AIM: To investigate the survival rates after transarterial embolization (TAE).
Hepatocellular carcinoma (HCC) is the fifth most common malignancy and the third cause of tumor associated deaths worldwide. HCC incidence rates are increasing in many parts of the world including developing and developed countries. Potentially curative treatments for HCC are resection and liver transplantation, but these are only suitable for patients with small tumors, meeting strict pre-defined criteria, or well-compensated liver disease. Early diagnosis of HCC can be achieved by surveillance of at-risk populations. For patients with non-resectable disease treatments modalities include loco-ablative and systemic therapies. In this review we focus on treatment options in HCC and their allocation. Although significant research is in progress, to this date, the results are unsatisfactory with limited long-term survival. In the fight against this deadly disease, there is still a long way to go.
Several hepatocellular carcinoma (HCC) staging systems have been established, and a variety of country-specific treatment strategies are also proposed. The barcelona - clinic liver cancer (BCLC) system is the most widely used in Europe. The Hong Kong liver Cancer is a new prognostic staging system; it might become the reference system in Asia. Transarterial chemoembolization (TACE) is the most widely used treatment for HCC worldwide; but it showed a benefit only for intermediate stage HCC (BCLC B), and there is still no consensus concerning treatment methods and treatment strategies. In view of the highly diverse nature of HCC and practices, a scoring system designed to assist with decision making before the first TACE is performed or prior to repeating the procedure would be highly useful.
Hepatocellular carcinoma (HCC) is one of the most common malignancies leading to high mortality rates in the general population; in cirrhotic patients, it is the primary cause of death. The diagnosis is usually delayed in spite of at-risk population screening recommendations, i.e., patients infected with hepatitis B or C virus. Hepatocarcinogenesis hinges on a great number of genetic and molecular abnormalities that lead to tumor angiogenesis and foster their dissemination potential. The diagnosis is mainly based on imaging studies such as computed tomography and magnetic resonance, in which lesions present a characteristic classical pattern of early arterial enhancement followed by contrast medium “washout” in late venous phase. On occasion, when imaging studies are not conclusive, biopsy of the lesion must be performed to establish the diagnosis.
Transjugular intrahepatic portosystemic shunt (TIPS) has been the main alternative to treating bleeding related to esophageal or gastric varices in the context of portal hypertension. Recently, as a less-invasive alternative, balloon-occluded retrograde transvenous obliteration (BRTO) of gastric varices has been introduced to treat bleeding gastric varices, which are less amenable to endoscopic sclerotherapy and banding. We describe a successful case of modified BRTO in the acute setting of gastric variceal bleeding.
A microcatheter is an essential tool in an interventionist’s armamentarium. We are fortunate to have a bounty of low-profile catheters to choose from today, most of which display an assortment of the qualities ascribed to a successful device: good torque response, distal flexibility, kink resistance, fluoroscopic visibility, low stretch, high pressure, and the ability to easily pass materials, including guidewires and embolic materials. Each of us has a favorite; however, this preference is mostly derived from default experience during training and availability in the face of tight financial constraints during practice rather than from real-world testing of each device.
A 79-year-old man with a history of a solitary hepatocellular carcinoma (HCC) in segment 6 presented to the interventional radiology department for hepatic angiography and preablative embolization.
Dr. Mastracci discusses patient-centered complex aortic care at the Royal Free London NHS Foundation Trust, radiation safety, and the era of social media.
After a yearlong delay, the switch-over is finally happening—and your practice needs to prepare.
Coils and plugs have emerged as the most commonly employed mechanical embolic devices. Various coils are used in daily practice for an array of clinical applications. Although effective, the main disadvantage of coils relates to the number of coils and time needed to achieve adequate vascular occlusion. Additional limitations of traditional pushable coils include lack of controlled deployment, occlusion of nontarget vessels secondary to coil migration, incomplete occlusion, and recanalization.
As data on coil embolization become more robust, so must the tools and technology we use. Penumbra, Inc. has advanced this technology with the Ruby® coil. Ruby’s large volume, extreme softness, full control, and long lengths have given interventionists the ability to reduce the number of devices and time needed for cases. The Ruby platform is similar in size to the 0.035-inch systems we currently use, but maintains high-flow microcatheter deliverability.
WHAT ARE THE ORIGINS OF APPLYING EMBOLIZATION AS A THERAPY FOR HEMORRHOIDS? Dr. Vidal: In 1994 and 1998, Prof. E.V. Galkin first described a potential interventional radiology treatment for chronic hemorrhoids complicated by hemorrhage. These two major articles were published in Russian, which limited their audience. Later, a few other published case reports demonstrated the efficiency of embolization of the superior rectal arteries for life-threatening rectal bleeding from various origins. These preliminary studies reported no rectal ischemic complications.
Classifications and diagnosis of aneurysm endoleak and the techniques and technologies available to treat them.
An interview with David Liu, MD, FRCPC, FSIR, in which this expert on radioembolic oncology discusses everything from room prep to clinical decision-making and optimal follow-up.
Early reports on the progress of research in applying embolization to provide relief for resistant chronic pain for musculoskeletal conditions.
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