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Prophylactic Embolization of the Cystic Artery Prior to Radioembolization of Liver Malignancies—An Evaluation of Necessity

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Abstract

Purpose

Prior to radioembolization (RE) of hepatic tumors, many centers prophylactically occlude the cystic artery (CA) during evaluation angiography (EVA) to prevent radiation-induced cholecystitis. There is no conclusive evidence for the protective effect of CA embolization and it bears the risk of inducing ischemic cholecystitis. The aim of this study is to evaluate the justification for CA embolization by comparing clinical and morphologic imaging parameters between patients undergoing coil occlusion of the cystic artery (COCA) and those with uncoiled CA (UCCA).

Materials and Methods

Retrospective comparison of 37 patients with UCCA versus 68 patients with COCA in terms of clinical findings (CRP, leukocyte count, body temperature, upper abdominal pain) and morphologic imaging parameters associated with cholecystitis (gallbladder (GB) wall thickness, free fluid in GB bed, bremsstrahlung SPECT) after EVA, after RE, and at 6-week follow-up.

Results

At none of the 3 time points (EVA, RE, 6-week follow-up) was there any significant difference in CRP, leukocyte count, body temperature, or upper abdominal pain between the UCCA and COCA group. There was also no significant difference between the two groups with regard to GB wall thickness, fluid in the GB bed, and bremsstrahlung in SPECT. One patient of the UCCA group and two patients of the COCA developed cholecystitis requiring treatment.

Conclusion

Comparison of clinical and imaging findings between patients with and without CA embolization prior to RE identified no predictors of radiogenic or ischemic cholecystitis after RE. Our study provides no evidence for a benefit of prophylactic CA embolization before RE.

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Conflict of interest

Oliver Dudeck and Maciej Pech are Proctors for Sirtex Medical and received funding for congress and scientific meetings. Jens Ricke received research funding for investigator initiated trials by Sirtex Medical. The other authors declare no conflict of interest.

Statement of Informed Consent

The patients consented to retrospective analysis of their data.

Statement of Human Rights

The retrospective study was approved by the ethics committee of the Medical Faculty of the University of Magdeburg.

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Authors and Affiliations

  1. Department of Radiology and Nuclear Medicine, Otto-von-Guericke University, Leipziger Strasse 44, 39120, Magdeburg, Germany

    Maciej Powerski, Anke Busse, Max Seidensticker, Frank Fischbach, Ricarda Seidensticker, Katharina Strach, Oliver Dudeck, Jens Ricke & Maciej Pech

  2. 2nd Department of Radiology, Medical University of Gdańsk, Mariana Smoluchowskiego 17, 80-214, Gdańsk, Poland

    Maciej Pech

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  1. Maciej Powerski
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  2. Anke Busse
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  3. Max Seidensticker
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  4. Frank Fischbach
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  5. Ricarda Seidensticker
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  6. Katharina Strach
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  7. Oliver Dudeck
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  8. Jens Ricke
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  9. Maciej Pech
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Correspondence to Maciej Powerski.

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Powerski, M., Busse, A., Seidensticker, M. et al. Prophylactic Embolization of the Cystic Artery Prior to Radioembolization of Liver Malignancies—An Evaluation of Necessity. Cardiovasc Intervent Radiol 38, 678–684 (2015). https://doi.org/10.1007/s00270-015-1088-1

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  • DOI: https://doi.org/10.1007/s00270-015-1088-1

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