Objective: As it is now known that primary aldosteronism (PA) is more prevalent than was previously recognized, and is a potentially curable cause of hypertension and related cardiovascular diseases, the search for a safe and effective means of its diagnosis has reemerged as a topic of interest. Adrenal venous sampling is the gold standard for diagnosis of PA, but the technique is challenging and the small right adrenal vein can be particularly difficult to cannulate. Our objective was to evaluate the usefulness of computed tomography during angiography (angio-CT) in increasing the success of adrenal venous sampling and to identify factors associated with cannulation failure. Design: Retrospective review. Methods: A total of 140 consecutive patients with suspected PA except Cushing's syndrome treated at a single hospital from June 2008 to May 2013 were included. Catheter misplacement and correct cannulation rates before angio-CT and success rate of sampling after angio-CT were calculated. Univariate analysis for factors related to incorrect cannulation included gender, age, height, weight, BMI, and adrenal nodules. Successful sampling was biochemically defined according to cortisol concentrations in the venous blood samples. Results: Angio-CT detected misplaced catheters in 13 patients (9.3%). The calculated correct cannulation rate of adrenal vein sampling increased from 86.4% before angio-CT to 95.7% after CT (P!0.001, McNemar's test). Univariate analysis showed a tendency for a higher rate of failure of right adrenal venous sampling in taller patients (PZ0.052, Mann-Whitney's U test). Conclusion: Angio-CT improved success of adrenal venous sampling.

Hepatocellular carcinoma (HCC) is the sixth most common cancer and third leading cause of cancer-related death in the world. The Barcelona clinic liver cancer classification is the current standard classification system for the clinical management of patients with HCC and suggests that patients with intermediate-stage HCC benefit from transcatheter arterial chemoembolization (TACE). Interventional treatments such as TACE, balloon-occluded TACE, drug-eluting bead embolization, radioembolization, and combined therapies including TACE and radiofrequency ablation, continue to evolve, resulting in improved patient prognosis. However, patients with advanced-stage HCC typically receive only chemotherapy with sorafenib, a multi-kinase inhibitor, or palliative and conservative therapy. Most patients receive palliative or conservative therapy only, and approximately 50% of patients with HCC are candidates for systemic therapy. However, these patients require therapy that is more effective than sorafenib or conservative treatment. Several researchers try to perform more effective therapies, such as combined therapies (TACE with radiotherapy and sorafenib with TACE), modified TACE for HCC with arterioportal or arteriohepatic vein shunts, TACE based on hepatic hemodynamics, and isolated hepatic perfusion. This review summarizes the published data and data on important ongoing studies concerning interventional treatments for unresectable HCC and discusses the technical improvements in these interventions, particularly for advanced-stage HCC.

TAE treatment was safe, effective, and provided a good outcome, except when only coils were used as the embolization agent.

Hepatocellular carcinoma (HCC) is the sixth most common cancer and the third leading cause of cancer-related deaths in the world. The Barcelona Clinic Liver Cancer (BCLC) classification has recently emerged as the standard classification system for clinical management of patients with HCC. According to the BCLC staging system, curative therapies (resection, transplantation, and percutaneous ablation) can improve survival in HCC patients diagnosed at an early stage and offer potential long-term curative effects. Patients with intermediate-stage HCC benefit from transcatheter arterial chemoembolization (TACE), and those diagnosed at an advanced stage receive sorafenib, a multikinase inhibitor, or conservative therapy. Most patients receive palliative or conservative therapy only, and approximately 50% of patients with HCC are candidates for systemic therapy. TACE is often recommended for advanced-stage HCC patients all over the world because these patients desire therapy that is more effective than systemic chemotherapy or conservative treatment. This paper aims to summarize both the published data and important ongoing studies for TACE and to discuss technical improvements in TACE for advanced-stage HCC.

Aim:To retrospectively compare the short-term antitumor efficacy and safety of transcatheter arterial chemoembolization (TACE) with a cisplatin-iodized oil suspension (C-IS) and a miriplatin-iodized oil suspension (M-IS) for hepatocellular carcinoma (HCC). Methods:Of patients who underwent TACE for unresectable HCC between January 2010 and August 2011, 25 and 21 patients received C-IS and M-IS, respectively. The short-term therapeutic efficacy of both groups was evaluated by the treatment effect seen on dynamic enhanced computed tomography or magnetic resonance imaging of tumor nodules 3 months after treatment. Adverse events were evaluated to compare C-IS and M-IS.Results: After TACE using C-IS and M-IS, 100% necrosis or tumor size reduction was achieved in 30 and 18 tumor nodules, respectively (81% vs 53%; P = 0.006). Objective responses were achieved in 30 nodules exposed to TACE using C-IS and 17 exposed to TACE using M-IS (81% vs 50%; P = 0.011). Disease control was achieved in 36 nodules exposed to C-IS and 27 exposed to M-IS (97% vs 79%; P = 0.017). The percentage of patients attaining a complete response, an objective response and disease control was significantly greater in the C-IS group than in the M-IS group. No significant differences were found in the aspartate aminotransferase, alanine aminotransferase, total bilirubin and creatinine levels between the two groups either before treatment or 1 month after treatment. Conclusion:The short-term antitumor effects of TACE with C-IS may be superior to those with M-IS in terms of the complete response, objective response and disease control rates.

NBCA embolization is technically feasible and is effective for the control of haemorrhage in endoscopically unmanageable GIH. However, the presence of coagulopathy or DIC significantly decreases the clinical success and increases the mortality rate.

Proper hepatic artery embolization is effective for hemostasis, and extrahepatic collateral development is expected. Therefore, this is a safe treatment without prolonged hepatic ischemic damage, especially in patients without severe portal venous stenosis or prior hepatic failure.

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