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Management of arterial dissections in 12 patients during transarterial chemoembolization and yttrium-90 selective internal radiotherapy for primary and secondary liver tumours

  • Interventional Radiology
  • Published:
Abdominal Radiology Aims and scope Submit manuscript

Abstract

Objective

To describe rates and management strategies of arterial dissections in transarterial chemoembolization (TACE) and Yttrium-90 selective internal radiotherapy (90Y SIRT) for primary and secondary liver tumours.

Materials and methods

This retrospective review included 1377 hepatic angiographies between May 2010 and June 2015 in a single centre for TACE and 90Y SIRT of liver tumours. The angiogram results, management, treatment outcomes and follow-up angiography/imaging findings were recorded.

Results and discussion

Twelve cases of arterial dissections (12/1377, 0.87%) were documented. Three dissections (3/633, 0.47%) occurred during TACE, seven (7/449, 1.56%) during pre-treatment planning angiographies (PTPA) for 90Y SIRT, and two (2/249, 0.80%) during the treatment procedure of 90Y SIRT. The preferred management strategy was to manoeuvre past the dissection and complete the procedure, which was achieved in six patients (50%). Angioplasty with stenting was performed in one patient. In three patients, the procedure was held off for up to 3 months to allow the dissection to heal before repeating the procedure. A dissection that occurred during PTPA was detected only when the patient returned for 90Y SIRT. PTPA was immediately repeated for this patient. The last patient opted for sorafenib. Residual 50% stenosis was seen in one patient on follow-up hepatic angiography, but he was otherwise asymptomatic. In the remaining patients, no residual dissection or clinical sequelae was observed on follow-up.

Conclusion

Arterial dissection is a rare but important complication of transarterial locoregional therapy. Where possible, attempts should be made at completing the therapy. Deferring treatment can be considered as dissections usually heal within 3 months.

Level of evidence

Level 4, case series.

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Funding

This study was not supported by any funding.

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Authors and Affiliations

  1. MOH Holdings Pte Ltd, 1 Maritime Square, #11-25 HarbourFront Centre, Singapore, 099253, Singapore

    Winfred Xi Tai Goh

  2. Department of Vascular and Interventional Radiology, Singapore General Hospital, Singapore, 169608, Singapore

    Chow Wei Too, Kristen Alexa Lee, Bien Soo Tan, Kiang Hiong Tay, Sivanathan Chandramohan, Richard Hoau Gong Lo, Farah Gillan Irani, Nanda Venkatanarasimha, Karthikeyan Damodharan, Kutty Krishnan Pradesh Kumar, Kun Da Zhuang, Jasmine Ming Er Chua, Ajay Bangaragiri & Sum Leong

  3. Office of Academic & Clinical Development, Duke-NUS Medical School, Singapore, 169857, Singapore

    Chow Wei Too, Bien Soo Tan, Kiang Hiong Tay, Sivanathan Chandramohan, Richard Hoau Gong Lo, Farah Gillan Irani, Nanda Venkatanarasimha, Karthikeyan Damodharan, Kun Da Zhuang, Jasmine Ming Er Chua & Sum Leong

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  1. Winfred Xi Tai Goh
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  2. Chow Wei Too
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  14. Ajay Bangaragiri
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  15. Sum Leong
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Corresponding author

Correspondence to Winfred Xi Tai Goh.

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The authors declare that they have no conflict of interest.

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For this type of study formal consent is not required. This study has obtained IRB approval from SingHealth Centralised Institutional Review Board.

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This study has obtained IRB approval from SingHealth Centralised Institutional Review Board and the need for informed consent was waived.

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Goh, W.X.T., Too, C.W., Lee, K.A. et al. Management of arterial dissections in 12 patients during transarterial chemoembolization and yttrium-90 selective internal radiotherapy for primary and secondary liver tumours. Abdom Radiol 46, 1737–1745 (2021). https://doi.org/10.1007/s00261-020-02810-1

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  • DOI: https://doi.org/10.1007/s00261-020-02810-1

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