnosis were similar in all four groups,while sequential TACE and PVE were well tolerated.The TACE-PVE group had a higher mean increase in percentage FLR volume compared with that of the PVE-only group(17.46%±6.63%vs.12.14%±5.93%;P=0.001).The TACE-PVE group had significantly better overall and disease-free survival rates compared with the other groups(both P<0.001).Conclusions:Sequential TACE and PVE prior to surgery can be an effective therapeutic strategy for patients with HCC scheduled for major hepatic resection.The active application of preoperative sequential TACE and PVE for HCC would allow more patients with marginal FLR volume to become candidates for major hepatic resection by promoting compensatory FLR hypertrophy without the deterioration of basal hepatic functional reserve or tumor progression.展开更多
Background:Post-hepatectomy liver failure(PHLF)is the Achilles’heel of hepatic resection for colorectal liver metastases.The most commonly used procedure to generate hypertrophy of the functional liver remnant(FLR)is...Background:Post-hepatectomy liver failure(PHLF)is the Achilles’heel of hepatic resection for colorectal liver metastases.The most commonly used procedure to generate hypertrophy of the functional liver remnant(FLR)is portal vein embolization(PVE),which does not always lead to successful hypertrophy.Associating liver partition and portal vein ligation for staged hepatectomy(ALPPS)has been proposed to overcome the limitations of PVE.Liver venous deprivation(LVD),a technique that includes simultaneous portal and hepatic vein embolization,has also been proposed as an alternative to ALPPS.The present study aimed to conduct a systematic review as the first network meta-analysis to compare the efficacy,effectiveness,and safety of the three regenerative techniques.Data sources:A systematic search for literature was conducted using the electronic databases Embase,PubMed(MEDLINE),Google Scholar and Cochrane.Results:The time to operation was significantly shorter in the ALPPS cohort than in the PVE and LVD cohorts by 27 and 22 days,respectively.Intraoperative parameters of blood loss and the Pringle maneuver demonstrated non-significant differences between the PVE and LVD cohorts.There was evidence of a significantly higher FLR hypertrophy rate in the ALPPS cohort when compared to the PVE cohort,but non-significant differences were observed when compared to the LVD cohort.Notably,the LVD cohort demonstrated a significantly better FLR/body weight(BW)ratio compared to both the ALPPS and PVE cohorts.Both the PVE and LVD cohorts demonstrated significantly lower major morbidity rates compared to the ALPPS cohort.The LVD cohort also demonstrated a significantly lower 90-day mortality rate compared to both the PVE and ALPPS cohorts.Conclusions:LVD in adequately selected patients may induce adequate and profound FLR hypertrophy before major hepatectomy.Present evidence demonstrated significantly lower major morbidity and mortality rates in the LVD cohort than in the ALPPS and PVE cohorts.展开更多
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.
文摘Portal vein embolization(PVE)is currently considered the standard of care to improve the volume of an inadequate future remnant liver(FRL)and decrease the risk of post-hepatectomy liver failure(PHLF).PHLF remains a significant limitation in performing major liver surgery and is the main cause of mortality after resection.The degree of hypertrophy obtained after PVE is variable and depends on multiple factors.Up to 20%of patients fail to undergo the planned surgery because of either an inadequate FRL growth or tumor progression after the PVE procedure(usually 6-8 wk are needed before surgery).The management of PVE failure is still debated,with a lack of consensus regarding the best clinical strategy.Different additional techniques have been proposed,such as sequential transarterial chemoembolization followed by PVE,segment 4 PVE,intra-portal administration of stem cells,dietary supplementation,and hepatic vein embolization.The aim of this review is to summarize the up-to-date strategies to overcome such difficult situations and discuss future perspectives on improving FRL hypertrophy.
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.
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.
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.
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 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.
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.
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.
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.
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Objective:The aim of this study was to evaluate the predictor of unsuccessful outcome of renal angioembolization(RAE).Knowing those predictors may help in avoiding unnecessary RAE procedures and their associated side effects,while helping to prepare for an alternate procedure and improving patient's overall satisfaction.Methods:A retrospective analysis between January 2006 and December 2018 was performed,and the indications for RAE were classified into post-traumatic,iatrogenic,renal tumors,and spontaneous.Patients who underwent RAE prior to nephrectomy were eliminated.Computed tomography angiography was performed in patients with normal renal function and those who had no contrast allergy,otherwise magnetic resonance angiography was performed.For the purpose of statistical analysis,we stratified patients into two main categories based on the final outcome—successful or failed.Results:Of 180 patients,32 with negative angiography were eliminated,leaving 148 patients;136(91%)had successful outcomes after one or more trials and 12 had unsuccessful outcomes.The mean age was 45±15 years,and 105(71%)were male.Neither gender,side of the lesion,presence of hematuria,indication for RAE,nor the type of lesion affected the outcome.On the other hand,renal anatomy with presence of accessory artery was the only predictor to failed RAE(p=0.001).Failed RAE trial was a predictor for nephrectomy as a secondary procedure(p=0.03).Conclusion:No pre-procedural predictors could anticipate the RAE outcome,and different indications can be scheduled to RAE,which is equally effective.The presence of accessory renal artery on diagnostic angiography is the only factor that may predict the failure of the procedure.
文摘AIM: To prospectively evaluate the effi cacy and safety of partial splenic embolization (PSE) combined with transcatheter hepatic arterial chemoembolization (TACE) in treatment of hepatocellular carcinoma (HCC). METHODS: Fifty patients suffering from primary HCC associated with hypersplenism caused by cirrhosis were randomly assigned to 2 groups: group A receiving PSE combined with TACE (n = 26) and group B receiving TACE alone (n = 24). Follow-up examinations included calculation of peripheral blood cells (leukcytes, platelets and red blood cells) and treatment-associated complications. RESULTS: Prior to treatment, there was no signifi cant difference in sex, age, Child-Pugh grade, tumor diameter, mass pathology type and peripheral blood cell counts between the 2 groups. After treatment, leukocyte and platelet counts were significantly higher in group A during the 3-mo follow-up period (P < 0.05), but lower in group B (P < 0.05). Severe complications occurred in 3 patients (11.5%) of group A and in 19 patients (79.2%) of group B (P < 0.05), and there was no significant difference in symptoms of post-embolization syndrome, including abdominal pain, fever, mild nausea and vomiting between the 2 groups (P > 0.05). CONCLUSION: PSE combined with TACE is more effective and safe than TACE alone for patients with HCC associated with hypersplenism caused by cirrhosis.
文摘Objective：Transcatheter arterial chemoembolization （TACE） is a standard treatment for hepatocellular carcinoma （HCC） and/or some unresectable liver metastasis tumors.Hypervascular liver metastatic lesions such as metastasis from gastrointestinal stromal tumor （GIST） are an indication for transcatheter arterial embolization （TAE）.The purpose of this study was to evaluate the efficacy and safety of Embosphere（㊣）-TAE （Embo-TAE） in comparison with conventional TACE （cTACE） for the treatment of liver metastasis from GIST.Methods：A total of 45 patients who underwent TACE between Aug 2008 and Feb 2013 were enrolled.Patients with GIST who underwent TAE with Embosphere（㊣） （n=19） were compared with controls who received cTACE （n=26）.The primary end points were treatment response and treatment-related adverse events.The secondary end points were progression-free survival （PFS） and overall survival （OS）.Results：The treatment response of Embo-TAE group was significandy higher than that of the cTACE group （P＜0.001）.The PFS was significandy better in the Embosphere（㊣）-group than in the cTACE group （56.6 and 42.1 weeks,respectively; P=0.003）.However,there was no statistically significant difference in liver toxicity between the two groups （P＞0.05）.The median OS in the Embo-TAE group was longer than that in the cTACE group （74.0 weeks,95％ CI：68.2-79.8 vs.61.7 weeks,95％ CI：56.2-67.2 weeks） （unadjusted P=0.045）.The use of Embo-TAE significantly reduced the risk of death in patients with GIST with liver metastases according to the Cox proportonal hazards regression model [hazard ratio （HR）：0.149; 95％ CI：0.064-0.475].Conclusions：TAE with Embosphcre（㊣） showed better treatment response and delayed tumor progression compared with cTACE.There was no significant difference in treatment-related hepatic toxicities.EmboTAE thus appears to be a feasible and promising approach in the treatment of liver metastasis from GIST.
基金the Institutional Review Board of Asan Medical Center,University of Ulsan College of Medicine(2019-0361).
文摘Background:Recent studies showed that sequential selective transcatheter arterial chemoembolization(TACE)and portal vein embolization(PVE)provided better future liver remnant(FLR)regeneration rate and disease-free survival following surgery compared with PVE alone.The present study aimed to clarify whether preoperative sequential TACE and PVE before right hemihepatectomy can reduce postoperative hepatocellular carcinoma(HCC)recurrence and improve long-term disease-free and overall survival.Methods:Recurrence and survival outcomes were retrospectively evaluated in 205 patients with HCC who underwent right hemihepatectomy by a single surgeon from November 1993 to November 2017.Patients were divided into four groups according to the procedure performed before the surgery:sequential TACE and PVE(TACE-PVE),PVE-only,TACE-only,or na?ve control groups.The baseline patient and tumor characteristics,postoperative outcomes,recurrence-free survival and overall survival were analyzed.Results:Baseline patient and tumor characteristics upon diagnosis were similar in all four groups,while sequential TACE and PVE were well tolerated.The TACE-PVE group had a higher mean increase in percentage FLR volume compared with that of the PVE-only group(17.46%±6.63%vs.12.14%±5.93%;P=0.001).The TACE-PVE group had significantly better overall and disease-free survival rates compared with the other groups(both P<0.001).Conclusions:Sequential TACE and PVE prior to surgery can be an effective therapeutic strategy for patients with HCC scheduled for major hepatic resection.The active application of preoperative sequential TACE and PVE for HCC would allow more patients with marginal FLR volume to become candidates for major hepatic resection by promoting compensatory FLR hypertrophy without the deterioration of basal hepatic functional reserve or tumor progression.
文摘Background:Post-hepatectomy liver failure(PHLF)is the Achilles’heel of hepatic resection for colorectal liver metastases.The most commonly used procedure to generate hypertrophy of the functional liver remnant(FLR)is portal vein embolization(PVE),which does not always lead to successful hypertrophy.Associating liver partition and portal vein ligation for staged hepatectomy(ALPPS)has been proposed to overcome the limitations of PVE.Liver venous deprivation(LVD),a technique that includes simultaneous portal and hepatic vein embolization,has also been proposed as an alternative to ALPPS.The present study aimed to conduct a systematic review as the first network meta-analysis to compare the efficacy,effectiveness,and safety of the three regenerative techniques.Data sources:A systematic search for literature was conducted using the electronic databases Embase,PubMed(MEDLINE),Google Scholar and Cochrane.Results:The time to operation was significantly shorter in the ALPPS cohort than in the PVE and LVD cohorts by 27 and 22 days,respectively.Intraoperative parameters of blood loss and the Pringle maneuver demonstrated non-significant differences between the PVE and LVD cohorts.There was evidence of a significantly higher FLR hypertrophy rate in the ALPPS cohort when compared to the PVE cohort,but non-significant differences were observed when compared to the LVD cohort.Notably,the LVD cohort demonstrated a significantly better FLR/body weight(BW)ratio compared to both the ALPPS and PVE cohorts.Both the PVE and LVD cohorts demonstrated significantly lower major morbidity rates compared to the ALPPS cohort.The LVD cohort also demonstrated a significantly lower 90-day mortality rate compared to both the PVE and ALPPS cohorts.Conclusions:LVD in adequately selected patients may induce adequate and profound FLR hypertrophy before major hepatectomy.Present evidence demonstrated significantly lower major morbidity and mortality rates in the LVD cohort than in the ALPPS and PVE cohorts.
