Prophylactic Embolization of the Cystic Artery Before Radioembolization: Feasibility, Safety, and Outcomes

PurposeTo evaluate the safety and efficacy of two different methods of proximal cystic artery embolization in patients undergoing yttrium-90 radioembolization.Materials and methodsForty-six patients had cystic artery embolization performed immediately before yttrium-90 radioembolization, either by using Gelfoam pledgets (n = 35) or coils (n = 11). Clinical symptomatology during the admission and angiographic findings at 1-month follow-up were retrospectively reviewed. Rates of collateralization or recanalization of the cystic artery were compared, as well as the frequency of postprocedural abdominal pain and need for cholecystectomy.ResultsTechnical success was achieved in all patients, and there were no procedural complications related to cystic artery embolization. Of the 11 coil-embolized patients, 5 (45%) demonstrated collateralization of the cystic artery at 1 month, and 1 (9%) demonstrated recanalization of the cystic artery. Of the 35 Gelfoam-embolized cases, 2 (6%) had collateralized at 1 month, and 14 (40%) had recanalized. Two patients (one from each group) had self-limited right upper quadrant pain after the procedure, and one patient in the coil embolization group required cholecystectomy.ConclusionProximal cystic artery embolization is safe and feasible and may be performed during liver-directed embolotherapy to minimize the exposure of the gallbladder to particulate, chemoembolic, or radioembolic agents

ОРТОТОПИЧЕСКАЯ ТРАНСПЛАНТАЦИЯ ПЕЧЕНИ: РОЛЬ ИНТЕРВЕНЦИОННОЙ РАДИОЛОГИИ

To study therapeutic modalities of interventional radiology in patients (pts) before and after orthotopic liver trans- plantation (OLT). OLT was performed in 53 pts between 1998 and 2008. Endovascular treatments were performed in 20 pts. Pre-OLT interventional procedures included transcatheter arterial chemoembolization (5 patients) and TIPS (8 patients). Post-OLT procedures were: dilatation or/and stenting of biliary strictures (4), stenting of IVC (2), balloon dilatation of cava-caval anastomosis (1), partial splenic embolization (PSE) in steel syndrome (1). All IR procedures were technically successful. There was no mortality or serious complication. After chemoemboliza- tion, there was partial tumor response in all 5 patients with HCC; two successfully transplanted are alive without recurrence in 11 and 15 months. After TIPS, 3 pts underwent OLT. Satisfactory biliary passage was achieved in all pts with strictures. Clinical symptoms and liver function improved in three pts with venous strictures. After PSE, steal syndrome regressed rapidly. All pts are asymptomatic and well in 5–24 mo after IR treatment. IR procedures prolong long-term patient survival before OLT and may improve outcomes in pts after OLT. В работе обсуждается эффективность интервенционных радиологических процедур у больных перед и после ортотопической трансплантации печени (ОТП). За период 1998–2008 гг. ОТП выполнена 53 паци- ентам. Лечебные эндоваскулярные вмешательства осуществлены у 20 из этих больных. Предоперацион- ные процедуры выполнены у 13 пациентов: масляная химиоэмболизация печеночной артерии (МХЭПА, n = 5), наложение внутрипеченочного портокавального шунта (TIPS, n = 8). У 7 больных произведены 8 послеоперационных вмешательств: дренирование и/или стентирование желчных протоков (n = 4), ре- канализация и стентирование стеноза/окклюзии нижней полой вены (НПВ, n = 2), баллонная дилатация кава-кавального анастомоза (n = 1), эмболизация селезеночной артерии (n = 1). После МХЭПА отмечено уменьшение злокачественной опухоли или замедление ее роста у всех 5 пациентов, ОТП к настоящему времени осуществлена у 3 из них. В результате TIPS снижение портальной гипертензии произошло у всех больных, ОТП выполнена в 3 наблюдениях. Все послеоперационные процедуры были также технически и клинически успешны. Методы интервенционной радиологии позволяют продлить время ожидания до- норской печени у больных, которым требуется ОТП. Рентгеноэндоваскулярные вмешательства позволяют устранить послеоперационные билиарные и сосудистые стриктуры, а также другие осложнения ОТП.

ЭВОЛЮЦИЯ ПРОГРАММЫ ТРАНСПЛАНТАЦИИ ПЕЧЕНИ В РОССИЙСКОМ НАУЧНОМ ЦЕНТРЕ РАДИОЛОГИИ И ХИРУРГИЧЕСКИХ ТЕХНОЛОГИЙ

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Transjugular intrahepatic portocaval shunting as a preparation phase for liver transplantation

Objective: to assess the first results of transjugular intrahepatic portocaval shunting (TIPS) as a technique for preventing portal hypertension complications in patients in the period of waiting for a donor liver.Subjects and methods. TIPS was performed in 6 patients on the list of waiting for orthotopic liver transplantation (OLT). The indications for TIPS were current (n=1) or high-risk recurrent hemorrhages from the esophageal varices and stomach (n=4) and diuretic-resistant ascitis (n=1).Results. TIPS was successfully carried out in all the patients. The portovenous gradient was reduced by 2—3 times (to 9—12 mm Hg). A further follow-up revealed recurrent varicose hemorrhage or ascitis in none patients. Doppler study indicated that the shunt showed a good function. OLT was successfully made in 3 patients 2, 8, and 19 months after TIPS; one female patient had been waiting for OLT for 5 months; 2 patients died from sepsis and hepatic failure following 1 and 5 months, respectively.Conclusion. The first results suggest that in patients with hepatic cirrhosis complicated with portal hypertension, TIPS can be regarded as a safety bridge while waiting for a donor liver

ENDOVASCULAR ABDOMINAL AORTIC ANEURISM REPAIR

The authors analyzed the single-center experience of treatment of 72 patients with abdominal aortic aneurisms and severe accompanied pathology. The aneurisms were repaired by stentgrafts. All the patients had abdominal aortic aneurisms with the diameters from 41 to 84 mm against the background of severe somatic pathology. It was a contraindication to planned open surgery. An installation of stent-graft was successful in all 72 follow-ups. It wasn’t necessary to use a conversion to open surgery. The follow-up period consisted of 44,6±2,1 months. Control ultrasound and computer tomography studies hadn’t revealed an increase of aneurism sack sizes or «leakages». A reduction of abdominal aortic aneurism sizes was noted in 37 patients on 4-5% during first year after operation. The stentgraft implantation extends the possibilities of abdominal aortic aneurism treatment for patients from a high surgical risk group

Capabilities of splenic artery embolization in the treatment of steal syndrome after orthotopic liver transplantation

The paper describes a case of the rare complication of orthotopic liver transplantation - steal syndrome successfully controlled by interventional radiology techniques

ORTHOTOPIC LIVER TRANSPLANTATION: ROLE OF INTERVENTIONAL RADIOLOGY

To study therapeutic modalities of interventional radiology in patients (pts) before and after orthotopic liver trans- plantation (OLT). OLT was performed in 53 pts between 1998 and 2008. Endovascular treatments were performed in 20 pts. Pre-OLT interventional procedures included transcatheter arterial chemoembolization (5 patients) and TIPS (8 patients). Post-OLT procedures were: dilatation or/and stenting of biliary strictures (4), stenting of IVC (2), balloon dilatation of cava-caval anastomosis (1), partial splenic embolization (PSE) in steel syndrome (1). All IR procedures were technically successful. There was no mortality or serious complication. After chemoemboliza- tion, there was partial tumor response in all 5 patients with HCC; two successfully transplanted are alive without recurrence in 11 and 15 months. After TIPS, 3 pts underwent OLT. Satisfactory biliary passage was achieved in all pts with strictures. Clinical symptoms and liver function improved in three pts with venous strictures. After PSE, steal syndrome regressed rapidly. All pts are asymptomatic and well in 5–24 mo after IR treatment. IR procedures prolong long-term patient survival before OLT and may improve outcomes in pts after OLT