Ethanol for hepatic artery embolization.

Reflecting on the studies by O'Riordan et al. and Doppman and Girton that are reported in this issue, the authors discuss the safety of using ethanol for hepatic artery embolization (HAE) and stress that the optimal indications for this procedure are still to be established. They indicate that the caution necessary with any technique can direct rather than inhibit action.

Calcification in the portal vein wall.

Calcification in the portal vein is a rare radiologic finding, occurring almost always in patients with portal hypertension. Calcium may be deposited in a thrombus or, as in this patient, in the vein wall. The characteristic position, location, and pattern of portal vein wall calcification permit its diagnosis from radiographs of the abdomen.

Gallbladder varices: a potential collateral pathway in portal hypertension and portal vein occlusion.

Varices of the gallbladder were demonstrated angiographically in four patients. One patient who had had a mesocaval shunt developed gallbladder varices as a result of hepatoportal shunting. Three patients had gallbladder varices owing to collateral circulation from portal vein occlusion.

Regional isolation-perfusion: an experimental percutaneous approach tested and compared with arterial occlusion-infusion.

A percutaneous approach was developed for the performance of regional isolation-perfusion, a surgical chemotherapeutic procedure for the intraarterial treatment of neoplasms. This technique was compared with percutaneous transcatheter arterial occlusion-infusion concerning local and systemic drug levels. Floxuridine (FUDR) was administered into a femoral artery of adult mongrel dogs, first by arterial occlusion-infusion, and 4 weeks later by regional isolation-perfusion of the opposite hind limb.

Treatment of hepatic neoplasm through extrahepatic collaterals.

Twenty-nine patients with hepatic artery occlusion were treated with additional hepatic infusion or embolization through extrahepatic collaterals. Seventeen courses of hepatic infusion were performed in 13 patients through the inferior pancreaticoduodenal artery, left gastric artery, or right gastric artery. Twenty-five hepatic embolization procedures were performed in 16 patients through the right and left phrenic arteries, left and right gastric arteries, pancreaticoduodenal artery, gastroduodenal artery, or omentoepiploic artery.

Work in progress: transcatheter management of primary carcinoma of the liver.

Twenty-four patients with hepatocellular carcinoma or cholangiocarcinoma were treated with hepatic artery infusion (HAI) of chemotherapeutic agents (14 patients) or hepatic artery embolization (HAE) (11 patients). One patient had a combination of the two treatments. Ten of the 14 (71%) patients who underwent HAI demonstrated partial remission.

Portal-hepatic venous malformation: ultrasound, computed tomographic, and angiographic findings.

A 59-year-old woman was evaluated for a mass in the right lobe of the liver. Ultrasonography (US) demonstrated multiple anechoic areas with enlargement of portal and hepatic veins. These areas were enhanced uniformly after bolus injection of contrast material during computed tomography (CT).

Radiographic and angiographic changes in osteosarcoma after intraarterial chemotherapy.

Transcatheter arterial infusion has improved the preoperative control of osteosarcoma. The conventional radiographs and angiograms of osteosarcoma were evaluated in 53 patients before and after treatment. In the responders, two types of calcifications representing healing are observed: peripheral and central.

Experimental canine hepatic artery embolization with polyvinyl alcohol foam particles.

Segmental and complete hepatic artery embolization with Ivalon (polyvinyl alcohol) particles (0.25 to 1 mm) was performed in 12 dogs to evaluate hepatic function alterations and histopathological changes. In dogs undergoing segmental embolization, liver function alterations were minimal and the liver was normal, both grossly and microscopically, at autopsy.

Angiographic classification of hepatic arterial collaterals.

Hepatic artery collaterals in 40 patients who had had hepatic artery occlusion following peripheral or central embolization, surgical ligation, intra-arterial chemotherapy, or intimal injury from catheterization were studied. The collaterals were classified as intrahepatic or extrahepatic collaterals. Intrahepatic arterial collaterals develop in the portal triads and subcapsular area between the lobes of the liver.

Bone metastases from renal carcinoma. The preoperative use of transcatheter arterial occlusion.

Surgical treatment of hypervascular bone lesions can result in excessive operative blood loss. We reviewed the cases of eight patients who were operated on for hypervascular bone metastases from renal carcinoma after preoperative transcatheter embolization. The embolization was successful in six of these patients and their operative blood loss averaged only 550 milliliters (range, 450 to 750 milliliters).

Injury to the intima of the hepatic artery. Results of follow-up in 11 cases.

Injury to the intima of the hepatic artery is an uncommon complication of selective arteriography. Eleven such cases were followed up for less than or equal to 12 months. The status of the vessels, the experience of the angiographer, and the materials used for catheterization all affected the frequency of injury, which was manifested by a spectrum of changes including an intimal flap, aneurysm, dissection, and occlusion.

Angiographic appearance of recurrent malignant melanoma before and after intra-arterial chemotherapy.

Intra-arterial infusion of chemotherapeutic agents (CDDP alone or combined with DTIC) was used to treat recurrent melanoma in 22 patients. In 17 cases, sequential arteriograms were obtained before and after infusion to monitor the procedure. Pre-treatment angiograms usually demonstrated rounded nodules with a homogeneous, hypervascular stain.

Therapeutic Ivalon embolization of hepatic tumors.

Ivalon particles were used for 80 hepatic artery embolizations in 50 patients who had either primary or metastatic hepatic neoplasms. Ten patients died within 1-5 months and the remaining 40 patients were still alive. The post-hepatic embolization syndrome was identical to that following Gelfoam embolization.

Segmental renal artery embolization in solitary renal carcinoma.

Segmental renal artery embolization was performed as an alternative method to treat solitary renal carcinoma in 2 patients who were poor surgical candidates. In the first patient, a recurrent renal carcinoma in a solitary kidney was selectively embolized. Tumor aggression was observed eighteen months later.

Displacement of the tail of the pancreas in the absence of the left kidney.

The tail of the pancreas may be displaced posteriorly and medially if the left kidney is small or absent. This variant can ben shown by computed tomography.