Tetsuya Yoshioka

Transcatheter hepatic segmental arterial embolization using lipiodol mixed with an anticancer drug and gelfoam particles for hepatocellular carcinoma

Transcatheter hepatic segmental arterial chemoembolization using Lipiodol mixed with an anticancer drug followed by the injection of Gelfoam particles, introduced into the tumor-bearing hepatic segment as the target area (segemental Lipiodol-TAE), was carried out in 54 patients with hepatocellular carcinoma (HCC), 7 of whom were later resected. In 5 of the resected 7 cases, complete necrosis was histologically verified. No death due to HCC was encountered in 47 nonoperated cases, and better therapeutic results were obtained with segmental Lipiodol-TAE. It was concluded that this technique does not adversely affect normal tissues, and it does reinforece the effect of TAE.

Aortic stent-grafting with transrenal fixation : use of newly designed spiral Z-stent endograft

PURPOSE To evaluate the feasibility and efficacy of a newly designed stent-graft placed across the renal arteries for exclusion of abdominal aortic aneurysms (AAAs) with short or tortuous proximal necks. METHODS Among a group of AAA patients treated with endovascular grafting, 5 had tortuous proximal necks and 13 had necks <20 mm (mean 13 mm). In these 18 cases, a 2- to 3-cm uncovered segment of the stent-graft was placed transrenally using a catheter inserted into the renal artery as a guide for graft margin positioning. A newly designed stent-graft was constructed from a custom-made spiral Z-stent covered with a thin-walled Dacron material; the endografts were deployed through 16-F (aortoaortic model) or 18-F sheaths (bifurcated devices). Renal function was assessed by preoperative and postoperative measurement of urea nitrogen and creatinine. Aneurysm exclusion and renal artery patency were evaluated during follow-up using spiral computed tomography and angiography. RESULTS The stent-grafts were correctly placed at the intended site in all 18 patients. Renal function was not affected except transiently in 1 patient who developed bilateral renal artery stenoses 24 hours after the procedure; Palmaz stents were deployed in each renal artery to reestablish satisfactory blood flow. Of the 33 renal arteries crossed by the bare stent-graft segment, all were patent over a mean 14-month follow-up (range 7-24), including the patient with Palmaz stents implanted for postprocedural renal stenosis. Complete aneurysm exclusion was maintained in 15 (83%) of 18 patients; proximal leaks persisted in 3 patients, including 2 with severely angled proximal necks. CONCLUSIONS Transrenal placement of the uncovered leading edge of custom-made spiral Z-stent-based endografts appears feasible and clinically effective in the treatment of AAAs with short or tortuous proximal necks.

Transcatheter arterial embolization using iodized oil (lipiodol) mixed with an anticancer drug for the treatment of hepatocellular carcinoma.

SummaryThe therapeutic results of Lp-TAE (transcatheter arterial embolization with Gelfoam particles preceded by the infusion of a mixture of lipiodol and an anticancer drug via the proper hepatic artery) were evaluated in hepatocellular carcinomas (523 non-resected and 24 resected cases). Excellent therapeutic effects were confirmed not only for the main tumor but also for the the daughter nodules by a histological examination of the liver tissues resected after Lp-TAE. The cumulative 1-year, 2-year and 3-year survival rates in the 523 non-resected cases were 60.4%, 42.9% and 28.0% respectively. These survival rates were all higher than those achieved by Gelfoam TAE. The above results suggest the usefulness of Lp-TAE in the treatment of hepatocellular carcinoma.

Computed tomography detection of small daughter nodules in hepatocellular carcinoma after iodized oil infusion into the hepatic artery

The detectability of small daughter nodules of hepatocellular carcinoma by computed tomography after hepatic arterial infusion of Lipiodol (iodized oil) and by infusion hepatic angiography was studied in 102 cases. The Lipiodol was selectively accumulated by the tumor. Tumors and small daughter nodules appeared as high-density areas on computed tomography. In 24 cases daughter nodules were identified only by computed tomography. In 50 cases computed tomography demonstrated superior ability to detect the daughter nodules when compared with infusion hepatic angiography. In 21 cases the daughter nodules were detected for the first time in areas other than the main site of the primary tumor. Lipiodol-computed tomography is very effective in the diagnosis of daughter nodules of hepatocellular carcinoma.

Evaluation of arterial embolization therapy for hepatocellular carcinoma by computed tomography

Changes in tumor area and the attenuation value determined from computed tomography (CT) slice section of the tumor at its maximum size were investigated in 18 patients with hepatocellular carcinoma who were studied by CT after arterial embolization therapy. The tumor area was reduced in all cases after embolization therapy. Greater than 50% reduction of the tumor area occurred during the follow-up period in 13 cases (87%). In cases evaluated by follow-up CT, the relative attenuation value of tumor to nontumor regions decreased during the initial stage after embolization therapy, but showed a tendency towards greater elevation than in the initial stage, despite tumor reduction. This change in the attenuation value was considered to reflect necrosis and shrinkage of the tumor after embolization therapy. The absence of such changes in nontumor regions supports the use of arterial embolization therapy as an effective, conservative treatment for hepatocellular carcinoma. Follow-up examination by CT of hepatocellular carcinoma after embolization therapy contributes to the post-therapeutic evaluation of tumors and to the determination of the appropriate time for reembolization therapy.