Is prophylactic embolization of the hepatic falciform artery needed before radioembolization in patients with 99mTc-MAA accumulation in the anterior abdominal wall?

Ahmadzadehfar, Hojjat; Möhlenbruch, Markus; Sabet, Amir; Meyer, Carsten H.; Muckle, Marianne; Haslerud, Torjan; Wilhelm, Kai; Schild, Hans H.; Biersack, H.-J.; Ezziddin, Samer

doi:10.1007/s00259-011-1807-z

Cited by 32 publications

(17 citation statements)

References 20 publications

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“…This is in accordance with results of a large study cohort in which HFA was seen in 2% of 1250 patients (Baba et al 2000 ). An even smaller prevalence of an angiographically patent HFA (0.5%) was reported by Ahmadzadehfar et al ( 2011 ) who investigated 192 patients. They found a 99m Tc-HSAM accumulation in the anterior abdominal wall in 9% of patients, which is comparable to the currently reported 8%.…”

Section: Discussionmentioning

confidence: 76%

Selective internal radiation therapy of hepatic tumors: procedural implications of a patent hepatic falciform artery

et al. 2014

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Selective internal radiation therapy (SIRT) using 90-yttrium is a local therapy for unresectable liver malignancies. Non-targeted 90-yttrium diversion via a patent hepatic falciform artery (HFA) is seen as risk for periprocedural complications. Therefore, this study aimed to evaluate the impact of a patent HFA on SIRT. 606 patients with SIRT between 2006 and 2012 were evaluated retrospectively. SIRT preparation was performed by digital subtraction angiography including 99mTc-HSAM administration and subsequent SPECT/CT. Patients with an angiographically patent HFA were analyzed for procedural consequences and complications. 19 of 606 patients (3%) with an angiographically patent HFA were identified. Only 11 of these 19 patients received 90-yttrium in the hepatic vessel bed containing the HFA. Initial coil embolization of the HFA succeeded only in three of 11 patients. Out of the eight remaining patients four had no abdominal wall 99mTc-HSAM accumulation. The other four patients presented with an abdominal wall 99mTc-HSAM accumulation, for those a reattempt of HFA embolization was performed or ice packs were administered on the abdominal wall during SIRT. In summary, all patients tolerated SIRT well. A patent HFA should not be considered a SIRT contraindication. In patients with abdominal wall 99mTc-HSAM accumulation HFA embolization or ice pack administration seems to prevent complications.

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Section: Discussionmentioning

confidence: 76%

Selective internal radiation therapy of hepatic tumors: procedural implications of a patent hepatic falciform artery

et al. 2014

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“…Although coil embolization is usually recommended prior to microsphere injection, the risk of complications appears to be low, since six of our seven patients who received microsphere injections without prior embolization did not present any complications. In a recent study, a hepatic falciform artery was identified using MAA SPECT/CT a posteriori in 16 patients who did not undergo coil embolization during treatment; only 1 patient complained of abdominal pain for 48 h, without presenting skin lesions [18]. However, identifying a falciform artery and the associated low risk of abdominal pain is important on the one hand to properly inform the patient and on the other to avoid performing multiple and unnecessary endoscopies to detect ulcer disease in patients with unexplained abdominal pain.…”

Section: Discussionmentioning

confidence: 99%

Usefulness and pitfalls of MAA SPECT/CT in identifying digestive extrahepatic uptake when planning liver radioembolization

Lenoir

Edeline

Rolland

et al. 2012

Eur J Nucl Med Mol Imaging

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Purpose Identifying gastroduodenal uptake of 99m Tcmacroaggregated albumin (MAA), which is associated with an increased risk of ulcer disease, is a crucial part of the therapeutic management of patients undergoing radioembolization for liver tumours. Given this context, the use of MAA single photon emission computed tomography (SPECT)/CT may be essential, but the procedure has still not been thoroughly evaluated. The aim of this retrospective study was to determine the effectiveness of MAA SPECT/CT in identifying digestive extrahepatic uptake, while determining potential diagnostic pitfalls. Methods Overall, 139 MAA SPECT/CT scans were performed on 103 patients with different hepatic tumour types. Patients were followed up for at least 6 months according to standard requirements.Results Digestive, or digestive-like, uptake other than free pertechnetate was identified in 5.7% of cases using planar imaging and in 36.6% of cases using SPECT/CT. Uptake sites identified by SPECT/CT included the gastroduodenal region (3.6%), gall bladder (12.2%), portal vein thrombosis (6.5%), hepatic artery (6.5%), coil embolization site (2.1%) as well as falciform artery (5.0%). For 2.1% of explorations, a coregistration error between SPECT and CT imaging could have led to a false diagnosis by erroneously attributing an uptake site to the stomach or gall bladder, when the uptake actually occurred in the liver. Conclusion SPECT/CT is more efficacious than planar imaging in identifying digestive extrahepatic uptake sites, with extrahepatic uptake observed in one third of scans using the former procedure. However, more than half of the uptake sites in our study were vascular in nature, without therapeutic implications. The risk of coregistration errors must also be kept in mind.

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“…Falsiform arter aracılığıyla karın ön duvarına kaçak saptanması durumunda Y-90 mikroküre tedavisi sonrası deri altı enflamasyon ve radyasyon hasarı gelişme riskine karşı tedavi sırasında karın ön duvarına soğuk kompres uygulaması ile vazospazm yapılması önerilir. Literatürde falsiform ligament boyunca karın ön duvarına kaçak olan hastalarda ciddi bir yan etki ve komplikasyon görülmemesi nedeniyle falsiform arterin koil ile embolizasyonu önerilmemektedir (10). (11,12,13,14,15,16).…”

Section: Hasta Seçimi Aşamasında Kişiselleştirilmiş Uygulamalar Ve Yaunclassified

Radioembolization: Personalized Treatment and Protection from Side Effects

Bozkurt¹

2019

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Is prophylactic embolization of the hepatic falciform artery needed before radioembolization in patients with 99mTc-MAA accumulation in the anterior abdominal wall?

Cited by 32 publications

References 20 publications

Selective internal radiation therapy of hepatic tumors: procedural implications of a patent hepatic falciform artery

Selective internal radiation therapy of hepatic tumors: procedural implications of a patent hepatic falciform artery

Usefulness and pitfalls of MAA SPECT/CT in identifying digestive extrahepatic uptake when planning liver radioembolization

Radioembolization: Personalized Treatment and Protection from Side Effects

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