Right Gastric Artery Embolization to Prevent Acute Gastric Mucosal Lesions in Patients Undergoing Repeat Hepatic Arterial Infusion Chemotherapy

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PURPOSE

The purpose of the study was to investigate the technical outcome and clinical effect of right gastric artery (RGA) embolization to prevent acute gastric mucosal lesions caused by influx of anticancer agents into the RGA in patients undergoing repeat hepatic arterial infusion chemotherapy (HAIC).

MATERIALS AND METHODS

In 217 patients with malignant hepatic tumors, we attempted RGA embolization with use of metallic coils and/or a mixture of n-butyl cyanoacrylate (n-BCA) and iodized oil, along with the embolization of the gastroduodenal artery. After this procedure, an infusion catheter was placed radiologically and HAIC was performed. We then evaluated the technical outcome and clinical effect of RGA embolization.

RESULTS

RGA embolization was technically successful in 201 of 217 patients (93%). Major complications—nausea, epigastric pain, and fever—were noted in 12%, 4%, and 2% of successful cases, respectively, and were treated conservatively. Recanalization occurred in 4% (nine of 201) of the patients. Eventually, sufficient RGA embolization was achieved in 192 patients. The incidence of acute gastric mucosal lesions confirmed endoscopically was only 3% (five of 192) in patients with sufficient RGA embolization, whereas it was 36% (nine of 25) in patients without sufficient RGA embolization, with a significant difference (P < .01).

CONCLUSION

RGA embolization is a highly feasible procedure that can reduce the incidence of acute gastric mucosal lesions associated with HAIC.

Section snippets

Patients

Between 1993 and 1997, 331 patients in our institution underwent HAIC with use of radiologically placed intraarterial infusion catheters for treatment of malignant hepatic tumors. Of these 331 patients, we attempted RGA embolization in 217 and excluded the patients on the following grounds: 49 for a history of radical gastrectomy, 39 whose right gastric arteries had been previously ligated at the time of resection of primary cancer, and 26 in whom the RGA could not be confirmed on celiac,

Technical Outcome

RGA embolization was technically successful in 201 of 217 patients (93%) (Figure 1, Figure 2). The embolization materials used in RGA embolization were microcoils in 83 patients, n-BCA and iodized oil in 63, coils and n-BCA/iodized oil in 48, and 0.035-inch steel coils in seven. The Technical success rate improved gradually during the 5-year study: 84% in 1993, 90% in 1994, 96% in 1995, 94% in 1996, and 96% in 1997. Microcoil use increased, steel coil use decreased, and use of n-BCA/ iodized

DISCUSSION

Systemic chemotherapy is not effective treatment of unresectable hepatic neoplasms in most cases. Therefore, HAIC, chemoembolization, and ablative procedures are usually considered for local management. Chemoembolization is usually effective for hypervascular lesions such as hepatocellular carcinoma. Ablative procedures are also effective according to the number, size, and location of the lesions (17). However, in cases with multiple or advanced lesions unsuitable for these procedures and

References (37)

  • JE Aruny et al.

    Quality improvement guidelines for percutaneous management of the thrombosed or dysfunctional dialysis access

    J Vasc Interv Radiol

    (1999)
  • Y Arai

    Interventional radiology for hepatic arterial infusion chemotherapy

    Gan To Kagaku Ryoho

    (1996)
  • VP Chuang et al.

    Hepatic artery infusion chemotherapy: gastroduodenal complication

    AJR Am J Roentgenol

    (1981)
  • H Nakamura et al.

    Prevention of gastric complications in hepatic arterial chemoembolization: balloon catheter occlusion technique

    Acta Radiol

    (1991)
  • M Granmayeh et al.

    Transcatheter occlusion of the gastroduodenal artery

    Radiology

    (1979)
  • AM Cohen et al.

    Treatment of hepatic metastases by transaxillary hepatic artery chemotherapy using an implanted drug pump

    Cancer

    (1983)
  • DA Hall et al.

    Gastroduodenal ulceration after hepatic arterial infusion chemotherapy

    AJR Am J Roentgenol

    (1981)
  • K Kurimoto et al.

    Acute gastric mucosal lesion (AGML) in patients receiving hepatic arterial infusion chemotherapy

    Nippon Shokakibyo Gakkai Zasshi

    (1987)
  • Y Arai et al.

    Right gastric arterial embolization for avoidance of gastric toxicity by hepatic infusion chemotherapy

    Rinsho Hoshasen

    (1988)
  • Y Arai et al.

    Interventional techniques for hepatic arterial infusion chemotherapy

  • VP Chuang et al.

    Hepatic arterial redistribution for intraarterial infusion of hepatic neoplasms

    Radiology

    (1980)
  • K Kodera et al.

    Hepatic arterial redistribution for hepatic arterial infusion chemotherapy

    Nippon Igaku Hoshasen Gakkai Zasshi

    (1984)
  • Y Takeuchi et al.

    A new percutaneous catheterization “side holed catheter placement with fixation” for a long term arterial chemotherapeutic infusion: its effectiveness to prevent hepatic arterial occlusion

    J Jpn Soc Angiogr Interv Radiol

    (1996)
  • Y Arai et al.

    Management of patients with unresectable liver metastases from colorectal and gastric cancer employing an implantable port system

    Cancer Chemother Pharmacol

    (1992)
  • Y Arai et al.

    Hepatic arterial infusion chemotherapy for liver metastases from breast cancer

    Cancer Chemother Pharmacol

    (1994)
  • Y Arai et al.

    Intermittent hepatic arterial infusion of high-dose 5FU on a weekly schedule for liver metastases from colorectal cancer

    Cancer Chemother Pharmacol

    (1997)
  • T Murakami et al.

    Interventional radiology for hepatocellular carcinoma: past and future

    J Jpn Soc Angiogr Interv Radiol

    (2000)
  • WD Ensminger et al.

    A totally implanted drug delivery system for hepatic arterial chemotherapy

    Cancer Treat Rep

    (1981)
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