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CardioVascular and Interventional Radiology
Published in: CardioVascular and Interventional Radiology 5/2016

Open Access 01-05-2016 | Clinical Investigation

Radioembolization: Is Prophylactic Embolization of Hepaticoenteric Arteries Necessary? A Systematic Review

Authors: Alicia S. Borggreve, Anadeijda J. E. M. C. Landman, Coco M. J. Vissers, Charlotte D. De Jong, Marnix G. E. H. Lam, Evelyn M. Monninkhof, Jip F. Prince

Published in: CardioVascular and Interventional Radiology | Issue 5/2016

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Abstract

Purpose

To study the effectiveness of prophylactic embolization of hepaticoenteric arteries to prevent gastrointestinal complications during radioembolization.

Methods

A PubMed, Embase and Cochrane literature search was performed. We included studies assessing both a group of patients with and without embolization.

Results

Our search revealed 1401 articles of which title and abstract were screened. Finally, eight studies were included investigating 1237 patients. Of these patients, 456 received embolization of one or more arteries. No difference was seen in the incidence of gastrointestinal complications in patients with prophylactic embolization of the gastroduodenal artery (GDA), right gastric artery (RGA), cystic artery (CA) or hepatic falciform artery (HFA) compared to patients without embolization. Few complications were reported when microspheres were injected distal to the origin of these arteries or when reversed flow of the GDA was present. A high risk of confounding by indication was present because of the non-randomized nature of the included studies.

Conclusion

It is advisable to restrict embolization to those hepaticoenteric arteries that originate distally or close to the injection site of microspheres. There is no conclusive evidence that embolization of hepaticoenteric arteries influences the risk of complications.
Literature
1.
Riaz A, Lewandowski RJ, Kulik LM, Mulcahy MF, Sato KT, Ryu RK, Omary RA, Salem R. Complications following radioembolization with yttrium-90 microspheres: a comprehensive literature review. J Vasc Interv Radiol. 2009;20(9):1121–30.CrossRefPubMed
2.
Riaz A, Awais R, Salem R. Side effects of yttrium-90 radioembolization. Front Oncol. 2014;29(4):198.
3.
Naymagon S, Warner RR, Patel K, Harpaz N, Machac J, Weintraub JL, Kim MK. Gastroduodenal ulceration associated with radioembolization for the treatment of hepatic tumors: an institutional experience and review of the literature. Dig Dis Sci. 2010;55(9):2450–8.CrossRefPubMed
4.
Peterson JL, Vallow LA, Johnson DW, Heckman MG, Diehl NN, Smith AA, Tzou KS, Paz-Fumagalli R, Kim S, Ko SJ, Daugherty LC, Kim GP, Brown N, Mori KW, Buskirk SJ. Complications after 90Y microsphere radioembolization for unresectable hepatic tumors: an evaluation of 112 patients. Brachytherapy. 2013;12(6):573–9.CrossRefPubMed
5.
Atassi B, Bangash AK, Lewandowski RJ. Biliary sequelae following radioembolization with Yttrium-90 microspheres. J Vasc Interv Radiol. 2008;19(5):691–7.CrossRefPubMed
6.
Jakobs TF, Hoffmann RT, Dehm K, et al. Hepatic yttrium-90 radioembolization of chemotherapy-refractory colorectal cancer liver metastases. J Vasc Interv Radiol. 2008;19(8):1187–95.CrossRefPubMed
7.
Schelhorn J, Theysohn J, Ertle J, Schlaak JF, Mueller S, Bockisch A, Lauenstein T. Selective internal radiation therapy of hepatic tumours: Is coiling of the gastroduodenal artery always beneficial? Clin Radiol. 2014;65(5):216–22.CrossRef
8.
Petroziello MF, McCann JW, Gonsalves CF, Eschelman DJ, Anne PR, Sato T, Doyle LA, Frangos A, Brown DBl. Side-branch embolization before 90Y radioembolization: rate of recanalization and new collateral development. Am J Roentgenol. 2011;197(1):W169.CrossRef
9.
Abdelmaksoud MH, Hwang GL, Louie JD, Kothary N, Hofmann LV, Kuo WT, Hovsepian DM, Sze DY. Development of new hepaticoenteric collateral pathways after hepatic arterial skeletonization in preparation for yttrium-90 radioembolization. J Vasc Interv Radiol. 2010;21(9):1385–95.CrossRefPubMed
10.
Moher D, Liberati A, Tetzlaff J, Altman DG. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. BMJ. 2009;339:b2535.CrossRefPubMedPubMedCentral
11.
Hamoui N, Minocha J, Memon K, Sato K, Ryu R, Salem R, Lewandowski RJ. Prophylactic embolization of the gastroduodenal and right gastric arteries is not routinely necessary before radioembolization with glass microspheres. J Vasc Interv Radiol. 2013;24(11):1743–5.CrossRefPubMed
12.
Cosin O, Bilbao JI, Alvarez S, De Luis E, Alonso A, Martinez-Cuesta A. Right gastric artery embolization prior to treatment with yttrium-90 microspheres. Cardiovasc Interv Radiol. 2007;30(1):98–103.CrossRef
13.
Daghir AA, Gungor H, Haydar AA, Wasan HS, Tait NP. Embolisation of the gastroduodenal artery is not necessary in the presence of reversed flow before yttrium-90 radioembolisation. Cardiovasc Interv Radiol. 2012;35(4):839–44.CrossRef
14.
Theysohn JM, Muller S, Schlaak JF, Ertle J, Schlosser TW, Bockisch A, Lauenstein TC. Selective internal radiotherapy (SIRT) of hepatic tumors: how to deal with the cystic artery. Cardiovasc Interv Radiol. 2013;36(4):1015–22.CrossRef
15.
Powerski M, Busse A, Seidensticker M, Fischbach F, Seidensticker R, Strach K, Dudeck O, Ricke J, Pech M. Prophylactic embolization of the cystic artery prior to radioembolization of liver malignancies: an evaluation of necessity. Cardiovasc Interv Radiol. 2015;38(3):678–84.CrossRef
16.
Schelhorn J, Ertle J, Schlaak JF, Mueller S, Bockisch A, Schlosser T, Lauenstein T. Selective internal radiation therapy of hepatic tumors: procedural implications of a patent hepatic falciform artery. SpringerPlus. 2014;3:595.CrossRefPubMedPubMedCentral
17.
Paprottka PM, Paprottka KJ, Walter A, Haug AR, Trumm CG, Lehner S, Fendler WP, Jakbos TF, Reiser MF, Zech CJ. Safety of radioembolization with 90Yttrium resin microspheres depending on coiling or no-coiling of aberrant/high-risk vessels. Cardiovasc Interv Radiol. 2015;38(4):946–56.CrossRef
18.
Ahmadzadehfar H, Mohlenbruch M, Sabet A, Meyer K, Muckle M, Haslerud T, Wilhelm K, Schild H, Biersack H, Ezziddin S. Is prophylactic embolization of the hepatic falciform artery needed before radioembolization in patients with 99mTc-MAA accumulation in the anterior abdominal wall. Eur J Nucl Med Mol Imaging. 2011;38(8):1477–84.CrossRefPubMed
19.
Salas M, Hofman A, Stricker BH. Confounding by indication: an example of variation in the use of epidemiologic terminology. Am J Epidemiol. 1999;149(11):981–3.CrossRefPubMed
20.
Cancer Therapy Evaluation Program, Common Terminology Criteria for Adverse Events, Version 3.0. DCTD, NCI, NIH, DHHS. 2003.
21.
Lam MG, Banerjee S, Louie JD, Abdelmaksoud MH, Iagaru AH, Ennen RE, Sze DY. Root cause analysis of gastroduodenal ulceration after yttrium-90 radioembolization. Cardiovasc Interv Radiol. 2013;36(6):1536–47.CrossRef
22.
Murthy R, Xiong H, Nunez R, Cohen AC, Barron B, Szklaruk J, Madoff DC, Gupta S, Wallace MJ, Ahrar K, Hicks ME. Yttrium 90 resin microspheres for the treatment of unresectable colorectal hepatic metastases after failure of multiple chemotherapy regimens: preliminary results. J Vasc Interv Radiol. 2005;16(7):937–45.CrossRefPubMed
23.
Lewandowski RJ, Salem R. Yttrium-90 radioembolization of hepatocellular carcinoma and metastatic disease to the liver. Semin Interv Radiol. 2006;23(1):64–72.CrossRef
24.
Lam MG, Seinstra BA, van den Bosch M, Louie JD, Sze DY. Comparison between resin and glass microspheres for Yttrium-90 radioembolization treatment of hepatocellular carcinoma. J Vasc Interv Radiol. 2013;24(4):S149.CrossRef
25.
Rhee TK, Lewandowski RJ, Liu DM, Mulcahy MF, Takahashi G, Hansen PD, Benson AB 3rd, Kennedy AS, Omary RA, Salem R. 90Y Radioembolization for metastatic neuroendocrine liver tumors: preliminary results from a multi-institutional experience. Ann Surg. 2008;247(6):1029–35.CrossRefPubMed
26.
Louie JD, Kotharty N, Kuo WT, Hwang GL, Hofmann LV, Goris ML, Iagaru AH, Sze DY. Incorporating cone-beam CT into the treatment planning for yttrium-90 radioembolization. J Vasc Interv Radiol. 2009;20(5):606–13.CrossRefPubMed
27.
Heusner TA, Hamami ME, Ertle J, Hahn S, Poeppel T, Hilgard P, Bockisch A, Forsting M, Antoch G. Angiography-based C-arm CT for the assessment of extrahepatic shunting before radioembolization. ROFO. 2010;182:603–8.CrossRefPubMed
28.
van den Hoven AF, Prince JF, de Keizer B, Vonken EJ, Bruijnen RC, Verkooijen HM, Lam MG, van den Bosch MA. Use of C-arm cone beam CT during hepatic radioembolization: protocol optimalization for extrahepatic shunting and parenchymal enhancement. Cardiovasc Interv Radiol. 2015;39(1):64–73.CrossRef
29.
Hagspiel KD, Nambiar A, Hagspiel LM, Ahmad EA, Bozlar U. Temporary arterial balloon occlusion as an adjunct to yttrium-90 radioembolization. Cardiovasc Interv Radiol. 2013;36(3):809–13.CrossRef
30.
Fischman AM, Ward TJ, Patel RS, Arepally A, Kim E, Nowakowski FS, Lookstein RA. Prospective, randomized study of coil embolization versus Surefire infusion system during yttrium-90 radioembolization with resin microspheres. J Vasc Interv Radiol. 2014;25(11):1709–16.CrossRefPubMed
31.
Louie JD, Wang EA, Broadwell S, Wible BC, Arepally A, Nutting C, Bester L, Sze DY. First in man experience with the surefire infusion system: a dedicated microcatheter system to eliminate reflux during embolotherapy. J Vasc Interv Radiol. 2012;23(3):S80.CrossRef
32.
Mahvash A, Odisio BC, Avritscher R, Chasen B, Murthy R. Temporary balloon occlusion of the common hepatic artery during Y90 radioembolization planning and treatment in patients with patent hepatoenteric collaterals. J Vasc Interv Radiol. 2014;25(3):S87–8.CrossRef
33.
Morshedi MM, Bauman M, Rose SC, Kikolski SG. Yttrium-90 Resin Microsphere Radioembolization Using an Antireflux Catheter: an Alternative to Traditional Coil Embolization for Nontarget Protection. Cardiovasc Interv Radiol. 2015;38(2):381–8.CrossRef
34.
Van Den Hoven A, Prince JF, Samim M, Arepally A, Zonneberg BA, Lam MGEH, Van Den Bosch M. Posttreatment PET-CT-confirmed intrahepatic radioembolization performed without coil embolization, by using the antireflux surefire infusion system. Cardiovasc Interv Radiol. 2014;37(2):523–8.CrossRef
35.
Rose SC, Kikolski SG, Chomas JE. Downstream hepatic arterial blood pressure changes caused by deployment of the surefire antireflux expandable tip. Cardiovasc Interv Radiol. 2013;36(5):1262–9.CrossRef
Metadata
Title
Radioembolization: Is Prophylactic Embolization of Hepaticoenteric Arteries Necessary? A Systematic Review
Authors
Alicia S. Borggreve
Anadeijda J. E. M. C. Landman
Coco M. J. Vissers
Charlotte D. De Jong
Marnix G. E. H. Lam
Evelyn M. Monninkhof
Jip F. Prince
Publication date
01-05-2016
Publisher
Springer US
Published in
CardioVascular and Interventional Radiology / Issue 5/2016
Print ISSN: 0174-1551
Electronic ISSN: 1432-086X
DOI
https://doi.org/10.1007/s00270-016-1310-9

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