Gallbladder necrosis after transcatheter hepatic arterial embolization: a technique to avoid this complication.

Onodera, Hidetaka; Oikawa, Masamichi; Abe, Mitsuyuki; Goto, Yasuki

doi:10.1148/radiology.152.1.6328575

Cited by 13 publications

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“…Kuroda explained that reflux of embolic material into the cystic artery is the possible mechanism, and that smaller embolic material may be more likely to induce severe infarction of the gallbladder. Although De Jode et al reported that necrosis of the gallbladder with the likelihood of perforation was the chief danger and recommended cholecystectomy, Kuroda et al [6], Onodera et al [23], and Okamura et al [10] all suggested that these patients can be treated conservatively under close observation. In the literature, no patient experienced perforation of the gallbladder as a result of infarction, but one occurred in our series.…”

Section: Discussionmentioning

confidence: 99%

“…Takayasu [17] proposed that such regurgitation was probably due to a sudden change in intraarterial pressure as a result of rapid injection and to bouncing back. Kuroda et al [6] and Onodera et al [23] emphasized that embolus injection should be as slow as possible to avoid reflux. A technique using balloon-tipped catheters has been reported suCcessfully in preventing the reflux during TAE [25]; but failure still occurred in our series in spite of the use of this technique due to too many collaterals in repeated embolization cases.…”

Section: Discussionmentioning

confidence: 99%

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The role of surgery in the management of unusual complications of transcatheter arterial embolization for hepatocellular carcinoma

Jeng

Ching

1988

World j. surg.

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Transcatheter arterial embolization (TAE) is accepted to be an effective treatment in both resectable and nonresectable hepatoma, which is very prevalent in Taiwan. Two hundred and twenty-five embolizations of TAE were performed in 137 patients in a 3-year period. Postembolization syndrome developed in the majority of patients. We analyzed these patients to study the nature and incidence of unusual complications and the surgical role in their managment. In our series, unusual complications, which were rarely reported in the literature, included 13 cases (5.8%) of gastroduodenal bleeding, 2 cases (0.9%) of duodenal perforation, 9 cases (4.0%) of acute pancreatitis with l case of gangrenous change, 24 cases (10.7%) of gallbladder infarction with 1 case of perforation, 4 cases (1.8%) of delayed formation of gallstones, 3 cases (1.3%) of hyperuricemia, and 2 cases (0.9%) of hepatoma rupture. Ischemic necrosis of the organs may be attributed to the inadvertent blockade of the gastroduodenal artery, gastric artery, cystic artery, and important collaterals. Inadequate superselectivity, the size of the tumor, regurgitation of embolus, anatomical variations, injury of vessel intima, or pseudoaneurysm formation resulting from previous embolization attempts made the avoidance of complications difficult with this technique. Most of the unusual complications could be managed by conservative treatment, but urgent operation was indicated in the cases of organ perforation. Elective operation was also needed for the delayed formation of gallstones with prominent symptoms. Awareness of the occurrence of these untoward sequelae makes us more careful in the evaluation and long-term follow-up of patients following TAE. Surgical intervention plays a selective but important role in the management of these unusual complications.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

The role of surgery in the management of unusual complications of transcatheter arterial embolization for hepatocellular carcinoma

Jeng

Ching

1988

World j. surg.

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“…Several reports state that complete or incomplete occlusion of the cystic artery following TAE has caused se· vere necrosis of the gallbladder. 5 -s There has been no report, however, of gallbladder perforation resulting from TAE ; therefore, this must be a rare complication. Nevertheless, the possibility of such perforation, as in the two cases reported here , must be considered when examining post-TAE patients.…”

Section: Discussionmentioning

confidence: 99%

“…4) with an onionskin appearance in the gallhladder lumen suggesting scaling of the wall, and a hypoechoic mass (fig. 5) suggesting an abscess in the area adjacent to the gallbladder and anterior to the right kidney. Computed tomography, however.…”

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confidence: 99%

Sonography of gallbladder perforation: a complication of transcatheter hepatic arterial embolization.

Sata¹,

Higashi²,

Ono³

1986

Journal of Ultrasound in Medicine

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“…Transcatheter arterial embolization was performed according to the method described in a previous report. 7 The embolic material was Oxycel® (absorbable cellulose, Parke-Davis). Oxycel fihers were cut into 0.5-to 1.5-mm pieces and mixed with mitomvcin and a contrast material.…”

Section: Methodsmentioning

confidence: 99%

Serial changes in sonographic appearance after transcatheter hepatic arterial embolization.

Onodera¹,

Oikawa²,

Abe³

et al. 1985

Journal of Ultrasound in Medicine

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Serial changes in sonographic appearance after transcatheter hepatic arterial embolization (TAE) were studied in 22 patients who had hepatoma and one patient who had a hepatoblastoma. These changes were classified into three types. In cases of type 1, the internal echo of the entire tumor became remarkably echogenic with or without an acoustic shadow. In cases of type 2, echogenic areas or scattered echogenic spots with or without acoustic shadows were observed. In Type 3 cases, no changes in sonographic appearance were observed. Tumor diameters in all of the type 1 cases were less than 4.9 cm. Various size tumors were observed in the cases of type 2 and type 3. Transcatheter arterial embolization was completely effective or effective in 89 per cent of the type 1 and type 2 cases, but was not effective in 75 per cent of the type 3 cases. The sonographic changes correlated well with the effectiveness of TAE.

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Gallbladder necrosis after transcatheter hepatic arterial embolization: a technique to avoid this complication.

Cited by 13 publications

References 0 publications

The role of surgery in the management of unusual complications of transcatheter arterial embolization for hepatocellular carcinoma

The role of surgery in the management of unusual complications of transcatheter arterial embolization for hepatocellular carcinoma

Sonography of gallbladder perforation: a complication of transcatheter hepatic arterial embolization.

Serial changes in sonographic appearance after transcatheter hepatic arterial embolization.

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