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1.
Hussein D. Aoun Peter J. Littrup Mohamed Jaber Fatima Memon Barbara Adam Mark Krycia Matthew Prus Elisabeth Heath Edson Pontes 《Journal of vascular and interventional radiology : JVIR》2017,28(10):1363-1370
Purpose
To retrospectively assess long-term outcomes of percutaneous renal cryoablation, including factors affecting complications and local recurrence rates.Materials and Methods
A total of 357 computed tomographic (CT) fluoroscopy–guided percutaneous cryoablation procedures were performed for 382 masses in 302 outpatients; 347 were biopsy-proven renal-cell carcinoma (RCC) or Bosniak category > III masses (n = 28). Benign pathologic conditions (n = 18) or metastatic non-RCC disease (n = 17) were included to analyze procedural complication rate, but recurrence rates, tumor staging, and nephrometry score were limited to RCCs. The average tumor diameter was 2.9 cm (range, 1–10.3 cm), and median nephrometry score for RCC was 8 (mean, 7.4). Protection of adjacent vital structures was performed in 34% of procedures (n = 121), and ureteral stent placement was performed for 9.2% (n = 33). All major complications were graded per surgical Clavien–Dindo criteria.Results
The average CT-visible cryoablation zone diameter was 5 cm (range, 2.5–10.5 cm). Grade ≥ 3 complications occurred in 2.8% of procedures (n = 10), and appeared related to only high nephrometry scores (P = .0086) and larger tumors (P = .0034). No significant changes in renal function before and after the procedure were noted (P = .18). At a mean follow-up of 31.8 months, the local tumor recurrence rate was 3.2% (11 of 347) for RCC, and no significant difference was noted between tumors larger or smaller than 3 cm (P = .15). The difference reached significance only among the small number of stage ≥ T2 RCC tumors (P = .0039).Conclusions
Long-term follow-up of percutaneous renal cryoablation demonstrates low recurrence rates with preserved renal function, even for patients with high nephrometry scores and body mass index, assuming thorough cytotoxic technique and protection measures. 相似文献2.
Nathan E. Frenk Dania Daye Kemal Tuncali Ronald S. Arellano Paul B. Shyn Stuart G. Silverman Florian J. Fintelmann Raul N. Uppot 《Journal of vascular and interventional radiology : JVIR》2018,29(2):276-284
Purpose
To evaluate local control and survival after image-guided ablation of adrenal gland metastases.Materials and Methods
Image-guided ablations of adrenal metastases measuring < 5 cm performed at 2 academic medical centers between July 2002 and June 2016 were analyzed. There were 51 procedures performed on 46 tumors (mean diameter 2.8 cm ± 1.1; range, 0.7–4.9 cm) in 38 patients (mean age 66 y; range, 41–80 y) with renal cell carcinoma (n = 17 patients; 45%), non–small cell lung cancer (n = 10 patients; 26%), and other primary malignancies (n = 11 patients; 29%). Treatment modalities included cryoablation (n = 30 procedures; 59%), radiofrequency ablation (n = 12 procedures; 24%) and microwave ablation (n = 9 procedures; 18%). Technical success, primary and secondary efficacy, local progression rate, local progression-free survival, and overall survival were assessed. Mean follow-up was 37 months (range, 2–128 months). Statistical analysis was performed with univariate Cox hazards regression and Kaplan-Meier analyses.Results
Technical success, primary efficacy, and secondary efficacy were 96%, 72%, and 76%. Local progression rate during all follow-up was 25%. Local tumor progression-free survival at 1, 3, and 5 years was 82%, 69%, and 55%. Overall survival at 1, 3, and 5 years was 82%, 44%, and 34%. In 16 patients with isolated adrenal metastasis, median disease-free survival was 8 months; 4 patients had no evidence of disease during follow-up. Lung cancer was associated with decreased survival (hazard ratio 4.41, P = .002).Conclusions
Image-guided ablation can achieve local control for adrenal metastases < 5 cm. 相似文献3.
Yozo Sato Hideyuki Nishiofuku Taku Yasumoto Atsuhiro Nakatsuka Kunihiro Matsuo Yoshihisa Kodama Hironao Okubo Daisuke Abo Haruyuki Takaki Yoshitaka Inaba Koichiro Yamakado 《Journal of vascular and interventional radiology : JVIR》2018,29(8):1061-1067
Purpose
To evaluate safety and efficacy of combining sorafenib with transarterial chemoembolization in patients with advanced stage hepatocellular carcinomas (HCCs).Materials and Methods
Systemic chemotherapy–naïve patients with a Child-Pugh class A liver profile and advanced stage HCCs were enrolled. Sorafenib therapy (daily dose 800 mg) was initiated within 4 weeks after initial conventional transarterial chemoembolization with an allowance of subsequent on-demand conventional chemoembolization. The primary endpoint was rate of protocol treatment completion, which was defined as sorafenib administration for at least 2 months. Secondary endpoints included objective response rate, disease control rate, overall survival, progression-free survival, and incidence of adverse events. Thirty-one patients (24 men, 7 women; median age, 75 years; vascular invasion, n = 19; extrahepatic metastases, n = 18; both, n = 6) who met the inclusion criteria were enrolled.Results
Protocol treatment was completed in 28 patients (90.3%, 28/31) with median protocol treatment duration of 7.0 months (range, 0.5–30 months) and median of 2 (range, 1–4) transarterial chemoembolization sessions. Objective response rate was 77.4% with median overall and progression-free survival of 17.3 months (95% confidence interval, 11.9–22.6 months) and 5.4 months (95% confidence interval, 4.6–6.2 months), respectively. The most common grade 3 or 4 adverse events were self-limiting elevation of aspartate aminotransferase (54.8%, 17/31) and alanine aminotransferase (45.2%, 14/31).Conclusions
This combination therapy is feasible and promising in patients with advanced stage HCCs. 相似文献4.
Rany Jawhari Olivier Chevallier Nicolas Falvo Philippe d’Athis Sophie Gehin Pierre-Emmanuel Charles Marco Midulla Romaric Loffroy 《Journal of vascular and interventional radiology : JVIR》2018,29(2):210-217
Purpose
To assess the efficacy and safety of n-butyl cyanoacrylate methacryloxy sulfolane (NBCA-MS) transcatheter arterial embolization for anticoagulation-related soft-tissue bleeding and to evaluate predictive factors of clinical success and 30-day mortality.Materials and Methods
A retrospective review of 50 anticoagulated patients (25 male; mean age, 71.7 y ± 14.2; range, 19–87 y) who underwent emergent Glubran 2 NBCA-MS embolization for iliopsoas hematomas (IPHs; n = 38), rectus sheath hematomas (n = 11), or both (n = 1) between 2011 and 2016 was performed. Inclusion criteria were active bleeding on computed tomography (CT) and anticoagulation. The mean number of red blood cell (RBC) units transfused was 4.8 ± 3.2 (range, 0–14), median hemoglobin level before embolization was 9.7 g/dL (range, 6.2–18 g/dL), and median “mean blood pressure” (MBP) was 62.5 mm Hg (range, 58.3–75 mm Hg). Mean International Normalized Ratio before intervention was 2.5 ± 1.5 (range, 1.0–6.9). Angiograms revealed extravasation in 44 of 50 patients (88%). Mean hematoma volume was 1,119.2 cm3 ± 863.5 (range, 134.0–3,589.0 cm3).Results
Technical success was achieved in 100% of patients, and 30-day clinical success was achieved in 66% of patients. Recurrent bleeding and mortality rates within 30 days of embolization were 34% and 44%, respectively. No complications related to the embolization procedure occurred. Lower MBP (P = .003), greater number of RBC units transfused (P = .003), greater volume of hematoma (P = .04), and IPH location (P = .02) were associated with decreased clinical success. Clinical failure (P = .00002), lower MBP (P = .004), greater number of RBC units transfused (P = .002), and IPH location (P = .01) were significantly associated with higher 30-day mortality rates.Conclusions
Transcatheter arterial embolization with NBCA-MS is safe and effective in treating refractory soft-tissue bleeding in anticoagulated patients despite the high mortality rates associated with this patient population. 相似文献5.
Geert Maleux Tom Matton Annouschka Laenen Lawrence Bonne Sandra Cornelissen Lieven Dupont 《Journal of vascular and interventional radiology : JVIR》2018,29(4):502-509
Purpose
To assess safety, efficacy, and long-term outcome of repeat bronchial artery embolization (BAE) for recurrent hemoptysis.Materials and Methods
This was a retrospective study of patients referred for repeat BAE to manage recurrent hemoptysis after initial successful embolization. BAE was performed in 223 patients; 36 (16.1%) of these patients underwent 59 repeat BAE procedures because of recurring symptoms. The most frequent underlying lung diseases were bronchiectasis (n = 8; 22%), cystic fibrosis (n = 7; 19%), and idiopathic hemoptysis (n = 7; 19%).Results
Most patients (64%) underwent 2 embolization procedures owing to vessel recanalization (71%) as the most frequent pathophysiologic mechanism of recurrent hemoptysis. No serious adverse events requiring prolonged hospital stay were noted. Risk for relapse of hemoptysis was significantly lower for bronchiectasis compared with other chronic infections (P = .0022) and cystic fibrosis (P = .0004). Overall survival after 3-year and 5-year follow-up was 92% and 84%, respectively.Conclusions
Repeat BAE for recurrent hemoptysis after initial successful BAE is safe and efficacious, especially in patients with bronchiectasis as the underlying lung disease. 相似文献6.
Eliel Ben-David Moran Shochat Ido Roth Isaac Nissenbaum Jacob Sosna S. Nahum Goldberg 《Journal of vascular and interventional radiology : JVIR》2018,29(10):1440-1446
Purpose
To assess overall targeting accuracy for CT-guided needle insertion using prototype robotic system for common target sites.Materials and Methods
Using CT guidance, metallic (2 × 1 mm) targets were embedded in retroperitoneum (n = 8), kidneys (n = 8), and liver (n = 14) of 8 Yorkshire pigs (55–65 kg). Bronchial bifurcations were targeted in the lung (n = 13). CT datasets were obtained for planning and controlled needle placement of commercially available 17- to 19-gauge needles (length 15–20 cm) using a small, patient-mounted, CT-guided robotic system with 5° of motion. Mean distance to target was 92.9 mm ± 19.7 (range, 64–146 mm). Planning included selection of target, skin entry point, and 4.6 ± 1.3 predetermined checkpoints (range, 2–9) where additional CT imaging was performed to permit stepwise correction of needle trajectory path as needed. Scanning and needle advancement were coordinated with breath motion using respiratory gating. Accuracy was assessed as distance from needle tip to predefined target.Results
Of 45 needle insertions performed, 2 were unsuccessful owing to technical issues. Accuracy of targeting was 1.2–1.4 mm ± 0.6 for kidney, retroperitoneum, and lung (P = .51), with 2.9 mm ± 1.9 accuracy for liver (P = .0003). This was achieved in 39 cases (91%) using a single insertion. Intraprocedural target movement was detected (3.5 mm ± 2.1 in retroperitoneum and 6.4 mm ± 3.9 in liver); the system compensated for 52.9% ± 30.3 of this movement. One pneumothorax was the only complication (8%).Conclusions
Accurate needle insertion (< 3 mm error) can be achieved in common target sites when using a CT-guided robotic system. Stepwise checks with corrective angulation can potentially overcome issues of target movement during a procedure from organ deformity and other causes. 相似文献7.
Trong Binh Le Taeg Ki Lee Keun-Myoung Park Yong Sun Jeon Kee Chun Hong Soon Gu Cho 《Journal of vascular and interventional radiology : JVIR》2018,29(6):774-780
Purpose
To investigate the incidence and potential causes of contralateral deep vein thrombosis (DVT) after common iliac vein (CIV) stent placement in patients with May-Thurner syndrome (MTS).Materials and Methods
Data of 111 patients (women: 73%) who had CIV stent implantation for symptomatic MTS at a single center were retrospectively analyzed. Mean patient age was 63.1 ± 15.2 years. Median follow-up was 36 months (range, 1–142 months). Stent location was determined by venogram and classified as extended to the inferior vena cava (IVC), covered the confluence, or confined to the iliac vein. Potential causes of contralateral DVT were presumed based on venographic findings. The relationship between stent location and contralateral DVT was analyzed.Results
Ten patients (9%, men/women: 4/6) exhibited contralateral DVT at a median timing of 40 months (range, 6–98 months). Median age was 69 years (range, 42–85 years). Median follow-up was 73.5 months (range, 20–134 months). Potential causes were venous intimal hyperplasia (VIH) (n = 7), “jailing” (n = 2), and indeterminate (n = 1). All patients with VIH had previous CIV stents overextended to the IVC. Overextension of CIV stent was associated with contralateral DVT (P < .001). The primary patency rate of the contralateral CIV stent was 70% at 20 months.Conclusions
Contralateral DVT after CIV stent implantation has a relatively high incidence and often occurs late during follow-up. Overextension of the CIV stent to the IVC is associated with development of contralateral DVT, and VIH should be considered a potential cause. 相似文献8.
Amar Karalli Ramin Ghaffarpour Rimma Axelsson Lars Lundell Bela Bozoki Torkel Brismar Ove Gustafsson 《Journal of vascular and interventional radiology : JVIR》2017,28(12):1664-1672
Purpose
To prospectively assess feasibility, safety, and cytoreductive effect of transarterial chemoembolization on renal cell carcinoma (RCC) using drug-eluting embolic agent (DEE) saturated with doxorubicin compared with transarterial embolization (TAE).Materials and Methods
Between 2012 and 2015, 12 patients (male/female = 5/7, age 66 y ± 9.8) with biopsy-verified RCC eligible for nephron-sparing surgery or radical nephrectomy were recruited. Mean tumor size was 3.2 cm ± 0.62. Patients were randomized at 1:1 ratio to receive either DEE transarterial chemoembolization or TAE before planned surgery. A microcatheter was used to inject particles selectively into arteries feeding the tumors. Response was evaluated by CT according to modified Response Evaluation Criteria In Solid Tumors and by microscopy of excised tumors. Complications were scored according to the Society of Interventional Radiology classification.Results
DEE transarterial chemoembolization (n = 6) resulted in a significantly (P = .018) higher degree of necrosis with an average of 88.3% (range, 70%–100%) compared with TAE (n = 5), which resulted in an average of 29.4% (range, 0–77%), as evaluated by CT. Histopathologic evaluation showed similar results (P = .016) with an average necrosis of 87.5% (range, 80%–95%) for DEE transarterial chemoembolization (n = 4) versus 26% (range, 0–70%) for TAE (n = 5). Percentage of necrosis seen on microscopy correlated significantly (P = .0005) with radiologic findings, as 4 tumors in each arm were evaluated by both CT and microscopy. No major complications were observed in either group.Conclusions
DEE transarterial chemoembolization is safe for treating localized RCC and has a significantly superior cytoreductive effect compared with TAE. 相似文献9.
Hyosook Hwang Hyeon-Soo Kim JeongIl Kwon Phil-Sun Oh Ho Sung Park Seok Tae Lim Myung-Hee Sohn Hwan-Jeong Jeong 《Journal of vascular and interventional radiology : JVIR》2018,29(4):575-583
Purpose
To investigate potential of chitosan hydrogel microparticles (CHI) for treatment of VX2 carcinoma.Materials and Methods
Two weeks after liver VX2 implantation, contrast-enhanced computerized tomographic scanning was conducted. Rabbits (n = 2) with successful tumor growth were treated with different sizes of 99mTc-labeled CHI (60–80 μm and 100–120 μm) via intra-arterial hepatic catheterization. Liver distribution of 99mTc-labeled CHI was determined by means of autoradiography, a radiation-based photographic technique. In the next part of this study, therapeutic effectiveness was examined with the use of CHI with the size range of 60–80 μm (n = 11). Tumor growth response and levels of blood liver enzymes were studied at baseline and 1 and 2 weeks after CHI treatment.Results
Successful tumor growth was confirmed in all rabbits (24/24). Intrahepatic CHI with the size range of 60–80 μm resulted in liver localization in more close proximity to tumor nodule versus 100–120 μm. Baseline tumor volume was 1,909 ± 575 mm3 in animals receiving CHI versus 1,831 ± 249 mm3 in control animals (P = .342). In control animals, tumor volume markedly increased by 1,544 ± 512% at 2 weeks after sham operation versus baseline. In animals receiving CHI, tumor volume remained relatively unchanged (54 ± 6% increase; P = .007 vs control). Levels of blood aspartate transaminase (AST) and alanine transaminase (ALT) in animals receiving CHI increased 1 week after treatment (P = .032 vs control for AST; P = .000 vs control for ALT), but returned to control levels at 2 weeks.Conclusions
CHI embolization suppressed tumor growth without appreciable damages in liver function. 相似文献10.
Carole Allimant Marilyne Kafrouni Julien Delicque Diana Ilonca Christophe Cassinotto Eric Assenat Jose Ursic-Bedoya Georges-Philippe Pageaux Denis Mariano-Goulart Serge Aho Boris Guiu 《Journal of vascular and interventional radiology : JVIR》2018,29(12):1662-1670.e4
Purpose
To identify predictive factors of tumor response, progression-free survival (PFS), overall survival (OS), and toxicity using three-dimensional (3D) voxel-based dosimetry in patients with intermediate and advanced stage hepatocellular carcinoma (HCC) treated by yttrium-90 (90Y) resin microspheres radioembolization (RE).Materials and Methods
From February 2012 to December 2015, 45 90Y resin microspheres RE procedures were performed for HCC (Barcelona Clinic Liver Cancer stage B/C; n = 15/30). Area under the dose-volume histograms (AUDVHs) were calculated from 3D voxel-based dosimetry to measure 90Y dose deposition. Factors associated with tumor control (ie, complete/partial response or stable disease on Modified Response Evaluation Criteria in Solid Tumors) at 6 months were investigated. PFS and OS analyses were performed (Kaplan-Meier). Toxicity was assessed by occurrence of radioembolization-induced liver disease (REILD).Results
Tumor control rate was 40.5% (17/42). Complete tumor targeting (odds ratio = 36.97; 95% confidence interval, 1.83–747; P < .001) and AUDVHtumor (odds ratio = 1.027; 95% confidence interval, 1.002–1.071; P = .033) independently predicted tumor control. AUDVHtumor ≥ 61 Gy predicted tumor control with 76.5% sensitivity and 75% specificity. PFS and OS in patients with incomplete tumor targeting were significantly shorter than in patients with complete tumor targeting (median PFS, 2.7 months [range, 0.8–4.6 months] vs 7.9 months [range, 2.1–39.5 months], P < .001; median OS, 4.5 months [range, 1.4–23 months] vs 19.2 months [range, 2.1–46.9 months], P < .001). Patients with incomplete tumor targeting and AUDVHtumor < 61 Gy, incomplete tumor targeting and AUDVHtumor > 61 Gy, complete tumor targeting and AUDVHtumor < 61 Gy, and AUDVHtumor > 61 Gy had median PFS of 2.7, 1.8, 6.3, and 12.1 months (P < .001). REILD (n = 4; 9.5%) was associated with higher dose delivered to normal liver (P = .04).Conclusions
Complete tumor targeting and 90Y dose to tumor are independent factors associated with tumor control and clinical outcomes. 相似文献11.
Tricia M. Kleidon Amanda J. Ullman Victoria Gibson Brett Chaseling Jason Schoutrop Gabor Mihala Claire M. Rickard 《Journal of vascular and interventional radiology : JVIR》2017,28(11):1548-1556.e1
Purpose
To evaluate feasibility of an efficacy trial comparing peripherally inserted central catheter (PICC) dressing and securement techniques to prevent complications and failure.Materials and Methods
This pilot, 3-armed, randomized controlled trial was undertaken at Royal Children’s Hospital and Lady Cilento Children’s Hospital, Brisbane, Australia, between April 2014 and September 2015. Pediatric participants (N = 101; age range, 0–18 y) were assigned to standard care (bordered polyurethane [BPU] dressing, sutureless securement device), tissue adhesive (TA) (plus BPU dressing), or integrated securement dressings (ISDs). Average PICC dwell time was 8.1 days (range, 0.2–27.7 d). Primary outcome was trial feasibility including PICC failure. Secondary outcomes were PICC complications, dressing performance, and parent and staff satisfaction.Results
Protocol feasibility was established. PICC failure was 6% (2/32) with standard care, 6% (2/31) with ISD, and 3% (1/32) with TA. PICC complications were 16% across all groups. TA provided immediate postoperative hemostasis, prolonging the first dressing change until 5.5 days compared with 3.5 days and 2.5 days with standard care and ISD respectively. Bleeding was the most common reason for first dressing change: standard care (n = 18; 75%), ISD (n = 11; 69%), TA (n = 4; 27%). Parental satisfaction (median 9.7/10; P = .006) and staff feedback (9.2/10; P = .002) were most positive for ISD.Conclusions
This research suggests safety and acceptability of different securement dressings compared with standard care; securement dressings may also reduce dressing changes after insertion. Further research is required to confirm clinically cost-effective methods to prevent PICC failure. 相似文献12.
Ammar Sarwar Lujia Zhou Nihara Chakrala Olga R. Brook Jeffrey L. Weinstein Max P. Rosen Muneeb Ahmed 《Journal of vascular and interventional radiology : JVIR》2017,28(5):629-636
Purpose
To determine all-cause readmission rates for 12 IR procedures and association of time to readmission with risk-adjusted 90-day mortality.Materials and Methods
Patients discharged after 12 inpatient IR procedures at a tertiary-care hospital between June 2008 and May 2013 (N = 4,163) were categorized as no readmission (n = 1,479; 40.5%) or readmission between 0 and 7 (n = 379; 10.4%), 8 and 30 (n = 650; 17.8%), 31 and 60 (n = 378; 10.3%), 61 and 90 (n = 169; 4.6%), or 91 and 180 days (n = 280; 7.7%). Readmission rate ≥ 15% was considered high based on published national readmission rates for procedures. Risk-adjusted 90-day mortality for each interval was calculated for transjugular intrahepatic portosystemic shunt (TIPS), transjugular and percutaneous liver biopsy (TJLB, PLB), ports, inferior vena cava (IVC) filter, lower extremity angioplasty (LEA), arteriovenous fistulagrams, vascular embolization (VE), percutaneous cholecystostomy (PC), percutaneous transhepatic biliary drainage (PTBD), primary urinary drainage, and feeding tube placement. Covariates included age, sex, race, insurance status, and Charlson Comorbidity Index.Results
All procedures had high 30-day readmission rates (15%–50.5%). Readmissions were highest for ports (50.5%), TJLB (43.4%), PTBD (38.5%), PC (31.9%), and TIPS (31.3%). Readmissions occurred most frequently 8–30 days after discharge for all procedures except VE (31–60 d; 10.6%), PC (31–60 d; 23.4%), and LEA (91–180 d; 15.1%). On multivariate analysis, 30-day readmissions for LEA (AOR 3.19; 95% CI, 1.2–8.2; P = .02), VE (AOR 10.01; 95% CI, 3.1–32.9; P < .001), IVC filter (AOR 2.98; 95% CI, 1.3–6.9; P = .01), PLB (AOR 2.86; 95% CI, 1.71–4.79; P < .001), and PCN (AOR 3.09; 95% CI, 1.29–7.37; P = .01) were associated with 90-day mortality.Conclusions
Inpatient IR procedures have high 30-day all-cause readmission rates, which can be associated with increased 90-day mortality. Further evaluation to determine preventable causes for readmission may impact 90-day mortality. 相似文献13.
Camillo Aliberti Riccardo Carandina Sara Lonardi Vincenzo Dadduzio Alessandro Vitale Enrico Gringeri Giacomo Zanus Umberto Cillo 《Journal of vascular and interventional radiology : JVIR》2017,28(11):1495-1502
Purpose
To assess the safety, tolerability, and efficacy of small drug-eluting embolic (DEE) agents (70–150 μm) for chemoembolization of hepatocellular carcinoma (HCC).Materials and Methods
This single-center, single-arm, retrospective study involved 421 patients (mean age, 66.1 y ± 9.8 [standard deviation]) with Barcelona Clinic Liver Cancer (BCLC) stage A (n = 88), B (n = 140), or C (n = 193) HCC and Child–Pugh class A (n = 233) or B (n = 188) cirrhosis. Patients had a mean of 7.2 lesions ± 4.8 (range, 1–21; mean diameter of target lesion, 21.4 cm ± 8.1; unilobar, n = 132; bilobar, n = 289; portal vein involvement, n = 193). One (n = 320) or 2 (n = 101) vials of small DEEs loaded with doxorubicin 50 mg per vial were delivered selectively (ie, segmentally) or superselectively (ie, directly into the tumor-feeding vessel) until complete delivery or stasis/near-stasis. Treatment was repeated in patients with partial response or stable disease at 1- or 3-month follow-up (mean, 2.0 cycles ± 0.9). Adverse events within 30 days of chemoembolization, response per modified Response Evaluation Criteria In Solid Tumors (mRECIST), and survival were assessed.Results
Within 30 days after treatment, no deaths or bleeding events occurred, but all patients had at least 1 episode of postembolization syndrome (pain, fever, and/or nausea/vomiting; 27.1% grade 3/4 per National Cancer Institute Common Terminology Criteria for Adverse Events, version 3.0) and increased bilirubin and liver aminotransferase levels (0.2% and 5.9% grade 3/4, respectively). Overall response rates were 94.5% at 3 months and 99.5% at 6 months. Median overall survival was 42.0 months (95% confidence interval, 38.0–43.0 mo).Conclusions
Chemoembolization with small DEE agents is well tolerated and an effective treatment for a broad range of patients with liver-confined HCC. 相似文献14.
Ron C. Gaba James T. Bui Rajyasree Emmadi Janesh Lakhoo 《Journal of vascular and interventional radiology : JVIR》2017,28(6):906-912.e1
Purpose
To test the hypothesis that a modified approach to portal vein embolization (PVE)—termed ablative liver partition (ALP) and PVE (ALP-PVE)—is feasible and results in greater future liver remnant (FLR) growth compared with PVE alone in a rabbit model.Materials and Methods
Eighteen rabbits (median weight, 2.7 kg) underwent PVE (n = 9) or ALP-PVE (n = 9). PVE to cranial liver lobes was performed with 100–300-μm microspheres and metallic coils; the caudal lobe was spared as the FLR. In the ALP-PVE cohort, a liver partition between cranial and caudal lobes was created by using microwave ablation (40 W, 1 min). Animals were euthanized and livers were harvested on postprocedure day 7. Caudal and cranial liver lobes were weighed after 4 weeks of oven drying. Ki-67 immunohistochemistry was used to quantify liver mitotic index. ALP-PVE feasibility was determined based on procedure technical success. Standardized FLR (sFLR; ie, FLR divided by whole liver weight) and mitotic index were compared between PVE and ALP-PVE groups by two-tailed independent-samples Mann–Whitney U test.Results
One PVE-group rabbit died during anesthesia induction and was excluded from technical success calculation. Eight of 8 (100%) and 8 of 9 rabbits (89%) underwent technically successful PVE and ALP-PVE, respectively. There was no difference in sex or weight distribution between groups. sFLR (0.32 vs 0.29; P = .022) and mitotic index (17.5% vs 6.2%; P = .051) were higher in ALP-PVE vs PVE caudal lobes when the first “learning-curve” case from each group was excluded.Conclusions
ALP-PVE is feasible and may stimulate greater FLR growth compared with PVE in a rabbit model. 相似文献15.
Dong Jae Shim Gi-Young Ko Kyu-Bo Sung Dong Il Gwon Heung Kyu Ko 《Journal of vascular and interventional radiology : JVIR》2018,29(6):800-808
Purpose
To evaluate the long-term efficacy of stent placement versus balloon angioplasty for portal vein (PV) stenosis in pediatric liver transplant (LT) recipients.Materials and Methods
Fifty patients (<18 years old; median, 14 months) who underwent percutaneous transhepatic balloon angioplasty (n = 12), transhepatic stent placement (n = 18), or intraoperative transmesenteric stent placement (n = 20) between 1994 and 2015 were retrospectively analyzed. The median intervals from LT to percutaneous transhepatic angioplasty, stent, and intraoperative stent were 145 days (range, 27–2072), 98 days (range, 5–2289), and 0 days (range, 0–14), respectively. The primary study endpoint was the primary patency of each group. Secondary study endpoints included procedural complications, functional stent stenosis, and stent fractures.Results
The median clinical follow-up periods were 81 months (range, 13–179), 118 months (range, 65–181), and 112 months (range, 47–168) in each group, respectively. In the angioplasty group, the 1-, 5-, and 10-year primary patency rates were all 75% ± 13%. The corresponding rates were all 100% in the percutaneous transhepatic stent group and 90% ± 7%, 90% ± 7%, and 85% ± 8%, respectively, in the intraoperative transmesenteric stent group (P = .103). Major procedural complications occurred in 4 patients, including 1 case with PV tear after percutaneous transhepatic post-stent angioplasty, and 3 cases with acute PV thrombosis after intraoperative transmesenteric stent. Functional stent stenosis and stent fractures occurred in 1 and 2 patients, respectively.Conclusions
No statistically significant difference was observed between the 3 groups in terms of the long-term primary patency rates. Therefore, angioplasty should be considered first to treat PV stenosis in pediatric LT recipients. 相似文献16.
Surinder K. Dhaliwal Ganesan Annamalai Nelofer Gafoor Robyn Pugash Chris Dey Elizabeth Nishani David 《Journal l'Association canadienne des radiologistes》2018,69(3):316-321
Purpose
The purpose of this study was to compare the effectiveness of portal vein embolization (PVE) with different embolic agents used at our centre. Specifically, the effectiveness of N-butyl cyanoacrylate (NBCA) glue is compared with that of polyvinyl alcohol (PVA) particles.Methods
We performed a retrospective chart review of all patients (N = 77) who underwent PVE at our institution over a 5-year period. Pre- and postprocedural computed tomography or magnetic resonance imaging, when available, were used to measure the volume of total liver volume and future liver remnant (FLR). The absolute values obtained were used to calculate percentage of FLR. The growth in FLR was determined 4–6 weeks after PVE. Technical details of the procedure including the type and amount of embolic agent used were obtained from the chart reviews, electronic patient records, and radiology reports. Statistical analysis was performed using Kruskal-Wallis test, Wilcoxon rank sum test, and the Spearman correlation coefficient with post hoc analysis. Results are expressed as mean ± SD (P < .05 considered statistically significant).Results
NBCA (n = 29) produced a mean change in FLR of 14.8% compared with 9.3% for PVA particles (n = 24; P = .007). Mean change in FLR was 10.1% in the group where a combination of NBCA and PVA particles was used (n = 24). The effect of glue volume and glue-to-lipiodol ratio on the outcome was not found to be statistically significant (P = .5 and .7, respectively).Conclusions
We conclude that NBCA glue is a better embolic agent than PVA particles in inducing liver hypertrophy. 相似文献17.
Bruno C. Odisio Suguru Yamashita Steven Y. Huang Scott E. Kopetz Kamran Ahrar Takashi Mizuno Claudius Conrad Thomas A. Aloia Yun Shin Chun Sanjay Gupta Jean-Nicolas Vauthey 《Journal of vascular and interventional radiology : JVIR》2018,29(3):395-403.e1
Purpose
To test the hypothesis that, given the current resection eligibility criteria for colorectal liver metastasis (CLM), prior hepatectomy would be associated with improved local tumor control and survival after percutaneous ablation of CLMs.Materials and Methods
This single-institution retrospective study included 82 consecutive patients with 97 CLMs treated with ablation (radiofrequency ablation, microwave ablation, or cryoablation) from January 2005 to December 2014. Local tumor progression-free survival (LTPFS), recurrence-free survival (RFS) at any organ, and overall survival (OS) were calculated using the Kaplan-Meier method from the time of ablation and compared between patients with (n = 49) and without (n = 33) prior hepatectomy. Cox regression models were used to identify LTPFS predictors.Results
Median overall follow-up period was 28 months (range, 4.5–132 months). Three-year actuarial LTPFS (patient level: 73% vs 34%, P < .001) was significantly higher in patients with than without prior hepatectomy, respectively. Similarly, 3-year RFS (23% vs 9.1%, P = .026) and OS (78% vs 48%, P = .003) were improved in patients with prior hepatectomy. At multivariate analysis, predictors of worse LTPFS were: no prior hepatectomy (hazard ratio [HR] 2.35, 95% confidence interval [CI] 1.02–5.45; P = .045), minimal ablation margin < 5 mm (HR 2.4, 95% CI 1.18–4.87; P = .016), and RAS-mutant tumor (HR 2.65, 95% CI 1.18–5.94; P = .019).Conclusions
Prior hepatectomy for CLMs is associated with improved local tumor control after percutaneous ablation of post-resection-developed CLMs. 相似文献18.
Ron C. Gaba Regina M. Schwind Sebastien Ballet 《Journal of vascular and interventional radiology : JVIR》2018,29(3):413-424
Purpose
To systematically review mechanism of action, pharmacokinetics (PKs), efficacy, and safety of ethiodized oil–based locoregional therapy (LRT) for liver cancer in preclinical models.Materials and Methods
A MEDLINE search was performed from 1988 to 2016. Search terms included hepatocellular carcinoma (HCC), HCC, liver-cell carcinoma, liver, hepatic, hepatocarcinoma, transarterial or chemoembolization, TACE, animal, Lipiodol, Ethiodol, iodized oil, and/or poppy-seed oil. Inclusion criteria were: publication in a peer-reviewed journal, an accepted animal model, and PK/safety/efficacy data reported. Exclusion criteria were: inadequate PK, safety, or efficacy data; anticancer drug name/dose not available; and article not in English. Outcomes included intratumoral anticancer drug uptake, PKs, tolerance, tumor response, and survival.Results
Of 102 identified articles, 49 (49%) met the inclusion criteria. Seventeen, 35, and 2 articles used rat, rabbit, and pig models. Mechanism of action was investigated in 11 articles. Eleven articles reported drug uptake, PK, and tolerance data, showing 0.5%–9.5% of injected chemotherapy dose in tumor. Tumor-to-liver drug distribution ratios were 2–157. Toxicology data across 6 articles showed transient liver laboratory level elevations 1 day after LRT. There was no noteworthy liver or extrahepatic histologic damage. Nine articles reported tumor response, with 0%–30% viable tumor and –10% to –38% tumor growth at 7 days after LRT. Two articles reported survival, showing significantly longer survival after LRT vs untreated controls (56/60 d vs 33/28 d). Several articles described ethiodized oil mixed with radiopharmaceutical (n = 7), antiangiogenic (n = 6), gene (n = 6), nanoembolic (n = 5), immune (n = 2), or other novel (n = 1) agents.Conclusions
Animal studies show preferential tumor uptake of anticancer agent, good hepatic/systemic tolerance, high tumor response, and enhanced survival after ethiodized oil–based LRT. 相似文献19.
Matthew D. Miller Daniel Y. Sze Siddharth A. Padia Robert J. Lewandowski Riad Salem Philani Mpofu Paul M. Haste Matthew S. Johnson 《Journal of vascular and interventional radiology : JVIR》2018,29(6):867-873
Purpose
To evaluate the effectiveness and safety of yttrium-90 transarterial radioembolization (TARE) for the treatment of primary and metastatic soft tissue sarcoma (STS) of the liver.Materials and Methods
A retrospective review of 39 patients with primary (n = 2) and metastatic (n = 37) hepatic STS treated with TARE at 4 institutions was performed. Fourteen STS subtypes were included, with leiomyosarcoma being the most common (51%). TARE with glass (22 patients) or resin (17 patients) microspheres was performed, with single lobe (17 patients) or bilobar treatment (22 patients) based on disease burden. Adverse events of treatment, overall survival (OS), and tumor response at 3, 6, and 12 months after TARE were assessed per the Response Evaluation Criteria in Solid Tumors.Results
Fourteen patients demonstrated either partial or complete response to therapy, with an objective response rate of 36%. Thirty patients (77%) demonstrated disease control (DC)—either stable disease or response to treatment. Median OS was 30 months (95% confidence interval 12–43 months) for all patients. DC at 3 months was associated with an increased median OS (44 months) compared with progressive disease (PD) (7.5 months; P < .0001). Patients with DC at 6 months also demonstrated an increased median OS (38 months) compared to patients with PD (17 months; P = .0443). Substantial adverse events included 1 liver abscess, 1 gastric ulceration, and 1 pneumonitis.Conclusions
Patients with hepatic STS treated with TARE demonstrated a high rate of DC and a median OS of 30 months, which suggests a role for TARE in the palliation of hepatic STS. 相似文献20.
Hyukjoon Lee Chang Jin Yoon Nak Jong Seong Chang Ho Jeon Ho Il Yoon Joongseok Go 《Journal of vascular and interventional radiology : JVIR》2017,28(8):1161-1166