Journal of Vascular and Interventional Radiology
Clinical studyConsolidation of Hepatic Arterial Inflow by Embolization of Variant Hepatic Arteries in Preparation for Yttrium-90 Radioembolization
Section snippets
Patient Cohort
We retrospectively reviewed all preparatory and treatment angiograms in 201 patients treated for unresectable hepatic malignancy from June 2004 to November 2010. Patients ranged in age from 20 to 92 years (mean, 60.1 y; median, 61 y), and underwent radioembolization treatment with SIR-Spheres (Sirtex, Lane Cove, Australia) or TheraSphere (MDS Nordion, Ottawa, Ontario, Canada). Iterative data on seven patients who underwent repeat radioembolization were also included. All data were handled in
Arterial Anatomy in Patient Cohort
A total of 73 patients (36.3%) had variant HAs; the other 128 patients (63.7%) had standard HA anatomy or underwent previous resection that eliminated variant HAs. The 73 patients had a total of 85 variant HAs amenable to consolidation (42 men, 31 women; age range, 22–81 y). Details about demographics, type of radioembolization microsphere used, and territory of liver treated are listed in Table 1. The majority of patients had diffuse bilobar metastatic disease and required whole-liver
Discussion
Hepatic radioembolization with 90Y-impregnated microspheres is a promising emerging treatment for patients with primary or metastatic hepatic malignancy, but the presence of variant HA anatomy poses certain risks and inconveniences. The potential complications resulting from nontarget radioembolization can be far more severe than those resulting from nontarget chemoembolization or bland embolization (13). Administration of radioembolic microspheres into variant HAs originating from the SMA,
Acknowledgments
The authors thank Dr. A.K. Hosni for expert statistical advice.
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Intrahepatic flow diversion prior to segmental Yttrium-90 radioembolization for challenging tumor vasculature
2022, Journal of Interventional MedicineCitation Excerpt :In FR, the nontarget vessel is embolized, usually with coils and/or microparticles during the mapping component of the procedure, with the expectation that this fraction of tumor will regain supply from the dominant feeder through which Y90 will be subsequently delivered. This is also referred to as “arterial consolidation” and has been used in a variety of treatment scenarios including the presence of extrahepatic feeding vessels, cases of multiple intrahepatic feeding vessels that are not each amenable to Y90 administration or to simplify Y90 dosage calculation and administration by treatment through a single vessel.9–12 It is valuable to distinguish ‘flow redistribution’ and ‘flow diversion’.
Interventional Oncology: Optimizing Transarterial Therapies for the Treatment of Hepatic Malignancy
2018, Techniques in Vascular and Interventional RadiologyCitation Excerpt :If these variants are not recognized, and the GDA is embolized, then it may preclude the operator's ability to even deliver transarterial therapy to the tumor once the origin of the feeding vessel is occluded (Fig. 13). This can sometimes be ameliorated by the development of intrahepatic collaterals, which can be used for delivery of therapy, but this is not always the case.14 The last important scenario to recognize, when evaluating the need or desirability of prophylactic GDA embolization is the situation in which there is a high grade celiac stenosis or even occlusion.
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2017, Journal of Vascular and Interventional RadiologyCitation Excerpt :In certain cases, a second mapping angiogram may be necessary if scintigraphic findings are concerning. The concept of vascular redistribution (ie, occluding intrahepatic vessels before radioembolization to induce redistribution of flow) has been developed to simplify treatment and potentially avoid gastric vessels (76,77). For example, in the case of a replaced left hepatic artery originating from a left gastric artery, the gastrohepatic trunk is embolized to redistribute flow to the left from the right hepatic artery.
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2016, Journal of Vascular and Interventional RadiologyProspective, randomized study of coil embolization versus surefireinfusion systemduring yttrium-90 radioembolization with resin microspheres
2014, Journal of Vascular and Interventional RadiologyCitation Excerpt :Finally, as shown by SPECT/CT, the use of an ARM successfully prevented reflux in patients who did not undergo coil embolization of nontarget vessels. Investigators have described the use of various permanent occlusive devices such as coils, plugs, and liquid embolic agents to occlude the extrahepatic network before SIRT; often, this requires extensive detailed catheterization of very small vessels resulting in extra fluoroscopy time and radiation dose (8–11). In patients with aberrant anatomy, such as a gastrohepatic trunk, placement of embolic coils in all extrahepatic vasculature may not be feasible.
Safety of <sup>90</sup>Y radioembolization in patients who have undergone previous external beam radiation therapy
2013, International Journal of Radiation Oncology Biology PhysicsCitation Excerpt :All patients underwent preparatory angiography, during which endovascular skeletonization of the hepatic artery was performed to prevent nontarget RE. All parasitized and select variant arteries were embolized to consolidate arterial inflow (10, 11). Technetium-99m macroaggregated albumin was injected for simulation scintigraphy, to calculate the lung shunt fraction, to characterize the intrahepatic distribution of injected tracer, and to detect extrahepatic deposition.
None of the authors have identified a conflict of interest.
From the SIR 2010 Annual Meeting.
This article includes an appendix available online at www.jvir.org.