The effect of the endovascular access on the effectiveness and safety of chemoembolization of the arteries of the liver with unresectable liver metastases

• Published in: Kliničeskaâ praktika Vol. 10; no. 4; pp. 5 - 15
• Main Authors: Lebedev, Dmitry P., Astakhov, Dmitry A., Zvezdkina, Elena A., Kosy, Valentina V., Kedrova, Anna G., Ivanov, Yury V., Panchenkov, Dmitry N.
• Format: Journal Article
• Language: English
• Published: Eco-vector 13.02.2020
• Subjects: drug-saturated microspheres; superselective chemoembolization of the liver arteries; transradial access
• ISSN: 2220-3095; 2618-8627
• DOI: 10.17816/clinpract17941

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 p0.05. 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 334.3 min and 9.91.3 min, respectively (p0.05). When performing CELA by means of microspheres 50100 um from the right femoral access with embolization of only the right hepatic artery, the above assessment criteria were the highest 6711 min and 19.15.3 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 70.8 days, and the postembolization period lasted 1.430.5 days, which is significantly longer (at p0.05) in comparison with the same parameters for the right radial arterial access, for which they were 30.6 days and 1.150.4 days, respectively, and for the left radial arterial access, for which they were 40.5 days and 10.001 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.