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Passive expansion of sub-maximally dilated transjugular intrahepatic portosystemic shunts and assessment of clinical outcomes

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World Journal of Hepatology 2017年第12期9卷 603-612页

作者： Michael C Hsu Charles N Weber S William Stavropoulos Timothy W Clark Scott O Trerotola Richard D Shlansky Goldberg Michael C Soulen Gregory J Nadolski Department of radiology Division of Interventional RadiologyMount Sinai Hospital Department of radiology Division of Interventional RadiologyHospital of the University of Pennsylvania

AIM To assess for passive expansion of sub-maximally dilated transjugular intrahepatic portosystemic shunts(TIPS) and compare outcomes with maximally dilated *** Polytetrafluoroethylene covered TIPS(Viatorr) from July 2002 to December 2013 were retrospectively reviewed at two hospitals in a single institution. Two hundred and thirty patients had TIPS maximally dilated to 10 mm(m TIPS), while 43 patients who were at increased risk for hepatic encephalopathy(HE), based on clinical evaluation or low pre-TIPS portosystemic gradient(PSG), had 10 mm TIPS sub-maximally dilated to 8 mm(sm TIPS). Group characteristics(age, gender, Model for End-Stage Liver Disease score, post-TIPS PSG and clinical outcomes were compared between groups, including clinical success(ascites or varices), primary patency,primary assisted patency, and severe post-TIPS HE. A subset of fourteen patients with sm TIPS underwent follow-up computed tomography imaging after TIPS creation, and were grouped based on time of imaging( 6 mo). Change in diameter and crosssectional area were measured with 3D imaging software to evaluate for passive *** Patient characteristics were similar between the sm TIPS and m TIPS groups, except for pre-TIPS portosystemic gradient, which was lower in the sm TIPS group(19.4 mm Hg ± 6.8 vs 22.4 mm Hg ± 7.1, P = 0.01). Primary patency and primary assisted patency between sm TIPS and m TIPS was not significantly different(P = 0.64 and 0.55, respectively). Four of the 55 patients(7%) with sm TIPS required TIPS reduction for severe refractory HE, while this occurred in 6 of the 218 patients(3%) with m TIPS(P = 0.12). For the 14 patients with follow-up computed tomography(CT) imaging, the median imaging follow-up was 373 d. There was an increase in median TIPS diameter, median percent diameter change, median area, and median percent area change in patients with CT follow-up greater than 6 mo after TIPS placement compared to follow-up within 6 mo(

关键词： Variceal hemorrhage Portal hypertension Transjugular intrahepatic portosystemic shunts Ascites Sub-maximal dilation Underdilated Passive expansion Hepatic encephalopathy

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Transcatheter embolization therapy in liver cancer:an update of clinical evidences

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Chinese Journal of Cancer Research 2015年第2期27卷 96-121页

作者： Yi-Xiang J.Wang Thierry De Baere Jean-Marc Idee Sebastien Ballet Department of Imaging and interventional radiology Faculty of MedicineThe Chinese University of Hong KongPrince of Wales Hospital Gustave Roussy Department of Interventional Radiology Guerbet Division of Research & Innovation

Transarterial chemoembolization （TACE） is a form of intra-arterial catheter-based chemotherapy that selectively delivers high doses of cytotoxic drug to the tumor bed combining with the effect of ischemic necrosis induced by arterial embolization. Chemoembolization and radioembolization are at the core of the treatment of liver hepatocellular carcinoma （HCC） patients who cannot receive potentially curative therapies such as transplantation, resection or percutaneous ablation. TACE for liver cancer has been proven to be useful in local tumor control, to prevent tumor progression, prolong patients＇ life and control patient symptoms. Recent evidence showed in patients with single-nodule HCC of 3 cm or smaller without vascular invasion, the 5-year overall survival （OS） with TACE was similar to that with hepatic resection and radiofrequency ablation. Mthough being used for decades, Lipiodol~ （Lipiodol~ Ultra Fluid~, Guerbet, France） remains important as a tumor-seeking and radio-opaque clrug delivery vector in intervendonal oncology. There have been efforts to improve the delivery of chemotherapeutic agents to tumors. Drug-eluting bead （DEB） is a relatively novel drug delivery embolization system which allows for fixed dosing and the ability to release the anticancer agents in a sustained manner. Three DEBs are available, i.e., Tandem~ （CeloNova Biosciences Inc., USA）, DC-Beads~ （BTG, UK） and HepaSphere~ （BioSphere Medical, Inc., USA）. Transarterial radioembolization （TARE） technique has been developed, and proven to be efficient and safe in advanced liver cancers and those with vascular complications. Two types of radioembolization microspheres are available i.e., SIR-Spheres~ （Sirtex Medical Limited, Australia） and TheraSphere~ （BTG, UK）. This review describes the basic procedure of TACE, properties and efficacy of some chemoembolization systems and radioembolization agents which are commercially available and/or currently under clinical evaluation. The key clinical tr

关键词： Transarterial chemoembolization hepatocellular carcinoma (HCC) drug-eluting particles microspheres Lipiodol radioembolization yttrium-90

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Portal hypertension: Imaging of portosystemic collateral pathways and associated image-guided therapy

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World Journal of Gastroenterology 2017年第10期23卷 1735-1746页

作者： Murad Feroz Bandali Anirudh Mirakhur Edward Wolfgang Lee Mollie Clarke Ferris David James Sadler Robin Ritchie Gray Jason Kam Wong Department of radiology Foothills Medical Centre University of Calgary division of interventional radiology Department of Radiology UCLA Medical Center

Portal hypertension is a common clinical syndrome, defined by a pathologic increase in the portal venous pressure. Increased resistance to portal blood flow, the primary factor in the pathophysiology of portal hypertension, is in part due to morphological changes occurring in chronic liver diseases. This results in rerouting of blood flow away from the liver through collateral pathways to low-pressure systemic veins. Through a variety of computed tomographic, sonographic, magnetic resonance imaging and angiographic examples, this article discusses the appearances and prevalence of both common and less common portosystemic collateral channels in the thorax and abdomen. A brief overview of established interventional radiologic techniques for treatment of portal hypertension will also be provided. Awareness of the various imaging manifestations of portal hypertension can be helpful for assessing overall prognosis and planning proper management.

关键词： Portal hypertension Diagnostic imaging Portosystemic collaterals Image-guided therapy

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Hepatocellular Carcinoma:Diagnosis, Treatment Algorithms, and Imaging Appearance after Transarterial Chemoembolization

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Journal of Clinical and Translational Hepatology 2018年第2期6卷 175-188页

作者： Patrick Vande Lune Ahmed K.Abdel Aal Sergio Klimkowski Jessica G.Zarzour Andrew J.Gunn University of Alabama at Birmingham School of Medicine BirminghamALUSA division of Vascular and interventional radiology Department of RadiologyUniversity of Alabama at BirminghamBirminghamALUSA Department of radiology University of Alabama at BirminghamBirminghamALUSA division of abdominal Imaging Department of RadiologyUniversity of Alabama at BirminghamBirminghamALUSA

Hepatocellular carcinoma(HCC)is a common cause of cancer-related death,with incidence increasing ***,the overall prognosis for patients with HCC is poor and many patients present with advanced stages of disease that preclude curative *** and interventional radiologists play a key role in the management of patients with *** radiologists can use contrast-enhanced computed tomography(CT),magnetic resonance imaging,and ultrasound to diagnose and stage HCC,without the need for pathologic confirmation,by following established *** staged,the interventional radiologist can treat the appropriate patients with percutaneous ablation,transarterial chemoem-bolization,or ***-up imaging after these liver-directed therapies for HCC can be characterized according to various radiologic response criteria;although,enhancement-based criteria,such as European Association for the Study of the Liver and modified Response Evaluation Criter in Solid Tumors,are more reflective of treatment effect in *** imaging technologies like volumetric analysis,dual-energy CT,cone beam CT and perfusion CT may provide additional benefits for patients with HCC.

关键词： interventional radiology interventional oncology Hepatocellular carcinoma Response criteria Transarterial chemoembolization Diagnostic radiology

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Evidence-based medical oncology and interventional radiology paradigms for liver-dominant colorectal cancer metastases

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World Journal of Gastroenterology 2016年第11期22卷 3127-3149页

作者： Alan Alper Sag Fatih Selcukbiricik Nil Molinas Mandel division of interventional radiology Department of RadiologyKoc University School of Medicine division of Medical Oncology Department of Internal MedicineKoc University School of Medicine

Colorectal cancer metastasizes predictably, with liver predominance in most cases. Because liver involvement has been shown to be a major determinant of survival in this population, liver-directed therapies are increasingly considered even in cases where there is(limited) extrahepatic disease. Unfortunately, these patients carry a known risk of recurrence in the liver regardless of initial therapy choice. Therefore, there is a demand for minimally invasive, non-surgical, personalized cancer treatments to preserve quality of life in the induction, consolidation, and maintenance phases of cancer therapy. This report aims to review evidence-based conceptual, pharmacological, and technological paradigm shifts in parenteral and percutaneous treatment strategies as well as forthcoming evidence regarding next-generation systemic, locoregional, and local treatment approaches for this patient population.

关键词： Colonic neoplasms Rectal neoplasms Neoplasm metastasis Antineoplastic agents FOLFOX protocol Irinotecan 5-flurouracil and leucovorin protocol Radiofrequency ablation Microwave ablation Chemoembolization Therapeutic Immunotherapy

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Editorial comment:a review on radiofrequency,microwave and high-intensity focused ultrasound ablations for hepatocellular carcinoma with cirrhosis

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Hepatobiliary Surgery and Nutrition 2022年第3期11卷 453-456页

作者： Merve Ozen Driss Raissi division of Vascular and interventional radiology Department of RadiologyUniversity of KentuckyLexingtonKYUSA

We read with great interest the article by Cheung et al.(1)recently published in Hepatobiliary Surgery and Nutrition,presenting a narrative review of various ablation systems for hepatocellular carcinoma(HCC)in cirrhotic *** would like to provide several *** would first like to offer our congratulations to the authors for their review,which extensively discusses radiofrequency(RFA),high-intensity focused ultrasound(HIFU),and microwave ablation(MWA)ablation *** review is a succinct summary to better understand the utility of various ablation techniques used in HCC treatment(1).

关键词： Surgery hepatocellular

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Effects of Yttrium-90 selective internal radiation therapy on non-conventional liver tumors

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World Journal of Gastroenterology 2015年第27期21卷 8271-8283页

作者： Andrew Kuei Sammy Saab Sung-Ki Cho Stephen T Kee Edward Wolfgang Lee division of interventional radiology Department of Radiology UCLA Medical Center David Geffen School of Medicine at UCLA Los Angeles Department of Medicine Division of Hepatology Pfleger Liver Institute University of California at Los Angeles Los Angeles division of interventional radiology Department of Radiology Samsung Medical Center Sungkyunkwan University School of Medicine

The liver is a common site of metastasis, with essentially all metastatic malignancies having been known to spread to the liver. Nearly half of all patients with extrahepatic primary cancer have hepatic metastases. The severe prognostic implications of hepatic metastases have made surgical resection an important first line treatment in management. However, limitations such as the presence of extrahepatic spread or poor functional hepatic reserve exclude the majority of patients as surgical candidates, leaving chemotherapy and locoregional therapies as next best options. Selective internal radiation therapy(SIRT) is a form of catheter-based locoregional cancer treatment modality for unresectable tumors, involving trans-arterial injection of microspheres embedded with a radioisotope Yttrium-90. The therapeutic radiation dose is selectively delivered as the microspheres permanently embed themselves within the tumor vascular bed. Use of SIRT has been conventionally aimed at treating primary hepatic tumors(hepatocellular carcinoma) or colorectal and neuroendocrine metastases. Numerous reviews are available for these tumor types. However, little is known or reviewed on non-colorectal or nonneuroendocrine primaries. Therefore, the aim of this paper is to systematically review the current literature to evaluate the effects of Yttrium-90 radioembolization on non-conventional liver tumors including those secondary to breast cancer, cholangiocarcinoma, ocular and percutaneous melanoma, pancreatic cancer, renal cell carcinoma, and lung cancer.

关键词： Liver metastases Breast cancer Melanoma Cholangiocarcinoma Radioembolization Selective internal radiation therapy Transarterial radioembolization Yttrium-90

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Preparing for Iiver surgery with "Alphabet Soup": PVE, ALPPS, TAE-PVE, LVD and RL

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Hepatobiliary Surgery and Nutrition 2020年第2期9卷 136-151页

作者： DaeHee Kim Joshua Cornman-Homonoff David C.Madoff Department of radiology Division of Interventional RadiologyMemorial Sloan Kettering Cancer CenterNew YorkNYUSA Department of radiology and Biomedical Imaging Section of Interventional RadiologyYale School of MedicineNew HavenCTUSA

Future liver remnant(FLR)is a critical limiting factor for treatment eligibility and postoperative prognosis when considering surgical ***-operative portal vein embolization(PVE)has been proven effective in modulating FLR and now widely accepted as a standard of ***,PVE is not always effective due to potentially inadequate augmentation of the FLR as well as tumor progression while awaiting liver *** concerns have prompted exploration of alternative techniques:associating liver partition and portal vein ligation for staged hepatectomy(ALPPS),transarterial embolization-portal vein embolization(TAE-PVE),liver venous deprivation(LVD),and radiation lobectomy(RL).The article aims to review the principles and applications of PVE and these newer hepatic regenerative techniques.

关键词： Hepatic regeneration future liver remnant embolization

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interventional treatment for symptomatic acute-subacute portal and superior mesenteric vein thrombosis

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World Journal of Gastroenterology 2009年第40期15卷 5028-5034页

作者： Feng-Yong Liu Mao-Qiang Wang Qing-Sheng Fan Feng Duan Zhi-Jun Wang Peng Song Department of interventional radiology Clinical Division of Internal Medicine Chinese People's Liberation Army General Hospital Beijing 100853 China

AIM: To summarize our methods and experience with interventional treatment for symptomatic acute-sub-acute portal vein and superior mesenteric vein throm-bosis (PV-SMV) thrombosis. METHODS: Forty-six patients (30 males, 16 females, aged 17-68 years) with symptomatic acute-subacute portal and superior mesenteric vein thrombosis were ac-curately diagnosed with Doppler ultrasound scans, com-puted tomography and magnetic resonance imaging. They were treated with interventional therapy, including direct thrombolysis (26 cases through a transjugular intrahepatic portosystemic shunt; 6 through percutane-ous transhepatic portal vein cannulation) and indirect thrombolysis (10 through the femoral artery to superior mesenteric artery catheterization; 4 through the radial artery to superior mesenteric artery catheterization). RESULTS: The blood reperfusion of PV-SMV was achieved completely or partially in 34 patients 3-13 d after thrombolysis. In 11 patients there was no PV-SMV blood reperfusion but the number of collateral vessels increased signif icantly. Symptoms in these 45 patients were improved dramatically without severe operationalcomplications. In 1 patient, the thrombi did not respond to the interventional treatment and resulted in intestinal necrosis, which required surgical treatment. In 3 patients with interventional treatment, thrombi reformed 1, 3 and 4 mo after treatment. In these 3 patients, indirect PV-SMV thrombolysis was performed again and was successful. CONCLUSION: interventional treatment, including direct or indirect PV-SMV thrombolysis, is a safe and effective method for patients with symptomatic acutesubacute PV-SMV thrombosis.

关键词： Portal thrombosis Superior mesenteric vein thrombosis Thrombolysis interventional treatment

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Hydrogel microspheres for bone regeneration through regulation of the regenerative microenvironment

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Biomaterials Translational 2024年第3期5卷 205-235页

作者： Pengrui Zhang Qiwei Qin Xinna Cao Honglin Xiang Dechao Feng Dilinaer Wusiman Yuling Li Department of Orthopaedics Laboratory of Biological Tissue Engineering and Digital MedicineAffiliated Hospital of North Sichuan Medical CollegeNanchongSichuan ProvinceChina division of Surgery&interventional Science University College LondonLondonUK Department of Comparative Pathobiology College of Veterinary MedicinePurdue UniversityWest LafayetteINUSA

Bone defects are a prevalent category of skeletal tissue disorders in clinical practice,with a range of pathogenic factors and frequently suboptimal clinical treatment *** bone regeneration of bone defects,the bone regeneration microenvironment-composed of physiological,chemical,and physical components-is the core element that dynamically coordinates to promote bone *** recent years,medical biomaterials with bioactivity and functional tunability have been widely researched upon and applied in the fields of tissue replacement/regeneration,and remodelling of organ structure and *** biomaterial treatment system based on the comprehensive regulation strategy of bone regeneration microenvironment is expected to solve the clinical problem of bone *** microspheres(HMS)possess a highly specific surface area and porosity,an easily adjustable physical structure,and high encapsulation efficiency for drugs and stem *** can serve as highly efficient carriers for bioactive factors,gene agents,and stem cells,showing potential advantages in the comprehensive regulation of bone regeneration microenvironment to enhance bone *** review aims to clarify the components of the bone regeneration microenvironment,the application of HMS in bone regeneration,and the associated *** also discusses various preparation materials and methods of HMS and their applications in bone tissue ***,it elaborates on the relevant mechanisms by which HMS regulates the physiological,chemical,and physical microenvironment in bone regeneration to achieve bone ***,we discuss the future prospects of the HMS system application for comprehensive regulation of bone regeneration microenvironment,to provide novel perspectives for the research and application of HMS in the bone tissue engineering field.

关键词： bone regeneration bone tissue engineering hydrogel microspheres regeneration microenvironment

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