| Transcatheter arterial embolization in the emergency department for hemodynamic instability due to ruptured hepatocellular carcinoma: analysis of 167 cases. | |
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MedLine Citation:
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PMID: 19020209 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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OBJECTIVE: The purpose of this study was to analyze the prognostic factors associated with emergency transcatheter arterial embolization in the treatment of patients in hemodynamically unstable condition caused by rupture of hepatocellular carcinoma. MATERIALS AND METHODS: An 8-year retrospective cohort study was conducted to evaluate emergency transcatheter arterial embolization in the treatment of 167 patients in unstable hemodynamic condition (systolic blood pressure < 90 mm Hg at presentation) due to rupture of hepatocellular carcinoma. The clinical, laboratory, and imaging findings of a group who died (survival period, < or = 30 days) were compared with those of a group who survived more than 30 days. RESULTS: On arrival in the emergency department, the group who died (n = 52) were in significantly worse condition than the group who survived (n = 115). The group who died had a poorer Child-Pugh class, lower hemoglobin and serum albumin levels, higher demand for blood transfusion, higher incidence of acute respiratory failure, worse neurologic status (Glasgow Coma Scale score, < or = 12), greater prevalence of portal vein thrombosis, and higher serum total bilirubin and creatinine levels (p < 0.05, two-sample Student's t test and Fisher's exact or chi-square test). Multivariate logistic regression analysis showed that patients who did not have portal venous thrombosis (odds ratio, 0.241; p = 0.012) or a lower creatinine level (odds ratio, 0.458; p = 0.003) had better probability of survival. Successful hemostasis with transcatheter arterial embolization was achieved in 99% of patients (30-day mortality rate, 31%). Patients with coexistent acute respiratory failure or impaired neurologic status and marked hyperbilirubinemia (> 2.7 mg/dL) had exceptionally high mortality rate (> 70%). CONCLUSION: Emergency transcatheter arterial embolization is effective for hemostasis of ruptured hepatocellular carcinoma in patients in hemodynamically unstable condition being treated in the emergency department. However, patients with portal venous thrombosis, a high serum creatinine level, acute respiratory failure, impaired neurologic status, and a high serum total bilirubin level continue to be at high risk of death. |
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Authors:
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Chia-Te Kung; Ber-Ming Liu; Shu-Hang Ng; Tze-Yu Lee; Yu-Fan Cheng; Min-Chi Chen; Sheung-Fat Ko |
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Publication Detail:
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Type: Journal Article |
Journal Detail:
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Title: AJR. American journal of roentgenology Volume: 191 ISSN: 1546-3141 ISO Abbreviation: AJR Am J Roentgenol Publication Date: 2008 Dec |
Date Detail:
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Created Date: 2008-11-21 Completed Date: 2009-01-06 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 7708173 Medline TA: AJR Am J Roentgenol Country: United States |
Other Details:
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Languages: eng Pagination: W231-9 Citation Subset: AIM; IM |
Affiliation:
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Department of Emergency Medicine, Chang Gung University, College of Medicine, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Kaohsiung, Taiwan. |
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| MeSH Terms | |
Descriptor/Qualifier:
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Balloon Occlusion
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statistics & numerical data* Carcinoma, Hepatocellular / mortality*, therapy* Cardiovascular Diseases / mortality*, prevention & control* Cohort Studies Comorbidity Emergency Medical Services / statistics & numerical data* Female Humans Liver Neoplasms / mortality*, therapy* Male Middle Aged Prevalence Retrospective Studies Risk Assessment / methods Risk Factors Rupture, Spontaneous / therapy Survival Analysis Survival Rate Taiwan / epidemiology Treatment Outcome |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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