Radioembolization: Is Prophylactic Embolization of Hepaticoenteric Arteries Necessary? A Systematic Review

• Published in: Cardiovascular and interventional radiology Vol. 39; no. 5; pp. 696 - 704
• Main Authors: Borggreve, Alicia S., Landman, Anadeijda J. E. M. C., Vissers, Coco M. J., De Jong, Charlotte D., Lam, Marnix G. E. H., Monninkhof, Evelyn M., Prince, Jip F.
• Format: Journal Article
• Language: English
• Published: New York Springer US 01.05.2016; Springer Nature B.V
• Subjects: ARTERIES; Brachytherapy - adverse effects; Cardiology; Clinical Investigation; Digestive System - blood supply; Duodenum - blood supply; Embolization, Therapeutic - adverse effects; Embolization, Therapeutic - methods; GADOLINIUM ARSENIDES; Gallbladder - blood supply; Gastrointestinal Diseases - etiology; Gastrointestinal Diseases - prevention & control; HAZARDS; Hepatic Artery; Humans; Imaging; LIVER; Liver - blood supply; Liver Neoplasms - radiotherapy; Medicine; Medicine & Public Health; MICROSPHERES; Nuclear Medicine; PATIENTS; RADIOEMBOLIZATION; Radiology; RADIOLOGY AND NUCLEAR MEDICINE; REVIEWS; Stomach - blood supply; Ultrasound; VASCULAR DISEASES; Hepatic falciform artery; Complications; Embolization; Gastroduodenal artery; Right gastric artery; Radioembolization; Yttrium; Cystic artery
• ISSN: 0174-1551; 1432-086X
• DOI: 10.1007/s00270-016-1310-9

Purpose To study the effectiveness of prophylactic embolization of hepaticoenteric arteries to prevent gastrointestinal complications during radioembolization. Methods A PubMed, Embase and Cochrane literature search was performed. We included studies assessing both a group of patients with and without embolization. Results Our search revealed 1401 articles of which title and abstract were screened. Finally, eight studies were included investigating 1237 patients. Of these patients, 456 received embolization of one or more arteries. No difference was seen in the incidence of gastrointestinal complications in patients with prophylactic embolization of the gastroduodenal artery (GDA), right gastric artery (RGA), cystic artery (CA) or hepatic falciform artery (HFA) compared to patients without embolization. Few complications were reported when microspheres were injected distal to the origin of these arteries or when reversed flow of the GDA was present. A high risk of confounding by indication was present because of the non-randomized nature of the included studies. Conclusion It is advisable to restrict embolization to those hepaticoenteric arteries that originate distally or close to the injection site of microspheres. There is no conclusive evidence that embolization of hepaticoenteric arteries influences the risk of complications.