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Post a Comment The effect of the endovascular access on the effectiveness and safety of chemoembolization of the arteries of the liver with unresectable liver metastases
- Authors: Lebedev D.P.1,2, Astakhov D.A.1,2, Zvezdkina E.A.1,3, Kosy V.V.1, Kedrova A.G.1, Ivanov Y.V.1,2, Panchenkov D.N.1,2,3
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Affiliations:
- Federal Scientific and Clinical Center of Specialized Types of Medical Care and Medical Technologies of the Federal Medical and Biological Agency of Russia
- Moscow State University of Medicine and Dentistry a.n. A.I. Evdokimov
- State Scientific Center of Laser Medicine named after O.K. Skobelkinof the Federal Medical and Biological Agency of Russia
- Issue: Vol 10, No 4 (2019)
- Pages: 5-15
- Section: Original Study Articles
- URL: https://journals.rcsi.science/clinpractice/article/view/17941
- DOI: https://doi.org/10.17816/clinpract17941
- ID: 17941
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Abstract
Background. Minimally invasive surgery techniques are widely used in the treatment of primary and metastatic liver cancer.
Objective. The goal was to evaluate the effect of the endovascular access on the efficiency and safety of chemoembolization of liver arteries (CELA) in patients with unresectable liver metastases.
Methods. In 30 patients with unresectable liver metastases, CELA was performed using the transradial and transfemoral approaches. The microcatheter technique was used for superselective chemoembolization of the liver arteries with introduction of drug-saturated microspheres (HepaSphere). All the digital material was statistically processed using the STATISTICA 6.0 software package (StatSoft, 2001). The results were considered statistically significant at p<0.05.
Results. In the normal type of the blood supply to the liver, only the left radial access with only the right hepatic artery embolization demonstrated a significantly shorter duration of CELA and fluoroscopy, which amounted to 33±4.3 min and 9.9±1.3 min, respectively (p<0.05). When performing CELA by means of microspheres 50–100 um from the right femoral access with embolization of only the right hepatic artery, the above assessment criteria were the highest — 67±11 min and 19.1±5.3 min, respectively, but without a significant difference between the other options for the puncture access. During the first CELA using a femoral access, the postoperative hospital stay in the studied group of patients was 7±0.8 days, and the postembolization period lasted 1.43±0.5 days, which is significantly longer (at p≤0.05) in comparison with the same parameters for the right radial arterial access, for which they were 3±0.6 days and 1.15±0.4 days, respectively, and for the left radial arterial access, for which they were 4±0.5 days and 1±0.001 days,respectively.
Conclusion. The use microspheres as a embolization material allowed the application of the microcatheter technique for hqTACE, and expanded the possibilities of the transradial access. A significantly better tolerance and safety of the transradial access was proven in 76.2% of the studied patients in whom it was applicable. The repetitions of CELA donot affect the severity of the post-embolization period, partially due to a lowered use of the contrast medium and superselective embolization of the affected areas of the liver with the preservation of a more intact parenchyma.
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##article.viewOnOriginalSite##About the authors
Dmitry P. Lebedev
Federal Scientific and Clinical Center of Specialized Types of Medical Care and Medical Technologies of the Federal Medical and Biological Agency of Russia; Moscow State University of Medicine and Dentistry a.n. A.I. Evdokimov
Email: lebedevdp@gmail.com
ORCID iD: 0000-0003-1551-3127
MD, endovascular diagnostic and treatment department
Russian Federation, 115682, Moscow, street Orekhovy Boulevard, 28; 127473, Moscow, Delegatskaya street, 20/1Dmitry A. Astakhov
Federal Scientific and Clinical Center of Specialized Types of Medical Care and Medical Technologies of the Federal Medical and Biological Agency of Russia; Moscow State University of Medicine and Dentistry a.n. A.I. Evdokimov
Author for correspondence.
Email: astakhovd@mail.ru
ORCID iD: 0000-0002-8776-944X
MD, Oncologist, Department of Oncology; Cand. of Sci.(Med.), Leading Researcher, Laboratory of Minimally Invasive Surgery
Russian Federation, 115682, Moscow, street Orekhovy Boulevard, 28; 127473, Moscow, Delegatskaya street, 20/1Elena A. Zvezdkina
Federal Scientific and Clinical Center of Specialized Types of Medical Care and Medical Technologies of the Federal Medical and Biological Agency of Russia; State Scientific Center of Laser Medicine named after O.K. Skobelkinof the Federal Medical and Biological Agency of Russia
Email: zvezdkina@yandex.ru
ORCID iD: 0000-0002-0277-9455
Cand. of Sci.(Med.), MD. Radiologist, X-ray department with MRI rooms
Russian Federation, 115682, Moscow, street Orekhovy Boulevard, 28; 40/1, Studentcheskaya street, Moscow, 121165Valentina V. Kosy
Federal Scientific and Clinical Center of Specialized Types of Medical Care and Medical Technologies of the Federal Medical and Biological Agency of Russia
Email: kvv24@mail.ru
ORCID iD: 0000-0002-4628-2328
MD. oncologist, oncological department
Russian Federation, 115682, Moscow, street Orekhovy Boulevard, 28Anna G. Kedrova
Federal Scientific and Clinical Center of Specialized Types of Medical Care and Medical Technologies of the Federal Medical and Biological Agency of Russia
Email: kedrova.anna@gmail.com
ORCID iD: 0000-0003-1031-9376
Doct. of Sci. (Med.), Professor, Head of the Department of Oncology
Russian Federation, 115682, Moscow, street Orekhovy Boulevard, 28Yury V. Ivanov
Federal Scientific and Clinical Center of Specialized Types of Medical Care and Medical Technologies of the Federal Medical and Biological Agency of Russia; Moscow State University of Medicine and Dentistry a.n. A.I. Evdokimov
Email: ivanovkb83@yandex.ru
ORCID iD: 0000-0001-6209-4194
Doct. of Sci. (Med.), Professor, Honored Doctor of the Russian Federation, Head of the Department of Surgery № 1
Russian Federation, 115682, Moscow, street Orekhovy Boulevard, 28; 127473, Moscow, Delegatskaya street, 20/1Dmitry N. Panchenkov
Federal Scientific and Clinical Center of Specialized Types of Medical Care and Medical Technologies of the Federal Medical and Biological Agency of Russia; Moscow State University of Medicine and Dentistry a.n. A.I. Evdokimov; State Scientific Center of Laser Medicine named after O.K. Skobelkinof the Federal Medical and Biological Agency of Russia
Email: dnpanchenkov@mail.ru
ORCID iD: 0000-0001-8539-4392
Doct. of Sci. (Med.), Professor, Head of the Laboratory of Minimally Invasive Surgery
Russian Federation, 115682, Moscow, street Orekhovy Boulevard, 28; 127473, Moscow, Delegatskaya street, 20/1; 40/1, Studentcheskaya street, Moscow, 121165References
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