Complications after transcatheter arterial chemoembolization via the inferior phrenic arteries: incidence, risk factors, and prophylaxis
- VernacularTitle:膈下动脉参与肝肿瘤供血栓塞后并发症及其预防
- Author:
Maoqiang WANG
;
Fengyong LIU
;
Jun GUAN
- Publication Type:Journal Article
- Keywords:
Chemotherapeutic infusion;
Complications Inferior phrenic arteries;
Chemotherapeutic embolization;
Liver neoplasms;
Therapy
- From:
Journal of Interventional Radiology
1992;0(01):-
- CountryChina
- Language:Chinese
-
Abstract:
Objective To investigate the frequency, patterns of the angiographic findings and risk factors for development of complications after transcatheter arterial chemoembolization (TACE) via the inferior phrenic artery (IPA).Methods One hundred and sixty eight patients with hepatic tumor fed by the IPA underwent a total of 226 procedures of TACE of the IPA, with combined routine TACEO(88.7%) or without (11.3%) the combination of routine TACE of the hepatic artery. TACE of the malignancy was performed with an emulsion of iodized oil and anti-cancer agents and then followed by gelatin sponge particle injection. The complications were assessed on clinical observation, laboratory tests, and computed tomographic (CT) images after TACE of the IPA; and finally were correlated with the angiographic findings of the IPA. Results The tumor supplied by IPA was noted at initial TACE in 25 (14.9%), at successive TACE in 97 (57.8%), after percutaneous tumor ablation guided by ultrasound in 28 (16.7%), and after hepatic surgery in 18 (10.7%) cases. The abnormal findings on arteriography showed enlargement of the IPA with tumor staining in all cases, dense non-tumor staining in 61(36.3%), artery-to-artery anastomosis in 62(36.9%),arteriovenous shunts in 12(7.1%) cases. 96.4% of these patients complained of shoulder pain during TACE of the IPA. The cumulative complication rate after the procedure was 8.9%,including hiccup in 13 cases (5.8%), chest pain with cough and mild hemoptysis in 9 (4.0%), phrenoparalysis in 8 (3.5%), angina with abnormal ECG in 4 (1.8%), increasing of CPK, AST, and ALT significantly in 6 (2.7%), transient myeloparalysis in 2 (0.9%), and subphrenic abscess in 2 cases (0.9%). Two patients with the subphrenic abscess were successfully treated with percutaneous catheter drainage and antibiotics. The symptoms of these mild complications subsided with symptomatic treatment.Conclusions Complications of TACE via the IPA occur in about 9% of the patients and these complications do not worsen the patients survival. IAP angiographic abnormalities such as arteriovenous shunts, artery-to-artery anastomoses, dense non-tumor contrast staining,are important risk factors for complications of TACE of the IPA.
