Previous experience shows promise for a venous disease treatment that recently received FDA approval.
How would you summarize the clinical trial experience and results to date in prostatic artery embolization (PAE)? Where are we in terms of collecting key data, and what are the research milestones on the horizon? Dr. Bagla: There have been a number of studies both in the United States and overseas that have looked at the safety and effectiveness of PAE in the treatment of benign prostatic hyperplasia (BPH). These have included retrospective, prospective, and randomized study designs. Research to date has demonstrated an excellent safety profile with very favorable clinical outcomes from PAE. When compared with standard treatments such as transurethral resection of the prostate, clinical improvement is also comparable.
Yttrium-90 transarterial radioembolization (Y-90 RE) is emerging as a promising treatment modality for managing patients with unresectable primary and secondary hepatic lesions. In patients with hepatocellular carcinoma (HCC), Y-90 RE represents a valid treatment option in selected cases of advanced-stage disease with portal vein neoplastic thrombosis or when other locoregional approaches are contraindicated or fail to achieve tumor response.1 Meticulous preprocedural planning with digital subtraction angiography (DSA) and technetium99m–labeled macroaggregated albumin (99mTc-MAA) scintigraphy is essential to avoid nontarget embolization and to ensure adequate delivery of microspheres to all the tumors. Therefore, DSA diagnostic work-up requires precise definition of all the feeding arteries, identification and potential embolization of parasitized collaterals, and visualization of extrahepatic vessels arising from the hepatic circulation.2 In this scenario, the performance of the high-flow coaxial microcatheters used during DSA becomes extremely important.
Today, the standard endovascular treatment of hepatocellular carcinoma (HCC) is transcatheter arterial chemoembolization (TACE) with calibrated particles preloaded with doxorubicin. This is a more selective and challenging technique compared to classical chemoembolization with ethiodized oil, especially concerning the use of microcatheters. New-generation microcatheters are developed to go further distally in more tortuous and smaller arteries and thus achieve more favorable results. In this sense, HCC with extrahepatic feeding arteries represents a more challenging condition for its treatment, and it is present in a nonnegligible proportion of cases. Although a conventional 2.7-F (0.9-mm) microcatheter usually reaches its goal in most procedures, the use of new-generation microcatheters in these particular cases is mandatory to achieve successful treatment of these lesions. This article presents our recent experience with the new 2.4-F, 150-cm- (0.8-mm, 1,500-mm-) long Direxion™ Torqueable Microcatheter with a distal radiopaque marker.
A 58-year-old woman was admitted to the hospital for sacral wound debridement. The patient had a history of hypercoagulability and was on anticoagulation medication before and after surgery. She presented to the interventional radiology department for treatment of a spontaneous chest wall hemorrhage several weeks after her surgery.
Management of hepatocellular carcinoma (HCC) with portal vein thrombosis (PVT) is complex and requires an understanding of multiple therapeutic options. PVT is present in 10%-40% of HCC at the time of diagnosis, and is an adverse prognostic factor. Management options are limited, as transplantation is generally contraindicated, and surgical resection is only rarely performed in select centers. Systemic medical therapy with sorafenib has been shown to modestly prolong survival. Transarterial chemoembolization has been performed in select cases but has shown a high incidence of complications. Emerging data on treatment of PVT with Y-90 radioembolization suggest that this modality is well-tolerated and associated with favorable overall survival. Current society guidelines do not yet specifically recommend radioembolization for patients with PVT, but this may change with the development of newer staging systems and treatment algorithms. In this comprehensive literature review, we present current and available management options with the relative advantages, disadvantages and contraindications of these treatment options with summarized data on overall survival.
AIM: To evaluate the techniques, results, and complications related to computed tomography (CT)-guided percutaneous core needle biopsies of solid pancreatic lesions.
AIM: To investigate whether transarterial chemoembolization (TACE) before liver transplantation (LT) improves long-term survival in hepatocellular carcinoma (HCC) patients.
AIM: To compare survival and recurrence in hepatocellular carcinoma (HCC) patients who did or did not receive adjuvant transarterial chemoembolization (TACE).
AIM: To compare the outcomes of hepatic resection and transarterial chemoembolization (TACE) for solitary hepatocellular carcinoma (HCC) according to the Barcelona Clinic Liver Cancer (BCLC) staging system.
We report an unusual case of Clostridium perfringens liver abscess formation after transcatheter arterial chemoembolization (TACE) for large hepatocellular carcinoma. Severe deterioration in liver and renal function accompanied with hemocytolysis was found on the 2nd day after TACE. Blood culture found Clostridium perfringens and abdominal computed tomography revealed a gas-containing abscess in the liver. Following antibiotics administration and support care, the infection was controlled and the liver and renal function turned normal. The 2nd TACE procedure was performed 1.5 mo later and no recurrent Clostridium perfringens infection was found.
AIM: To investigate transarterial chemoembolization (TACE) with hepatic infusion of oxaliplatin and 5-fluorouracil and Lipiodol chemoembolization in large hepatocellular carcinoma (HCC).
AIM: To identify criteria for predicting successful drainage of unresectable malignant hilar biliary strictures (UMHBS) because no ideal strategy currently exists.
Post-gastrectomy anastomosis site obstruction is a relatively rare complication after a subtotal gastrectomy. We present a case of a 75-year-old man who underwent a truncal vagotomy, omental patch, gastrojejunostomy, and Braun anastomosis for duodenal ulcer perforation and a gastric outlet obstruction. Following the 10th postoperative day, the patient complained of abdominal discomfort and vomiting. We diagnosed post-gastrectomy anastomosis site obstruction by an upper gastrointestinal series and an upper endoscopic examination. We inserted a self-expandable metallic stent (SEMS) at the anastomosis site. The stent was fully expanded after deployment. On the day following the stent insertion, the patient began to eat, and his abdominal discomfort was resolved. This paper describes the successful management of post-gastrectomy anastomosis site obstruction with temporary placement of a SEMS.
AIM: To investigate the feasibility and clinical value of magnetic resonance imaging (MRI)-MRI image fusion in assessing the ablative margin (AM) for hepatocellular carcinoma (HCC).
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