Changes in Esophageal Variceal Pressure after Transcatheter Arterial Embolization for Hepatocellular Carcinoma

Okada, Kensaku; Koda, Masahiko; Murawaki, Yoshiyuki; Kawasaki, Hiroaki

doi:10.1055/s-2001-15310

Cited by 13 publications

(9 citation statements)

References 12 publications

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“…As such, it is of clinical relevance to know whether TACE-related hemodynamic changes and liver damage translate into an increase in PVP, which may potentially lead to portal hypertension-related complications. Circulatory changes in the portal/splanchnic venous system seem to appear immediately post-TACE and may remain elevated for some weeks (9,(12)(13)(14). However, these early modifications in PVBF measured on ultrasound do not necessarily translate in changes in HVPG (10,11) and systematic increase in variceal pressure (12).…”

Section: Discussionmentioning

confidence: 99%

“…HVPG measured within 9 days and 2 months after TACE did not significantly change from measurements prior therapy, but did increase at 6 months (11). TACE resulted in a significant increase in esophageal variceal pressure in about half of HCC patients with most (89%) showing an increase in portal blood flow (PVBF) on ultrasound 3 days post-procedure (12). PVBF was noted to increase after TACE, reaching a peak at 1 week and returning to pre-procedural values after 3-4 weeks (9,13) or remaining elevated for at least 2 weeks post-embolization (14).…”

Section: Introductionmentioning

confidence: 93%

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Longitudinal Analysis of the Effect of Repeated Transarterial Chemoembolization for Liver Cancer on Portal Venous Pressure

et al. 2021

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ObjectivesInvestigate long-term effects of repeated transarterial chemoembolization (TACE) on portal venous pressure (PVP) using non-invasive surrogate markers of portal hypertension.MethodsRetrospective, Institutional Review Board-approved study. 99 patients [hepatocellular carcinoma (HCC) group (n=57); liver metastasis group (n=42)] who underwent 279TACEs and had longitudinal pre-/post-therapy contrast-enhanced-MRI (n=388) and complete blood work were included. Outcomes of interest were platelet count (PC), spleen volume, ascites and portosystemic collaterals. Variables included TACE type/number, tumor type, microcatheter location, Child-Pugh, baseline tumor burden (tumor number/total/largest size), vessel invasion, alpha-fetoprotein, Eastern Cooperative Oncology Group (ECOG) performance status, and Model for End-Stage Liver Disease (MELD) score. Generalized Estimating Equations assessed the associations between TACE and outcomes. Power analysis determined the sample size was sufficient.ResultsNo significant change in PC over time was observed in either groups, regardless of liver function (P>0.05). Baseline spleen volume was 226 cm3 for metastatic group, and was larger by 204 cm3 for HCC group (P<0.001). Spleen volume increased by 20 cm3 (95%CI: 8-32; P=0.001) for both groups after 1stTACE and by 16cm3/TACE (P=0.099) over the full follow-up (up to 9TACEs). Spleen volume also tended to increase by 23cm3 (95%CI: -1–48; P=0.064) with higher tumor burden. Odds of developing moderate/severe ascites for metastatic patients was decreased by 0.5 (95%CI: 0.3–0.9; P=0.014), regardless of the Child-Pugh, and increased by 1.5 (95%CI: 1.2–1.9; P<0.001) among HCC patients with unstable Child-Pugh, whereas no change was noted with stable Child-Pugh. HCC patients with unstable Child-Pugh demonstrated a significant increase in portosystemic collaterals number over time (P=0.008). PVP-related complications such as variceal bleeding post-TACE were low (0.4%).ConclusionRepeated TACEs did seem to have an impact on PVP. However, the increase in PVP had marginal effects with low portal hypertension-related complications.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 93%

Longitudinal Analysis of the Effect of Repeated Transarterial Chemoembolization for Liver Cancer on Portal Venous Pressure

et al. 2021

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“…74,75 While Lipoidol is being introduced, in addition to tumor uptake of the agent, it is common to observe that small nontumor vascular branches that belong to portal vessels become opacified and are occluded. This occlusion is temporary, but it causes an increase in presinusoidal portal pressure, which can bring about a pressure increase in the esophageal varices, 76 possibly leading to rupture and gastrointestinal hemorrhage.…”

Section: Hepatocarcinomamentioning

confidence: 99%

Complications of Embolization

Bilbao

Martínez-Cuesta²,

Urtasun³

et al. 2006

Semin intervent Radiol

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Embolization is a remarkably versatile procedure used in nearly all vascular and nonvascular systems to treat a wide range of pathology. The published literature is rich with studies demonstrating the enormous therapeutic potential offered by embolization procedures, and the possibilities continue to expand with the advent of new embolization agents and techniques. Unfortunately, with this variety and innovation comes a wide spectrum of potential complications, not always easy to classify and summarize, associated with embolization. This article reviews the procedures and associated complications of arterial and venous embolization procedures, organized by vascular distribution.

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“…Prophylactic endoscopic treatment of the existing esophageal varices has therefore been proposed prior to TAE in patients with HCC. Okada et al [50] studied the influence of TAE on esophageal variceal pressure and portal hemodynamics. Of 18 cirrhotic patients with HCC, 12 underwent TAE, and the remaining six patients underwent angiography only as a control.…”

Section: Miscellaneousmentioning

confidence: 99%

Variceal Bleeding and Portal Hypertension: Has There Been Any Progress in the Last 12 Months?

Seewald

Mendoza²,

Seitz³

et al. 2003

Endoscopy

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A review of the literature on the management of esophagogastric varices published in the last 12 months shows that the data are still quite conflicting. In the primary and secondary prophylaxis of variceal bleeding, beta-blockers are still the mainstay of pharmacotherapy. Measurement of the hepatic portal venous pressure gradient is considered to be a reliable parameter for successful reduction of portal pressure using medical therapy. However, intolerance of propranolol requiring discontinuation of therapy has been observed in approximately 30 % of patients. Patients' compliance with medication may represent another drawback of medical therapy. The role of endoscopic band ligation in secondary prophylaxis is now indisputable, especially in comparison with sclerotherapy. In the primary prevention of variceal bleeding, band ligation is beginning to have a competitive edge over pharmacological therapy. Acute variceal bleeding is no longer a frequent morbid emergency. Most cases of bleeding can now be managed successfully with band ligation and N-butyl-2-cyanoacrylate obliteration. N-butyl-2-cyanoacrylate has come into increasingly widespread use in the treatment of bleeding gastric fundal varices in which surgery or transjugular intrahepatic portosystemic shunting were previously regarded as the preferred therapies.

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Changes in Esophageal Variceal Pressure after Transcatheter Arterial Embolization for Hepatocellular Carcinoma

Abstract: Our study demonstrated that transcatheter arterial embolization resulted in an increase in esophageal variceal pressure in about half of the patients, bearing little relation to portal hemodynamic parameters.

Cited by 13 publications

References 12 publications

Longitudinal Analysis of the Effect of Repeated Transarterial Chemoembolization for Liver Cancer on Portal Venous Pressure

Longitudinal Analysis of the Effect of Repeated Transarterial Chemoembolization for Liver Cancer on Portal Venous Pressure

Complications of Embolization

Variceal Bleeding and Portal Hypertension: Has There Been Any Progress in the Last 12 Months?

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