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46 - Complications of Therapeutic Endovascular Procedures in Malignant Liver Diseases

from PART IV - SPECIALIZED INTERVENTIONAL TECHNIQUES IN CANCER CARE

Published online by Cambridge University Press:  18 May 2010

By
José I. Bilbao  and
José J. Noguera
Edited by
Jean-François H. Geschwind  and
Michael C. Soulen
José I. Bilbao
Affiliation:
Servicio de Radiología Clínica Universitaria de Navarra Universidad de Navarra Pamplona, Spain
José J. Noguera
Affiliation:
Servicio de Radiología Clínica Universitaria de Navarra Universidad de Navarra Pamplona, Spain
Jean-François H. Geschwind
Affiliation:
The Johns Hopkins University School of Medicine
Michael C. Soulen
Affiliation:
University of Pennsylvania School of Medicine
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Summary

In recent years, intra-arterial treatment has become one of the first options in the therapeutic approach to primary and metastatic liver tumors. In spite of having good results, these endovascular procedures are not exempt of complications that have to be understood and promptly recognized in order to decrease their morbidity and mortality. The most common complications are described subsequently and distributed in three main groups. First, the complications arising from embolization of liver tumors, with reference to systemic toxicities (post-embolization syndrome [PES], hepatic insufficiency and changes in portal pressure), local complications (rupture of hepatocarcinoma [HCC] and biliary complications) and distant complications (pulmonary embolism of lipiodol or particles and metastatic spread of disease in the lungs). Secondly, the complications related to chemotherapy administered directly from the hepatic artery are then discussed, with mention of the complications caused by the catheter (migration and arterial obstruction), and complications associated with drug infusion in the extra-hepatic arteries. Finally, the complications of radioembolization, a relatively new approach that is performed with microspheres loaded with 90Ytrium (90Y) are also discussed.

EMBOLIZATION OF HEPATIC TUMORS

Systemic Toxicities

Post-embolization Syndrome

PES is characterized by a set of signs and symptoms occurring after embolization. Some of them are subjective and hard to quantify, which include nausea, vomiting, abdominal pain, fever and hypertransaminasemia, lasting a maximum of 7 to 10 days (1, 2) with variable incidence according to the diagnostic criteria (15% to 90%).

Type
Chapter
Information
Interventional Oncology
Principles and Practice
 , pp. 589 - 598
Publisher: Cambridge University Press
Print publication year: 2008

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