Interventional Radiological Treatment of Perihepatic Vascular Stenosis or Occlusion in Pediatric Patients After Liver Transplantation

Purpose

Evaluation of the efficacy and safety of percutaneous treatment of vascular stenoses and occlusions in pediatric liver transplant recipients.

Methods

Fifteen children (mean age 8.3 years) underwent interventional procedures for 18 vascular complications after liver transplantation. Patients had stenoses or occlusions of portal veins (n = 8), hepatic veins (n = 3), inferior vena cava (IVC; n = 2) or hepatic arteries (n = 5). Technical and clinical success rates were evaluated.

Results

Stent angioplasty was performed in seven cases (portal vein, hepatic artery and IVC), and sole balloon angioplasty was performed in eight cases. One child underwent thrombolysis (hepatic artery). Clinical and technical success was achieved in 14 of 18 cases of vascular stenoses or occlusions (mean follow-up 710 days).

Conclusion

Pediatric interventional radiology allows effective and safe treatment of vascular stenoses after pediatric liver transplantation (PLT). Individualized treatment with special concepts for each pediatric patient is necessary. The variety, the characteristics, and the individuality of interventional management of all kinds of possible vascular stenoses or occlusions after PLT are shown.     

Radiological features of complications of laparoscopic adjustable gastric banding

Purpose

Laparoscopic adjustable gastric banding (LAGB) is used to treat morbid obesity. We reviewed the associated complications with emphasis on radiological features and the role of radiology in suspected complications.

Materials and methods

Between 30 January 2001 and 3 October 2006, 313 consecutive LAGB patients’ data was entered into a prospective database. A contrast swallow was routinely performed on the first postoperative day, and port adjustments were done at variable intervals. Additional radiological studies were performed in patients with suspected complications.

Results

Of 313 patients who underwent LAGB, 46 had 51 complications (16.3%). The commonest complications were LAGB system leakage (5.1%), anterior band slippage (3.5%) and infected port (1.6%). Two mortalities (0.6%), one early and one late, occurred.

Conclusions

LAGB is a relatively low-risk procedure widely performed for treating morbid obesity. Imaging plays a pivotal role in the early evaluation and detection of LAGB complications.     

An integrated, self-expanding, Y-shaped, metallic stent for patients with complex obstruction after gastrojejunostomy (Billroth II): initial experience

Purpose

This paper reports our initial experience with an integrated, self-expandable, Y-shaped, metallic stent (SEMS) for patients with complex anastomotic obstructions after gastrojejunostomy (Billroth II).

Materials and methods

Eight consecutive patients with complex anastomotic obstructions involving the afferent and efferent loops after gastrojejunostomy (Billroth II) were treated with an integrated Y-shaped SEMS. The stents were placed in the anastomosis under fluoroscopy. Technical and clinical success; complications, including recurrent obstruction and stent migration; reintervention; and survival were assessed during follow-up.

Results

Y-shaped SEMS placement in the anastomotic areas was technically successful and well tolerated in all patients, with no procedure-related complications. Clinical success was observed in all patients 1?C7 days after the procedure. The improvement between pre- and postoperative gastric outlet obstruction scoring system (GOOSS) was statistically significant (p=0.01). During follow-up for 3.13±1.81 months, all stenoses were resolved without stent-related complications, and general physical examination of the eight patents showed improvement. Five patients continued with follow-up health care after the procedures; the remaining three died of causes unrelated to stent insertion. The mean and median survival periods were 3.92±0.81 months [95% confidence interval (CI) 2.34?C5.50] and 3.0±0.64 months (95% CI 1.74?C4.26), respectively.

Conclusions

Deployment of an integrated Y-shaped SEMS proved to be an expedient, simple, safe and minimally invasive procedure for treating complex anastomotic stenoses after gastrojejunostomy (Billroth II).     

Biodegradable biliary stent implantation in the treatment of benign bilioplastic-refractory biliary strictures: preliminary experience

Objectives

To evaluate feasibility, safety, and outcome of patients treated with biodegradable biliary stents for benign biliary stenosis refractory to other treatments.

Methods

Between March 2011 and September 2012, ten patients (seven men, three women; age 59?±?7 years) with recurrent cholangitis due to postsurgical biliary stricture, previous multiple unsuccessful (two to five) bilioplasties, and unsuitability for surgical/endoscopic repair underwent percutaneous implantation of a biodegradable biliary stent. Patients were followed-up clinically and with ultrasound at 1, 3 and 6 months, and then at 6-month intervals.

Results

Stent implantation was always feasible. No immediate major or minor complications occurred. In all patients, 48-h cholangiographic control demonstrated optimal stent positioning and stenosis resolution. In a median follow-up time of 16.5 months (25th–75th percentiles = 11–20.25 months) no further invasive treatment was needed. Three patients experienced transient episodes of cholangitis. Neither re-stenosis nor dilatation of the biliary tree was documented during follow-up. No stent was visible at the 6-month follow-up.

Conclusions

Percutaneous placement of biodegradable biliary stents represents a new option in treating benign biliary stenoses refractory to treatment with bilioplasty. This technique seems to be feasible, effective and free from major complications. Further investigations are warranted to confirm our preliminary results.

Key Points

? Percutaneous biodegradable stents can be used to treat benign biliary stenosis. ? They can be used in patients refractory to bilioplasty. ? The procedure for insertion appears free from major complication. ? Biodegradable stents may represent an alternative device to covered expandable stents.     

Diagnostic accuracy of 64-slice CT in evaluating coronary artery bypass grafts and of the native coronary arteries

Purpose

Our aim was to evaluate the accuracy, sensitivity and specificity of 64-slice multidetector computed tomography (MDCT) in the assessment of occlusions and stenoses of arterial and venous bypass grafts and disease progression in the native vessels distal to the graft, and to compare the results with those of conventional coronary angiography.

Materials and methods

We enrolled 78 individuals (45 men, 33 women; mean age 59) and evaluated 213 bypass grafts using a 64-slice MDCT scanner. All patients underwent conventional coronary angiography with a mean time interval between the two examinations of 2 days.

Results

One patient was excluded due to arrhythmia during the examination. The 212 bypass grafts in the remaining 77 patients (98.7%) consisted of 115 (54%) venous grafts and 97 (46%) arterial grafts. In the 115 venous grafts, MDCT showed a sensitivity, specificity and accuracy of 100% in evaluating occluded grafts and a sensitivity of 94.4%, specificity of 98.4% and accuracy of 96.9% in evaluating significant stenoses. In evaluating occluded arterial grafts, sensitivity was 83.3%, specificity 100% and accuracy 98.9%, whereas in evaluating stenoses of arterial grafts, sensitivity was 100%, specificity 97.7% and accuracy 98%.

Conclusions

Sensitivity, specificity and accuracy in evaluating native coronary vessels distal to the graft allow for a complete assessment of the surgical and native circulation. The examination appears therefore to be exhaustive in ruling out or confirming the presence of diseased vessels in the postoperative follow-up.     

Contrast-enhanced MR cholangiography (MRCP) with GD-EOB-DTPA in evaluating biliary complications after surgery

Purpose

We assessed the usefulness of contrast-enhanced magnetic resonance cholangiography (CE-MRC) with liver-specific contrast agent in evaluating the biliary tree after hepatic surgery.

Materials and methods

A total of 142 patients with suspected biliary complications after liver surgery underwent hepatobiliary MR before and after administration of gadolinium ethoxy benzylic diethylenetriamine pentaacetic acid (Gd-EOB-DTPA). Unenhanced MR cholangiopancreatography (MRCP) and postcontrast MRC were obtained in all patients. Blinded image evaluation and semiquantitative analysis comparing MRCP and CE-MRC were performed by two experienced radiologists.

Results

In all cases, optimal postcontrast visualisation of the biliary tract was obtained. In 22 patients, a postsurgical biliary complication was confirmed. MRCP detected 64% of lesions, but in 36% of cases, an alteration was only suspected but not clearly defined. CE-MRC allowed definite diagnosis in 100% of cases.

Conclusions

Hepatobiliary-specific contrast agents allow for accurate and extensive study of biliary tract alterations, especially in assessing postsurgical complications.     

Malpractice claims in interventional radiology: frequency, characteristics and protective measures

Purpose

The use of interventional radiology procedures has considerably increased in recent years, as has the number of related medicolegal litigations. This study aimed to highlight the problems underlying malpractice claims in interventional radiology and to assess the importance of the informed consent process.

Materials and methods

The authors examined all insurance claims relating to presumed errors in interventional radiology filed by radiologists over a period of 14 years after isolating them from the insurance database of all radiologists registered with the Italian Society of Medical Radiology (SIRM) between 1 January1993 and 31 December 2006.

Results

In the period considered, 98 malpractice claims were filed against radiologists who had performed interventional radiology procedures. In 21 cases (21.4%), the event had caused the patient’s death. In >80% of cases, the event occurred in a public facility. The risk of a malpractice claim for a radiologist practising interventional procedures is 47 per 1,000, which corresponds to one malpractice claim for each 231 years of activity.

Discussion

Interventional radiology, a discipline with a biological risk profile similar to that of surgery, exposes practitioners to a high risk of medicolegal litigation both because of problems intrinsic to the techniques used and because of the need to operate on severely ill patients with compromised clinical status.

Conclusions

Litigation prevention largely depends on both reducing the rate of medical error and providing the patient with correct and coherent information. Adopting good radiological practices, scrupulous review of procedures and efficiency of the instruments used and audit of organisational and management processes are all factors that can help reduce the likelihood of error. Improving communication techniques while safeguarding the patient’s right to autonomy also implies adopting clear and rigorous processes for obtaining the patient’s informed consent to the medical procedure.     

Cutaneous complications after transcatheter arterial treatment for hepatocellular carcinoma via the internal mammary artery: how to avoid this complication

Purpose

To lower the rate of cutaneous complications after transcatheter arterial treatment for hepatocellular carcinoma (HCC) via the internal mammary artery (IMA) we retrospectively assessed the complications.

Materials and methods

We reviewed cutaneous complications in 14 patients with 18 HCCs who had undergone 17 treatment procedures via the IMA, including selective transcatheter arterial infusion chemotherapy with Lipiodol (Lip-TAI) (n = 3), selective Lip-TAI + transcatheter arterial embolization (TAE) (n = 3), nonselective Lip-TAI (n = 1), nonselective Lip-TAI + TAE (n = 5), and nonselective TAE (n = 5). The filling and nonfilling of subcutaneous vessels with Lipiodol was examined on postoperative computed tomography (CT) scans.

Results

Skin rash (n = 3) and ulceration (n = 1) occurred after 4 of 17 (24%) procedures: two of three selective Lip-TAI procedures and two of five nonselective Lip-TAI + TAE procedures. The doses of chemotherapeutic agents for tumor sizes in selective Lip-TAI procedures were higher than those in selective Lip-TAI + TAE procedures. Cutaneous complications were encountered after two of three procedures with filling but not after any of eight procedures without filling.

Conclusion

A lower dose of chemotherapeutic agents may be less risky when undertaking a selective procedure via the IMA for HCC. If nonselective, TAE alone may be less risky. Postoperative CT may be helpful for predicting cutaneous complications.     

Role of magnetic resonance cholangiography in biliary complications of orthotopic liver transplantation

Purpose

The aim of this study was to evaluate the role of magnetic resonance cholangiography (MRC) in the detection of biliary complications following orthotopic liver transplantation (OLT).

Materials and methods

Seventy-eight transplant patients with clinically suspected biliary complications were evaluated with 1.5-T magnetic resonance imaging (MRI) using a surface coil. All patients were imaged with the following sequences: axial T1-weighted and axial and coronal T2-weighted, 2D spin echo (SE) breath-hold radial cholangiography, and coronal 3D single-shot turbo spin echo (SS-TSE) with respiratory triggering. Patients with negative MRI underwent clinical and sonographic followup. When biliary complications were present, diagnostic confirmation was obtained by endoscopic retrograde cholangiopancreatography (ERCP) (n=13), percutaneous transhepatic cholangiography (PTC) (n=20), ultrasonography (n=10) or computed tomography (CT) (n=2). In 11 cases, surgical confirmation was also obtained.

Results

MRC detected biliary complications in 44/78 patients, in particular, 42 biliary strictures (37 anastomotic and five intrahepatic), 40 of which were confirmed by other imaging modalities. In 25/37 cases of anastomotic stricture, preanastomotic dilatation of the biliary tract was also demonstrated. Other MRC-detected biliary complications were biliary sludge (n=4), biloma (n=5), and biliary stones (n=3). In four cases, PTC revealed biliary complications that had not been detected with MRC (false negative results). In two cases, MRC showed unconfirmed strictures of the intrahepatic ducts and biliodigestive anastomosis (false positive results). The sensitivity, specificity, positive (PPV) and negative (NPV) predictive values and diagnostic accuracy of MRC were 93.5%, 94.4%, 96.7%, 89.5% and 93.9%, respectively.

Conclusions

Our results confirm that MRC is a reliable technique for depicting biliary anastomoses and detecting biliary complications after OLT. The high diagnostic accuracy of MRC indicates that this examination should be routinely employed in all OLT patients with clinically suspected biliary complications.     

Radial Artery Approach to Salvage Nonmaturing Radiocephalic Arteriovenous Fistulas

Purpose

To evaluate the usefulness of an approach through the radial artery distal to the arteriovenous anastomosis for salvaging nonmaturing radiocephalic arteriovenous fistulas.

Methods

Procedures that fulfilled the following criteria were retrospectively reviewed: (1) autogenous radiocephalic fistulas, (2) fistulas less than 3 months old, (3) distal radial artery approach for salvage. From 2005 to 2011, a total of 51 patients fulfilling the above criteria were enrolled. Outcome variables were obtained from angiographic, clinical and hemodialysis records, including the success, complication, and primary and secondary patency rates.

Results

The overall anatomical and clinical success rates for the distal radial artery approach were 96 and 94 %, respectively. The average procedure time was 36 ± 19 min. Six patients (12 %) experienced minor complications as a result of extravasations. No arterial complication or puncture site complication was noted. The postinterventional 6-month primary patency rate was 51 %, and the 6-month secondary patency rate was 90 %. When the patients were divided into a stenosed group (20 patients) and an occluded group (31 patients), there were no differences in the success rate, complication rate, or primary and secondary patency rates.

Conclusion

An approach through the radial artery distal to the arteriovenous anastomosis is an effective and safe alternative for the salvage of nonmaturing radiocephalic arteriovenous fistulas, even for occluded fistulas.     

Health Technology Assessment (HTA)

Clinical/methodical issue

Cost-intensive measures and procedures, such as also employed in radiology, have far-reaching economic implications in respect to increasing expenditure with limited resources.

Standard radiological methods

Health technology assessment (HTA) describes the systematic evaluation of medical procedures and technologies which in recent years has been introduced by many countries into healthcare politics.

Assessment

In many cases HTA analyses can be directly implemented into practice as shown by the examples given in this article; however, in the current form of HTA the practical implementation for radiology often presents the problem that the cost-benefit ratio does not yet have a comprehensive view in the HTA report but is limited to a subsection, e.g. current costs versus sensitivity of a method. Since its inception radiology has had a high power of innovation and new developments will also substantially determine the future years. These procedures must not only be evaluated with respect to feasibility but also in the sense of the HTA in the total concept.

Practical recommendations

In radiology there are also a large number of possibilities for radiologists not only as passive consumers of HTA reports but also to become active participants in this process, an opportunity which should be taken advantage of.     

Cost-effectiveness of two breast biopsy procedures: surgical biopsy versus vacuum-assisted biopsy

Purpose

The aim of this study was to compare the costeffectiveness of two breast biopsy procedures: surgical biopsy and vacuum-assisted biopsy (VAB).

Materials and methods

Between November 2008 and September 2009, 200 patients with suspicious breast lesions underwent biopsy procedures at our radiology department: 100 underwent VAB and 100 underwent surgical biopsy. 66 lesions were sampled under sonographic guidance, 109 under mammographic guidance and 25 under magnetic resonance guidance.

Results

All procedures were successfully completed. No significant differences in diagnostic efficacy were found between the biopsy procedures. Surgical biopsy has a higher unit cost compared with VAB.

Conclusions

Our analysis emphasises the benefits of VAB compared with surgical biopsy in terms of both costeffectiveness, and less invasiveness from a psychological and aesthetic point of view.     

Treatment of intracranial atherosclerotic arterial stenoses with a balloon-expandable cobalt chromium stent (Coroflex Blue): procedural safety, efficacy, and midterm patency

Introduction

We evaluated the coronary balloon-expandable cobalt chromium stent Coroflex Blue for the treatment of intracranial atherosclerotic arterial stenoses (IAAS).

Methods

Between March 2007 and October 2007, a total of 25 patients (20 male, age median 67 years) with 30 IAAS underwent endovascular treatment using Coroflex Blue stents (B. Braun, Germany). Location and degree of target stenoses before and after treatment and at follow-up and adverse clinical sequelae of treatment were registered. Angiographic follow-up was scheduled for 6, 12, 26, and 52 weeks after the treatment.

Results

The 30 treated lesions were located as follows: nine in intracranial–extradural internal carotid artery (ICA), three in intradural ICA, five in middle cerebral artery, eight in intradural vertebral artery, and five in basilar artery. The technical success rate was 100%. The degree of stenoses prior to and after treatment was 61?±?2% and 26?±?3% (mean ± SE), respectively. A residual stenosis of <50% was achieved in 29 (97%) procedures. Treatment was uneventful in 28 out of 30 procedures (93%); one patient suffered a transient and one patient a permanent neurological deficit. Angiographic follow-up was available in all of the patients (100%) after 15.2 months (median) and showed significant (i.e., more than 50%) degree of recurrent stenosis in 11 (37%) of the lesions. Retreatment was performed in 11 (37%) lesions.

Conclusion

The Coroflex Blue stent is easily inserted and safely deployed into intracranial arteries. The incidence of recurrent stenoses remains a concern. Stringent angiographic and clinical follow-up and retreatment are therefore mandatory.     

Dosisoptimierung bei CT-Untersuchungen von Kindern

Clinical/methodical issue

Problems arise due to the increased clinical use of computed tomography (CT) and the high radiosensitivity of children.

Standard radiological methods

The ALARA concept (as low as reasonably achievable) prevails in pediatric radiology.

Methodical innovations

Justified indications and full utilization of available dose optimization methods.

Performance

Medical physicists and the manufacturers should support pediatric radiology in the implementation of the ALARA concept.

Achievements

The referring physicians and radiology staff should be integrated into training programs.

Practical recommendations

Sufficient diagnostic image quality is paramount and not the pretty images.     

Cerebrovascular stenosis in neurofibromatosis type 1 and utility of magnetic resonance angiography: our experience and literature review

Purpose

Neurofibromatosis type 1 (NF1) is a multisystem autosomal dominant disorder that primarily involves the skin and the nervous system. Development of cerebral arterial stenosis is a potentially deadly complication of NF1, which is frequently underestimated. The aim of our paper is to report the frequency of this cerebrovascular disease in a series of patients affected by NF1, using magnetic resonance angiography (MRA). A review of the literature was also performed, focused on the usefulness of MRA in NF1 patients.

Materials and methods

Among 125 patients with NF1 (clinical diagnosis according to the standard National Institutes of Health criteria), 81 (65 %) were studied with brain MRI (magnetic resonance imaging) and MRA using a 1.5 T magnet.

Results

Multiple intracranial arterial stenoses were found in six patients (7.4 %). In our study, MRA proved to be critical, especially for the detection of stenoses in the branches of the Circle of Willis.

Conclusion

Few case series have investigated the incidence of vascular complications of NF1, and most of them have used MRI. We suggest adding MRA to the brain imaging of all these patients, as stenoses of the branches of the Circle of Willis are often undetectable by MRI only.     

Endovascular management of spinal dural arteriovenous fistulas in 78 patients

Introduction

The purpose of this study was the evaluation of the safety and efficiency of the endovascular treatment of spinal dural arteriovenous fistulas (SDAVFs).

Methods

Between May 1992 and August 2012, 78 patients (59 men) with an angiographically proven SDAVF with pial venous drainage were treated by endovascular embolization (n?=?61) and/or surgery (n?=?31) at three German hospitals by a single team of physicians and according to a uniform therapeutic concept.

Results

Endovascular treatment resulted in a complete occlusion of the fistula in 47 cases (77 %). After failed embolization with residual shunt, 14 DAVFs were surgically cured (23 % failure rate). We had one permanent and two minor complications after endovascular therapy. Within a postoperative period of 2 weeks, 73.6 % of patients improved in gait disability, 51.1 % in micturition function, and 70.5 % in paresthesia of the lower extremities. Long-term follow-up data showed further improvement of clinical symptoms confirmed by normalization or resolution of spinal changes on MRI.

Conclusions

An interdisciplinary approach to the management of SDAVFs is mandatory. Patients without a common origin of arteries supplying the spinal cord and the dural fistula, and without a stenosis or occlusion of the concerning segmental artery are potential candidates for endovascular treatment (diluted n-butyl-2-cyanoacrylate). Only occlusion of the “nidus” and the proximal segment of the draining vein can lead to clinical improvement.     

Interventionelle Verfahren bei entzündlichen Darmerkrankungen

Introduction. Abscesses, fistulas,hemorrhages and stenoses are common complications of inflammatory bowel diseases.This study provides an overview on various methods of radiological intervention and the clinical usefulness of these methods is analyzed. Methods. The success rate of percutaneous abscess drainage (PAD), embolisation of hemorrhages and dilatation of bowel stenoses is reviewed and current literature is adressed.Success rate is defined in terms of cure rate and need for subsequent surgery. Results. After PAD, surgery can be avoided during the observation period in about 50% of patients with abscesses due to Crohn's disease and diverticulitis.Preoperative PAD reduces the degree of invasiveness and thus the risk of surgery.Abscess recurrence is found with the same frecuency following surgery or PAD.Bowel dilatation can be perfomed both with radiological and with endoscopic guidance.Embolisation of GI-hemorrhage is technically feasible, but the indication should be limitied to strictly selected cases. Conclusions. In treating abscesses and fistulas associated with Crohn's disease and diverticulitis,PAD is a valuable treatment option.Embolisation or dilatation are restricted to rare cares.     

Die präsakkale Stenose als Ursache der Epiphora

Background

Dacryocystographic evaluation of the location of stenoses of the lacrimal pathways was carried out in patients with epiphora to define the frequency and morphology of canalicular stenosis.

Patients and methods

Digital subtraction angiography (DSA) dacryocystograms of 55 consecutive patients with severe epiphora and stenoses of the lacrimal draining system were reviewed in a consensus between three evaluators to determine radiomorphologic criteria for the diagnosis of canalicular stenosis. In 9 cases 3D rotational dacryocystography was additionally used.

Results

A total of 80 stenotic lesions were detected including 19 (24%) canalicular, 26 (32%) saccal and 35 (44%) ductal stenoses. In 9 of the patients 3D rotational dacryocystography was used to differentiate between canalicular (n=4) and saccal (n=5) stenosis. Increased resistance during continuous injection of contrast material and lack of distension of the distal ductal system were the main criteria for diagnosis of canalicular stenosis.

Conclusion

Presaccal stenoses accounted for nearly 25% of the stenoses found in this study. This type of stenosis occurs frequently and should not be overlooked on dacryocystography. 3D rotational dacryocystography may be helpful in unclear cases.     

Image-guided percutaneous treatment of abdominal-pelvic abscesses: a 5-year experience

Purpose

This study was undertaken to evaluate the efficacy of image-guided percutaneous drainage in treating abdominal and pelvic abscesses.

Materials and methods

From August 2001 to August 2006, 95 patients (49 men and 46 women; mean age 61 years, range 25–92) with 107 abscesses underwent image-guided percutaneous drainage. Thirty-one abscesses were retroperitoneal (9 peripancreatic, 17 perirenal, 5 pararenal), 37 intraperitoneal (2 in communication with the small bowel), 8 intrahepatic (2 in communication with the extrahepatic biliary system and 2 with the intrahepatic biliary system), 4 perisplenic and 27 pelvic (4 in communication with the large bowel). Seventy-one of 107 procedures were performed with ultrasonographic (US) guidance and 36/107 with computed tomography (CT) guidance. All procedures were carried out with 8-to 14-Fr pigtail drainage catheters.

Results

Immediate technical success was achieved in 107/107 fluid collections. No major complications occurred. In 98/107 abscesses, we obtained progressive shrinkage of the collection (>50%) with consequent clinical success. In 9/107 cases, percutaneous drainage was unable to resolve the fluid collection. There were 12 cases of catheter displacement and six of obstruction.

Conclusions

Percutaneous drainage is feasible and effective in treating abdominal and pelvic abscesses. It may be considered both as a preparatory step for surgery and a valuable alternative to open surgery. Failure of the procedure does not, however, preclude a subsequent surgical operation.     

N-butyl Cyanoacrylate Glue Embolization of Arterial Networks to Facilitate Hepatic Arterial Skeletonization before Radioembolization

Purpose

Avoidance of nontarget microsphere deposition via hepatoenteric anastomoses is essential to the safety of yttrium-90 radioembolization (RE). The hepatic hilar arterial network may remain partially patent after coil embolization of major arteries, resulting in persistent risk. We retrospectively reviewed cases where n-butyl cyanoacrylate (n-BCA) glue embolization was used to facilitate endovascular hepatic arterial skeletonization before RE.

Methods

A total of 543 RE procedures performed between June 2004 and March 2012 were reviewed, and 10 were identified where n-BCA was used to embolize hepatoenteric anastomoses. Arterial anatomy, prior coil embolization, and technical details were recorded. Outcomes were reviewed to identify subsequent complications of n-BCA embolization or nontarget RE.

Results

The rate of complete technical success was 80 % and partial success 20 %, with one nontarget embolization complication resulting in a minor change in treatment plan. No evidence of gastrointestinal or biliary ischemia or infarction was identified, and no microsphere-related gastroduodenal ulcerations or other evidence of nontarget RE were seen. Median volume of n-BCA used was <0.1 ml.

Conclusion

n-BCA glue embolization is useful to eliminate hepatoenteric networks that may result in nontarget RE, especially in those that persist after coil embolization of major vessels such as the gastroduodenal and right gastric arteries.