| Development of new hepaticoenteric collateral pathways after hepatic arterial skeletonization in preparation for yttrium-90 radioembolization. | |
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MedLine Citation:
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PMID: 20688531 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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PURPOSE: Development of new hepaticoenteric anastomotic vessels may occur after endovascular skeletonization of the hepatic artery. Left untreated, they can serve as pathways for nontarget radioembolization. The authors reviewed the incidence, anatomy, management, and significance of collateral vessel formation in patients undergoing radioembolization. MATERIALS AND METHODS: One hundred thirty-eight treatments performed on 122 patients were reviewed. Each patient underwent a preparatory digital subtraction angiogram (DSA) and embolization of all hepaticoenteric vessels in preparation for yttrium-90 ((90)Y) administration. Successful skeletonization was verified by C-arm computed tomography (CACT) and technetium-99m macroaggregated albumin ((99m)TcMAA) scintigraphy. During the subsequent treatment session, DSA and CACT were repeated before administration of (90)Y, and the detection of extrahepatic perfusion prompted additional embolization. RESULTS: Forty-two patients (34.4%) undergoing 43 treatments (31.2%) required adjunctive embolization of hepaticoenteric vessels immediately before (90)Y administration. Previous scintigraphy findings showed extrahepatic perfusion in only three cases (7.1%). Vessels were identified by DSA in 54.1%, by CACT in 4.9%, or required both in 41.0%. The time interval between angiograms did not correlate with risk of requiring reembolization (P = .297). A total of 19.7% of vessels were new collateral vessels not visible during the initial angiography. Despite reembolization, three patients (7.1%) had gastric or duodenal ulceration, compared with 1.3% who never had visible collateral vessels, all of whom underwent whole-liver treatment with resin microspheres (P = .038). CONCLUSIONS: Development of collateral hepaticoenteric anastomoses occurs after endovascular skeletonization of the hepatic artery. Identified vessels may be managed by adjunctive embolization, but patients appear to remain at increased risk for gastrointestinal complications. |
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Authors:
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Mohamed H K Abdelmaksoud; Gloria L Hwang; John D Louie; Nishita Kothary; Lawrence V Hofmann; William T Kuo; David M Hovsepian; Daniel Y Sze |
Publication Detail:
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Type: Journal Article Date: 2010-08-04 |
Journal Detail:
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Title: Journal of vascular and interventional radiology : JVIR Volume: 21 ISSN: 1535-7732 ISO Abbreviation: J Vasc Interv Radiol Publication Date: 2010 Sep |
Date Detail:
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Created Date: 2010-08-30 Completed Date: 2010-12-22 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 9203369 Medline TA: J Vasc Interv Radiol Country: United States |
Other Details:
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Languages: eng Pagination: 1385-95 Citation Subset: IM |
Copyright Information:
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Copyright 2010 SIR. Published by Elsevier Inc. All rights reserved. |
Affiliation:
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Division of Interventional Radiology, H-3646 Stanford University Medical Center, 300 Pasteur Drive, Stanford, CA 94305-5642, USA. |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Adult Aged Aged, 80 and over Angiography, Digital Subtraction Brachytherapy* / adverse effects California Collateral Circulation* Embolization, Therapeutic* / adverse effects Female Gastrointestinal Diseases / etiology Hepatic Artery / physiopathology*, radiography, radionuclide imaging Humans Infusions, Intra-Arterial Liver Circulation* Liver Neoplasms / blood supply*, radiography, radionuclide imaging, radiotherapy* Male Middle Aged Radiopharmaceuticals / administration & dosage*, adverse effects, diagnostic use Retrospective Studies Risk Assessment Risk Factors Technetium Tc 99m Aggregated Albumin / diagnostic use Time Factors Tomography, X-Ray Computed Treatment Outcome Young Adult Yttrium Radioisotopes / administration & dosage*, adverse effects |
| Chemical | |
Reg. No./Substance:
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0/Radiopharmaceuticals; 0/Technetium Tc 99m Aggregated Albumin; 0/Yttrium Radioisotopes |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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