Top

CardioVascular and Interventional Radiology

Published in:

Open Access 01-08-2011 | Clinical Investigation

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

Authors: Justin P. McWilliams, Stephen T. Kee, Christopher T. Loh, Edward W. Lee, David M. Liu

Published in: CardioVascular and Interventional Radiology | Issue 4/2011

Abstract

Purpose

To evaluate the safety and efficacy of two different methods of proximal cystic artery embolization in patients undergoing yttrium-90 radioembolization.

Materials and Methods

Forty-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.

Results

Technical 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.

Conclusion

Proximal 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.

Andrews JC, Walker SC, Ackerman RJ et al (1994) Hepatic radioembolization with yttrium-90 containing glass microspheres: preliminary results and clinical follow-up. J Nucl Med 35:1637–1644PubMed

Herba MJ, Illescas FF, Thirlwell MP et al (1988) Hepatic malignancies: improved treatment with intraarterial Y-90. Radiology 169:311–314PubMed

Herba MJ, Thirlwell MP (2002) Radioembolization for hepatic metastases. Semin Oncol 29:152–159PubMedCrossRef

Lewandowski RJ, Thurston KG, Goin JE et al (2005) ⁹⁰Y microsphere (TheraSphere) treatment for unresectable colorectal cancer metastases of the liver: response to treatment at targeted doses of 135–150 Gy as measured by [¹⁸F] fluorodeoxyglucose positron emission tomography and computed tomographic imaging. J Vasc Interv Radiol 16:1641–1651PubMed

Miller FH, Keppke AL, Reddy D et al (2007) Response of liver metastases after treatment with yttrium-90 microspheres: role of size, necrosis, and PET. Am J Roentgenol 188:776–783CrossRef

Sato KT, Lewandowski RJ, Mulcahy MF et al (2008) Unresectable chemorefractory liver metastases: radioembolization with Y-90 microspheres—safety, efficacy, and survival. Radiology 247:507–515PubMedCrossRef

Jakobs TF, Hoffmann RT, Dehm K et al (2008) Hepatic yttrium-90 radioembolization of chemotherapy-refractory colorectal cancer liver metastases. J Vasc Interv Radiol 19:1187–1195PubMedCrossRef

Carr BI (2004) Hepatic arterial yttrium-90 glass microspheres (Therasphere) for unresectable hepatocellular carcinoma: interim safety and survival data on 65 patients. Liver Transplantation 10(2(suppl 1)):S107–S110PubMedCrossRef

Liu DM, Salem R, Bui JT et al (2005) Angiographic considerations in patients undergoing liver-directed therapy. J Vasc Interv Radiol 16:911–935PubMed

10.

Lewandowski RJ, Sato KT, Atassi B et al (2007) Radioembolization with Y-90 microspheres: angiographic and technical considerations. Cardiovasc Intervent Radiol 30:571–592PubMedCrossRef

11.

Murthy R, Brown DB, Salem R et al (2007) Gastrointestinal complications associated with hepatic arterial Yttrium-90 microsphere therapy. J Vasc Interv Radiol 18:553–562PubMedCrossRef

12.

Tarazov PG, Polysalov VN, Prozorovskij KV et al (2000) Ischemic complications of transcatheter arterial chemoembolization in liver malignancies. Acta Radiol 41:156–160PubMedCrossRef

13.

Gates J, Hartnell GG, Stuart KE et al (1999) Chemoembolization of hepatic neoplasms: safety, complications, and when to worry. Radiographics 19:399–414PubMed

14.

Leung DA, Goin JE, Sickles C et al (2001) Determinants of postembolization syndrome after hepatic chemoembolization. J Vasc Interv Radiol 12:321–326PubMedCrossRef

15.

Kuroda C, Iwasaki M, Tanaka T et al (1983) Gallbladder infarction following hepatic transcatheter arterial embolization. Radiology 149:85–89PubMed

16.

Takayasu K, Moriyama N, Muramatsu Y et al (1985) Gallbladder infarction after hepatic artery embolization. Am J Roentgenol 144:135–138

17.

Lewandowski RJ, Salem R (2004) Incidence of radiation cholecystitis in patients receiving Y-90 treatment for unresectable liver malignancies (abstract). J Vasc Interv Radiol 15:S162CrossRef

18.

Atassi B, Bangash AK, Lewandowski RJ et al (2008) Biliary sequelae following radioembolization with yttrium-90 microspheres. J Vasc Interv Radiol 19:691–697PubMedCrossRef

19.

Murthy R, Nunez R, Szklaruk J et al (2005) Yttrium-90 microsphere therapy for hepatic malignancy: devices, indications, technical considerations, and potential complications. Radiographics 25(suppl 1):S41–S55PubMedCrossRef

20.

Molmenti EP, Pinto PA, Klein J et al (2003) Normal and variant arterial supply of the liver and gallbladder. Pediatr Transpl 7:80–82CrossRef

21.

Mlakar B, Gadzijev EM, Ravnik D et al (2003) Anatomical variations of the cystic artery. Eur J Morphol 41:31–34PubMedCrossRef

22.

Price P, Holden C (1993) Anatomic variance in the cholecystic blood supply: a case report. Am Surg 59:278–280PubMed

23.

Salem R, Thurston KG (2006) Radioembolization with yttrium-90 microspheres: a state-of-the-art brachytherapy treatment for primary and secondary liver malignancies. Part 2: special topics. J Vasc Interv Radiol 17:1425–1439PubMedCrossRef

24.

Bergey E, Einstein DM, Herts BR (1995) Cystic artery pseudoaneurysm as a complication of laparoscopic cholecystectomy. Abdom Imaging 20:75–77PubMedCrossRef

25.

Maeda A, Kunou T, Saeki S et al (2002) Pseudoaneurysm of the cystic artery with hemobilia treated by arterial embolization and elective cholecystectomy. J Hepatobiliary Pancreat Surg 9:755–758PubMedCrossRef

26.

Polyzonis MB, Tsikaras P, Hytiroglou P (1989) Further observations on the vascular system of the gallbladder in man. Bull Assoc Anat 73:25–28

27.

Michels NA (1966) Newer anatomy of the liver and its variant blood supply and collateral circulation. Am J Surg 112:337–347PubMedCrossRef

28.

Komatsu T, Matsui O, Kadoya M et al (1999) Cystic artery origin of the segment V hepatic artery. Cardiovasc Intervent Radiol 22:165–167PubMedCrossRef

29.

Couinaud C (1954) Distribution de l’artere hepatique dans le foie. Acta Anat 22:49–81PubMedCrossRef

30.

Miyayama S, Matsui O, Nishida H et al (2003) Transcatheter arterial chemoembolization for unresectable hepatocellular carcinoma fed by the cystic artery. J Vasc Interv Radiol 14(9 (pt1)):1155–1161PubMed

31.

Ahmadzadehfar H, Sabet A, Biermann K et al (2010) The significance of ^99mTc-MAA SPECT/CT liver perfusion imaging in treatment planning for ⁹⁰Y-microsphere selective internal radiation treatment. J Nucl Med 51:1206–1212PubMedCrossRef

Title: Prophylactic Embolization of the Cystic Artery Before Radioembolization: Feasibility, Safety, and Outcomes
Authors: Justin P. McWilliams
Stephen T. Kee
Christopher T. Loh
Edward W. Lee
David M. Liu
Publication date: 01-08-2011
Publisher: Springer-Verlag
Published in: CardioVascular and Interventional Radiology / Issue 4/2011
Print ISSN: 0174-1551
Electronic ISSN: 1432-086X
DOI: https://doi.org/10.1007/s00270-010-0021-x

Keynote webinar | Spotlight on medication adherence

Springer Medicine

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

Abstract

Purpose

Materials and Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Materials and Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 4/2011

Safety Profile of Sequential Transcatheter Chemoembolization with DC Bead™: Results of 237 Hepatocellular Carcinoma (HCC) Patients

Utility of MRI Before and After Uterine Fibroid Embolization: Why to Do It and What to Look For

Silicon Carbide as a Heat-enhancing Agent in Microwave Ablation: In Vitro Experiments

Lipoproteins and the Development of Restenosis After Stent Implantation in the Superficial Femoral Artery in Patients with Peripheral Artery Disease

Nanotechnology and its Relationship to Interventional Radiology. Part II: Drug Delivery, Thermotherapy, and Vascular Intervention

MR Imaging Guided Percutaneous Nephrostomy using a 1.0 Tesla Open MR Scanner