Lipiodol Embolism Following Transarterial Chemoembolization

Taupin, Daniel; Mukherjee, Vikramjit; Nathavitharana, Ruvandhi R.; Green, David A.; Fridman, David

doi:10.1097/ccm.0000000000000307

Cited by 8 publications

(5 citation statements)

References 11 publications

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“…42 Spontaneous liver rupture after DEB-TACE has also been reported. 43 These ADE do not appear to be specific to DEB-TACE, because they have also been reported after cTACE, [44][45][46][47] and the affected patients are usually older and experience multiple preoperative complications.…”

Section: Discussionmentioning

confidence: 99%

Systematic review comparing the safety and efficacy of conventional and drug‐eluting bead transarterial chemoembolization for inoperable hepatocellular carcinoma

Xie

Wang

Peng

et al. 2014

Hepatology Research

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Aim: Conventional transarterial chemoembolization (cTACE)is widely used for treating patients with inoperable hepatocellular carcinoma (HCC). A variation on the technique based on drug-eluting beads (DEB-TACE) has recently entered the clinic, but trials of its safety and efficacy have given conflicting results. This systematic review aimed to gain a current, comprehensive picture of how DEB-TACE compares with cTACE.Methods: MEDLINE, EMBASE, the Cochrane Library, the Chinese National Knowledge Infrastructure database and clinical trial registries were searched through June 2014. Risk ratios (RR), hazard ratios (HR) and 95% confidence intervals (CI) were calculated. Results:The analysis included four randomized controlled trials, one uncontrolled prospective study and one prospective case-control study, altogether involving 652 patients. Overall survival benefit was similar between cTACE and DEB-TACE patients (HR = 1.07, 95% CI = 0.82-1.40, P = 0.875). However, DEB-TACE was associated with a significantly higher objective tumor response rate (RR = 1.14, 95% CI = 1.01-1.29, P = 0.03) and a slightly lower incidence of adverse events. Conclusion:Though the available evidence suggests that although DEB-TACE is associated with better tumor response and potentially fewer adverse events, it does not provide greater survival benefit than cTACE. These results need to be validated in high-quality trials with large sample size.

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Section: Discussionmentioning

confidence: 99%

Systematic review comparing the safety and efficacy of conventional and drug‐eluting bead transarterial chemoembolization for inoperable hepatocellular carcinoma

Xie

Wang

Peng

et al. 2014

Hepatology Research

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“…Because of a low clearance rate in tumors, lipiodol is stranded in local tumor for a very long time and induces ischemia and hypoxia in the tumor, and finally, coagulation necrosis; the more lipiodol deposits in the tumor, the higher the degree of necrosis [10]. However, tumor cells remaining in the local area with little lipiodol or without lipiodol makes relapse easy.…”

Section: Discussionmentioning

confidence: 99%

Assessment of the feasibility of TACE combined with intratumoral injection of cisplatin in hepatocellular carcinoma

et al. 2015

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The feasibility of transcatheter arterial chemo-embolization (TACE) combined with intratumoral injection of cisplatin as treatment for hepatocellular carcinoma. 30 cases receiving TACE were denoted the TACE group, another 30 cases receiving TACE combined with an intratumoral multi-point injection of cisplatin were denoted the TACE/cisplatin group. Cases with partial remission/complete remission (PR/CR) were analyzed using 2 tests; alpha fetoprotein (AFP), aspartate amino transferase (AST), total bilirubin (TBIL), erythrocyte, and platelet levels were detected and the differences between two groups were analyzed using the Student’s t-test; cases with complications, including intrahepatic metastasis (IM), upper gastrointestinal bleeding (UGB), and liver failure were also counted. The correlation of clinical parameters with PR/CR was analyzed using multifactorial correlation analysis. Cases with PR/CR in the TACE/cisplatin group were significantly more than in TACE group, accompanied by significant declination in FAP. There were no significant differences of AST, ALT, TBIL, blood urea nitrogen (BUN), white blood cells (WBC), red blood cells (RBC), and platelets (PLT) between two groups; 3 cases with IM, one case with UGB and one case with LF were found in the TACE group, but only 1 case with IM was found in the TACE/cisplatin group. In addition, tumor stage was correlated with PR/CR. We concluded that TACE combined with intratumoral injection of cisplatin was more effective than TACE, and with fewer complications and side effects.

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“…[4][5][6] High density iodinated oil was found on the CT scan of some cases. 7 The postmortem examination also revealed a fat droplet embolism in the arterioles of lung tissues. 6 However, the mechanism of diffused exudation of both lungs was unclear.…”

Section: Introductionmentioning

confidence: 96%

Clinical Characteristics of Transarterial Chemoembolization in Treatment of Primary Hepatocellular Carcinoma Complicated With Respiratory Distress Syndrome

Ruan

Lin

Xiong

et al. 2020

Technol Cancer Res Treat

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Objective: The present study aims to analyze the clinical characteristics and etiology of transarterial chemoembolization (TACE) in the treatment of hepatocellular carcinoma (HCC) complicated with acute respiratory distress syndrome (ARDS), in order to improve the early diagnosis rate and cure rate. Methods: A total of 816 patients with primary HCC received 2,200 TACE treatments from January 2014 to May 2018. Among these patients, 6 patients developed ARDS after TACE. The clinical data, lesion characteristics, laboratory tests, treatment process and prognosis of 6 patients were retrospectively analyzed. Results: The longest lesion diameter ranged within 5.0-10.2 cm (mean: 6.6 cm) in the 6 patients with primary HCC. Among these patients, 4 patients had lesions mainly located in the left lateral lobe of the liver, while 5 patients had no hepatic arteriovenous fistula detected before TACE. Nedaplatin, epirubicin and iodinated oil suspension chemoembolization were used in all 6 patients during TACE, and all of them experienced ARDS symptoms within 24-48 hours after TACE. However, no clear pathogenic bacteria were incubated in the sputum culture after the onset of the disease. Diffused exudative changes of both lungs were found in the chest X-ray, and the oxygenation index (PaO2/FiO2) was within 100-300 mmHg. The symptoms of 6 patients improved after 3-6 days of hormone therapy. Conclusion: In this study, we found that although the incidence of ARDS after TACE was low in the treatment for HCC, the symptoms after onset were serious, and the early hormone therapy may be beneficial to improve the prognosis and reduce mortality. Further research with larger samples is still needed to confirm the pathogenesis of ARDS after TACE in the treatment for HCC.

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Lipiodol Embolism Following Transarterial Chemoembolization

Cited by 8 publications

References 11 publications

Systematic review comparing the safety and efficacy of conventional and drug‐eluting bead transarterial chemoembolization for inoperable hepatocellular carcinoma

Systematic review comparing the safety and efficacy of conventional and drug‐eluting bead transarterial chemoembolization for inoperable hepatocellular carcinoma

Assessment of the feasibility of TACE combined with intratumoral injection of cisplatin in hepatocellular carcinoma

Clinical Characteristics of Transarterial Chemoembolization in Treatment of Primary Hepatocellular Carcinoma Complicated With Respiratory Distress Syndrome

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