Liver embolization

Fig. 14.2. Histological appearance of the gall bladder wall after microsphere liver embolization. Particles are seen within the gall bladder wall without inflammatory cells...

Eriksson BK, Larsson EG, Skogseid BM, et al. (1998) Liver embolizations of patients with malignant neuroendocrine gastrointestinal tumors. Cancer 83 2293-2301... 

An earlier cross sectional study had found that the PME/PDE ratio was a measure of disease severity in chronic hepatitis-C. ° More recently, it was found that this ratio may also serve as a biomarker of response to treatment with antiviral therapy. ° Whereas non-responders had similar or even elevated PME/PDE initially, that ratio declined from 0.27 0.02 (standard error) to 0.16 0.01 after treatment (p<0.001) in responders. Liver resection is a common therapy for liver metastases. Prior portal vein embolization (PVE) of the resected lobe results in h) ertrophy of the remaining contralateral lobe. Phosphorus-31 MRSI has been used to monitor metabolism of the regenerating lobe after PVE. ° ... 

Problem/lnfluence of Medication. St. John s wort can cause enzyme induction, which results in an increase in the liver s ability to metabolize other medications, including warfarin. This process could result in the warfarin being metabolized too rapidly and therefore failing to reach therapeutic levels. Lack of adequate anticoagulant effects would place the patient at increased risk for subsequent thrombosis and pulmonary embolism. 

Alteplase was the first commercially available recombinant tissue-type plasminogen activator (rt-PA) (25), It has a plasma half-life of less than five minutes and is metabolized by the liver, This agent was initially hailed as fibrin-specific unlike its precursors (urokinase and streptokinase). It was thought that this would result in a better safety profile, but this has not been born out in either the coronary or the peripheral experience, where actually there may be a higher bleeding risk as infusion time increases. Alteplase is currently indicated for use in the treatment of myocardial infarction, acute ischemic stroke, and pulmonary embolism. 

Intravenously administered particles with dimensions exceeding 7 /mi (the diameter of the smallest capillaries) will be filtered by the first capillary bed they encounter, usually the lungs, leading to embolism. Intra-arterially administered particles with dimensions exceeding 7 m will be trapped in the closest organ located upstream for example, administration into the mesenteric artery leads to entrapment in the gut, into the renal artery leads to entrapment in the kidney etc. This approach is under investigation to improve the treatment of diseases in the liver. 

Therapeutic assessment of the vascularization of liver tumours after surgical interventions, chemo-embolization or parenteral chemotherapy... 

In traumatic bleeding in the area of the liver, haemostasis may be performed within the framework of diagnostic arteriography by means of embolization. Arterial access likewise facilitates embolization and cytostatic treatment of liver tumours (following angiographic insertion of the catheter), (s. tab. 8.4)... 

Satoh, H., Takeda, T., Takashima, M., Sumlyoshl, K., Imaizninl, N. Gas-forming liver abscess following transcatheter hepatic arterial embolization for an iatrogenic intrahepatic pseudoaneurysm report of a case. Jpn. J. Surg. 1995 25 361 -364... 

In cases of severe fatty liver, there is indeed a risk of fat embolism occurring in the lungs, brain and kidneys. In view of the considerable fat masses stored in the hepatic parenchyma due to this condition, R. Virchow suspected the manifestation of fat embolism as early as 1886. (s. tab. 31.9) Blunt traumatism of the (enlarged) liver with subsequent mobilization of fat is thought to be the cause of this condition. It is not clear at present whether this so-called inundation theory offers sufficient explanation or whether it needs to be amended or even replaced by the so-called segregation theory (high lipaemia, deemulsification of blood fats, etc.). While hepatic fat embolism may be rare, it is nevertheless clinically relevant. 

Treatment A ruptured haemangioma requires immediate surgical intervention it is often necessary to ligate the hepatic artery. Enucleation is sometimes possible. (76, 87) Resection or arterial embolization are recommended for very large and symptomatic haemangiomas. Inoperable tumours should be reduced in size by external irradiation or interferon-a therapy. Liver transplantation is a rare indication. (88,89,93) All in all, prognosis is good. (94)... 

Treatment If it is possible, elective resection is indicated. (98) However, due to cardiac or (increasing) hepatic insufficiency, invasive techniques cannot usually be attempted. External irradiation may be used in an effort to minimize the tumour. Ligature or embolization of the afferent hepatic artery is sometimes indicated. Steroid therapy has proved unsuccessful. The use of interferon-a is a new therapeutic approach tumour regression is accelerated and cardiac insufficiency is compensated. (103) Liver transplantations have also been carried out successfully. This infantile, benign tumour may regress with increasing age. 

There have been three studies of the effects of percutaneous ethanol injections in the treatment of hepatocellular carcinoma, either alone (12,13) or in combination with transcatheter arterial embolization (14). The procedure was effective and safe and improved long-term survival. Adverse effects were generally mild and of short duration, and commonly included abdominal pain, fever, intoxication (especially among non-drinkers), transient rises in serum transaminases, and chemical thrombosis of the tributary branch of the portal vein. Hepatic infarction has been reported in two patients with hepatocellular carcinoma after percutaneous ethanol injection of the tumors (15). Both patients had previously been treated with transcatheter arterial infusion using a suspension of styrene maleic acid neocarzinostatin, and the liver damage may have occurred through a combination of arterial damage due to the neocarzinostatin and vasculitis caused by flow of the injected ethanol into a portal vein branch. 

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