Transcatheter arterial embolization therapy in cases of recurrent and advanced pelvic cancer--estimation by Cox's proportional hazard model

From April 1983 through September 1988, transcatheter internal iliac arterial embolization therapy (TAE) using Gelfoam particles was performed in 36 patients with recurrent pelvic cancer and 18 patients with advanced pelvic cancer. The tumor showed complete response (CR) to the therapy in seven patients, partial response (PR) in 18, minor response (MR) in five, and no change (NC) in 24 patients, with the response rate (CR + PR) of 46.3%. Univariate analysis, using Kaplan-Meier estimates and log-rank test, revealed that overall survival was related to performance status (p = 0.0001) and tumor reduction by TAE (p = 0.0008). Similarly, a multivariate analysis, using Cox's proportional hazard model, revealed a strong relationship between prognosis and performance status and tumor reduction by TAE. These results show that both good general condition and tumor reduction by TAE are significant characteristics for the prognosis of recurrent and advanced pelvic cancer treated by TAE.     

Clinical evaluation of transcatheter arterial embolization for the management of retroperitoneal bleeding in cases of pelvic fracture

PURPOSE: We evaluated the clinical efficacy of TAE for the management of retroperitoneal bleeding in a case of pelvic fracture. MATERIALS AND METHODS: A retrospective review of 206 patients with pelvic fractures was performed. Thirty-four patients who were hemodynamically unstable or had evidence of ongoing hemorrhage required TAE. Rescue rate, effective rate, and mortality rate among the patients with multiple organ injuries were calculated. Charts were reviewed for age, Japanese coma scale (JCS), hemoglobin, blood pressures, extent of retroperitoneal hemorrhage, pelvic fracture pattern/extent of embolization, and time from judging indication of TAE to angiography. Data of patients who died of pelvic fracture hemorrhage was compared with that of others. Statistical analysis was done with analysis of variance, and the two groups were compared using Student's t-test. RESULTS: Rescue rate, success rate, and mortality rate were 76% (26/34), 91% (31/34), and 33% (8/24), respectively. Only JCS reached statistical significance. The complications of gluteal skin and muscle necrosis were experienced in one patient. Two patients with lung contusion and one patient who had suffered from idiopathic interstitial pneumonia died from disseminated intravascular coagulation associated with pneumonia. Viscorectal dysfunctions, which were observed in ten patients, were considered to be independent of TAE. CONCLUSION: TAE for pelvic fracture hemorrhage was considered effective. Complications of gluteal skin and muscle necrosis should be kept in mind.     

肝动脉化疗栓塞术后联合射频热凝治疗大肝癌

目的探讨晚期原发性大肝癌(直径大于5cm)患者,先行肝动脉化疗栓塞(TACE),再行B超引导下经皮肝穿刺射频热凝(PRFA)治疗的疗效。方法分析我院2002年6月至2003年5月晚期原发性大肝癌患者62例,其中联合组32例,即先行TACE治疗,再行B超引导下PRFA治疗。TACE组30例,仅行TACE治疗。治疗后1个月定期检测甲胎蛋白(AFP)值,同时行CT、MRI或B超复查肿瘤坏死的情况。评价两组AFP值转阴率、1年生存率以及肿瘤完全坏死率。结果经过治疗后,联合组和TACE组AFP值转阴率分别为50．0％,42．8％(P=0．639)。1年生存率分别为37．5％,30．0％(P=0．243)。肿瘤完全坏死率分别为68．7％,40．0％(P=0．023)。两组间肿瘤完全坏死率有显著性差异,但两组间AFP值转阴率及1年生存率均无显著性差异。结论原发性大肝癌患者先行TACE治疗,再行PRFA治疗,较仅行TACE治疗,并不能延长患者的生存期。     

Complications following transcatheter arterial embolization for massive hemorrhage associated with pelvic fracture]

Complications of internal iliac artery embolization were studied in 21 patients. The 9 male and 12 female patients were 12-70 years old (average 39). This procedure was carried out for control of hemorrhage due to pelvic fracture. Embolization was performed using gelfoam cubes (1-2 mm) for main internal iliac artery or its branches subselectively. In the earlier series, steel coils were placed in the internal iliac artery routinely after gelfoam embolization. In the group of 9 men, 4 male had impotence and 5 had no change in sexual function. As a possible post embolization neurological damage, 4 patients had sensory disturbance and 8 patients had gait disturbance. Three patients had dysuria and one of them had also difficulty in defecation. All these complications following internal iliac artery embolization are suspected to be due to associated injuries and varied effect of traumatic pelvic fracture than a result of the vascular occlusion. Percutaneous transcatheter therapeutic embolization is a safe and effective procedure of choice for controlling massive bleeding associated with pelvic fracture.     

急诊肝动脉栓塞治疗肝癌破裂出血

目的 探讨急诊肝动脉栓塞治疗肝癌破裂出血.方法 对23例肝癌破裂出血患者采用急诊肝动脉栓塞止血.结果 22例患者均得以有效止血;1例患者因供血血管发育走行异常,导管不能达靶血管,转入外科治疗.22例患者均无复发出血及急性肝功能衰竭,9例患者经栓塞术后,再根据病情行多次介入治疗,肿瘤均有不同程度的缩小和坏死.结论 急诊肝动脉栓塞是治疗肝癌破裂出血的有效方法,可达到立即止血的目的,同时可为肝癌后续血管内治疗提供途径.     

经导管动脉栓塞术在顽固性鼻出血中的应用

目的探讨经导管动脉栓塞术在治疗顽固性鼻出血中的应用价值。方法41例顽固性鼻出血患者均采用经皮股动脉穿刺,将导管插入患侧上颌动脉或超选择至出血动脉,采用明胶海绵或聚乙烯(PVA)颗粒行栓塞治疗术。结果41例患者,39例1次栓塞治愈,其余2例于术后第2天发生再出血,经再次介入治疗,治愈。结论经导管动脉栓塞术对于治疗顽固性鼻出血是一种简便、安全、有效的治疗方法。     

Rupture of hepatocellular carcinoma following transcatheter arterial embolization

In one of our patients, intra-abdominal bleeding caused by rupture of hepatocellular carcinoma occurred after TAE. The tumor did not become completely necrotic after TAE and there was fairly rapid recurrence. TAE was then performed a second time and the tumor, which projected from the surface of the liver, ruptured after six days. Among the diagnostic imaging methods, CT proved most useful in locating the site of tumor rupture.     

盆腔血管性栓塞治疗的严重并发症分析

目的 研究应用血管性介入栓塞治疗盆腔疾病导致严重并发症的原因,进一步提高临床应用的安全性。方法 201例盆腔疾病患者用Seldinger法穿刺插管行盆腔靶器官的供血动脉栓塞,对术后出现的严重并发症进行归纳、总结。结果 发生严重并发症9例,发生率为4．5％。其中臀部缺血坏死4例,尿频、尿急、尿痛、血尿2例,下肢麻木、感觉障碍2例,阴道流脓血性分泌物2例,会阴严重水肿1例。结论 盆腔血管性栓塞治疗中注意控制某些相关因素可有效预防严重并发症的发生。     

妇科恶性肿瘤介入治疗的并发症

目的 对妇科恶性肿瘤介入治疗的并发症进行分析,并就其出现原因、处理措施及如何避免做进一步探讨。方法 对经病理证实的78例妇科恶性肿瘤患者共作了130次介入治疗,每人1－6次。全部病例均采用Seldinger穿刺术,一侧股动脉插管（通常为右侧股动脉）,一侧或两侧盆腔动脉内灌注化疗药物和（或）栓塞的方法。结果 本组妇科恶性肿瘤介入治疗后有6例（7.69%）出现了较为严重的臀部、外阴部皮肤组织缺血坏死等。其中5例患者经换药、抗炎治疗2周至2个月后逐步痊愈。1例患者接受了局部清创术治疗,恢复时间长达5个月。结论 盆腔动脉介入治疗出现严重并发症的原因有：短时间内灌注的化疗药物用量过大、过浓;靶动脉分出异常丰富的皮支或插管过深;栓塞剂颗粒太小;盆腔手术及放疗后髂内动脉侧支循环不够丰富等。介入术者应尽可能选择适当的置管位置,应用适量的化疗药物稀释后缓慢灌注,栓塞时最好用胶海绵颗粒或明胶海绵条。     

Prognostic factors in liver metastases after transcatheter arterial embolization or arterial infusion

From January 1986 to December 1988, 85 patients (55 men and 30 women, mean age 59 years) with metastatic liver tumors were treated with hepatic artery embolization (TAE) or infusion (HAI). Sixty-eight patients with successful catheterization were treated with TAE using iodized oil (Lipiodol) mixed with anticancer agent (ACA). In 12 of 68 patients with hypervascular tumors gelatin sponge was added. Patients with unsuccessful catheterization were treated with hepatic artery infusion of ACA. Forty-three patients received oral chemotherapy following TAE or HAI. Overall, the 6-month, and 1- and 2-year survival rates were 69.5, 31.8 and 4.1 per cent, respectively (mean 233 days). A univariate analysis of prognostic factors showed that number of metastases, stage, treatment times and oral chemotherapy were all significant factors (p less than 0.05). Ascites, jaundice, percentage of hepatic replacement and treatment protocol also had some influence (p less than 0.1). Sex, age, primary site, elevation of tumor markers, other metastatic lesions, portal vein involvement and difference in anticancer agent had no prognostic significance. A multivariate analysis using Cox's proportional hazard model revealed that the number of treatments had the most important prognostic significance, followed by oral chemotherapy, stage and percentage of hepatic replacement.     

对比微球与传统碘油栓塞治疗原发性肝癌疗效

原发性肝癌是世界上最常见的恶性肿瘤之一,经导管动脉化疗栓塞术（TACE）已经成为公认的肝癌非手术治疗的首选方法。碘油是目前临床治疗肝癌最常用的栓塞剂,微球是一种新型的末梢栓塞剂,近年来,有学者认为微球栓塞延长肝癌患者的生存率,而且毒性较小,其临床疗效优于应用碘油的传统TACE;然而,另一些学者则认为传统碘油栓塞更具优势。本文就这两种栓塞剂研究进展及其疗效对比加以综述。     

急症动脉栓塞治疗难治性产后出血疗效评价

目的评价急症经导管动脉栓塞术(TAE)治疗难治性产后出血的疗效及安全性。方法临床25例难治性产后出血患者,采用右股动脉Seldinger穿刺技术,选择性插管至双侧髂内动脉或子宫动脉,行DSA明确出血部位后以明胶海绵颗粒栓塞。结果插管成功率100%,手术时间25～60min,平均(42.5±4.6)min,术后止血时间3～15min。术后止血总有效率100%。比较术前术后患者血红蛋白及心率,差异具有显著性(t=29.49,P<0.01;t=16.51,P<0.01)。所有患者宫体按期复旧,转经后月经正常。结论TAE创伤小,疗效快速肯定,术后短期及长期随访无严重并发症,对危及生命的产后出血是一种有效治疗措施。     

Percutaneous transcatheter embolization in arterial injuries of the lower limbs

Purpose: To evaluate the efficacy and safety of percutaneous transcatheter arterial embolization (PTE) in lower extremity arterial injuries.

Material and Methods: From January 2000 to June 2004, patients who presented with a penetrating trauma of the lower limbs, along with bleeding and with no sign of ischemia or hemodynamic instability, were included in the study. The injuries were embolized by coils and Gelfoam. The efficacy of PTE was defined as its ability to stop bleeding both radiographically and clinically, and its safety was determined by the complication rate.

Results: There were 10 embolizations, which consisted of 5 profundal femoral, 3 superior gluteal, and 2 inferior gluteal artery embolizations. PTE was effective in all patients. There were two inguinal hematomas, which did not require any intervention, and there was a temporary renal function alteration. The mean hospital stay of these patients was 2.67±0.91 days.

Conclusion: PTE may be an effective and safe method of treatment in certain cases with lower limb arterial injuries. However, patients should be selected meticulously by both the vascular surgeon and the interventional radiologist, and PTE should be undertaken only in experienced hands.     

The movement of antineoplastic solutions in transcatheter hepatic arterial embolization

Transcatheter hepatic arterial embolization (TAE) with gelatin sponge particles soaked in anticancer agents has been widely employed in the treatment of Hepatocellular carcinoma (HCC). The mechanism of TAE has been explained by blocking of blood flow to the tumor, however the role of anticancer agents used with embolic materials has remained unclear. The purpose of this study is to prove the role of anticancer agents used in TAE. 1) In eighteen cases of HCC and 4 cases of metastatic liver cancer, TAE was performed with gelatin sponge, anticancer agents and contrast media. The livers were examined by CT 4, 24 and 48 hours after TAE. A selective retention of contrast media containing anticancer agent in the tumor area was observed in 14 of 14 cases examined 4 hr. in 15 of 17 cases examined 24 hr and in 6 of 6 cases examined 48 hr after TAE. In the cases of metastatic liver cancer, retention of contrast media, was also observed in 4 of 4 cases examined at 24 hr and 3 of 3 cases examined 48 hr after TAE. 2) TAE was done in 12 cases of HCC by using gelatin sponge soaked in anticancer agent mixed with 99M-Tc-pertechnetate. Livers were observed by a scintillation camera 4 hr and 24 hr after TAE. A selective retention of 99M-Tc-pertechnetate in the tumor was observed in 12 of 12 cases examined 4 hr and in 3 of 3 cases examined 24 hr after TAE. 3) In one cases of HCC, hepatectomy was performed 2 days after TAE.(ABSTRACT TRUNCATED AT 250 WORDS)     

Study of the additional filter in transcatheter hepatic arterial embolization

It is well known that Interventional Radiology (IVR) is useful. However, the patient dose in IVR is increasing because of the prolongation of fluoroscopic time and the increase in the number of radiographies in recent years. We studied the adequacy of the additional filter for the decrease of the skin surface dose in patients with hepatocellular carcinoma of transcatheter arterial embolization (TAE). In 20 patients (15 men and 5 women, average age: 66.9 and 72.0 years old) who had undergone TAE, we estimated the skin surface dose from the records of their exposure condition (tube voltage, tube current, time, and field size of image intensifier) and the results of the phantom experiment with 2 kinds of additional filter. The estimated skin surface dose of the patient was 1.75 ± 0.84 with the additional filter of 1.5 mm thickness of aluminum (1.5 mmAl), 1.46 ± 0.67 Gy with 0.03 mm thickness tantalum (0.03 mmTa) and 1.17 ± 0.55 Gy with 0.06 mm thickness of tantalum (0.06 mmTa). Against a skin surface dose of 1.5 mmAl, the dose reduction of 16.7% was shown in 0.03 mmTa and 33.2% in 0.06 mmTa. With a DSA phantom of iodine density 0.5 and 1.0 and 2.0 mgI/ml, DSA images were acquisitioned at tube voltage 70, 80 and 90 kV to compare the detectability of contrast media in 0.06 mmTa with 1.5 mmAl. To evaluate the detectability of contrast media in 0.06 mmTa in 1.5 mmAl, receiver operating characteristic (ROC) analysis was performed with the pixel value of the phantom image. The area under the ROC curve in a 1.5 mmAl filter and the 0.06 mmTa filter provided with each contrast media density and each tube voltage was approximately a constant value. It was suggested that there was no differences in the detectability of contrast media in both additional filters. In conclusion, the skin surface dose of the patient was able to be reduced 33.2% without decreasing contrast media detectability by changing the additional filter from 1.5 mmAl to 0.06 mmTa. It was most suitable in TAE in our hospital to choose 0.06 mmTa as an additional filter.     

Pathogenesis and prevention of gastrointestinal complications following transcatheter arterial embolization

Prospective evaluation of gastrointestinal complications after transcatheter arterial embolization (TAE) was performed on 149 TAEs of 133 patients with endoscopy in order to evaluate whether the use of antiulcer medication can prevent such complications. In 21 of 141 TAEs (14%) there developed gastrointestinal complications. The incidence of complications with administration of H2-blocker was 30.4%, whereas the incidence with administration of PGE1 and without medication were 2.8% (p less than 0.01) and 9.0%, respectively. It has been suggested that such complications are mainly due to backflow of the embolic materials to the gastric artery. These findings indicates that decrease of gastric mucosal blood flow due to backflow of the embolic materials to the gastric artery cause the gastrointestinal complications.     

Lymphoma of the cervix. Imaging and transcatheter arterial embolization

A case of uterine cervix lymphoma with selective embolization after angiography is described. Chemotherapy and radiotherapy were carried out and surgery was avoided.     

Labelled gelfoam in transcatheter arterial embolization of renal cell carcinoma

Six patients with renal cell carcinoma underwent transcatheter arterial embolization with Gelfoam labelled by metallic clips. The embolization procedure was more easily monitored by fluoroscopy, and the complication of peripheral embolization was prevented. Tumor regression can be evaluated by changes in the distribution of the metallic clips on plain films.