Interventional management of gastroduodenal lesions complicating intra-arterial hepatic chemotherapy
Stefania Proietti1, Thierry De Baere, Bertrand Bessoud
1Department of Radiology, Centre Hospitalier , Universitaire Vaudois, 46 rue du Bugnon, 1011 Lausanne, Switzerland. stefania.proietti@chuv.ch
Insights
Embolization of gastric or duodenal arteries effectively treats gastroduodenal complications arising from hepatic arterial infusion therapy (HAIC). This interventional radiology technique resolves misperfusion, alleviates symptoms, and enables the continuation of HAIC treatment.
Area of Science:
- Interventional Radiology
- Gastroenterology
- Oncology
Background:
- Hepatic arterial infusion therapy (HAIC) can cause gastroduodenal complications like pain and lesions.
- These complications may persist despite interrupting HAIC, necessitating alternative treatments.
Purpose of the Study:
- To evaluate the efficacy of embolizing aberrant gastric or duodenal arteries in managing HAIC-induced gastroduodenal complications.
- To determine if embolization can restore HAIC treatment in affected patients.
Main Methods:
- Selective hepatic arteriography was performed to identify arteries causing gastroduodenal misperfusion.
- Embolization of the identified arteries (right gastric or gastroduodenal) was achieved using platinum coils.
- Catheter ports for HAIC were placed percutaneously or surgically.
Main Results:
- Successful embolization of the right gastric artery (4 cases) or gastroduodenal artery (1 case) relieved patient symptoms.
- Embolization allowed for the resumption of HAIC treatment in all patients.
- Gastroduodenal lesions, including gastroduodenitis and ulcerations, were observed in all cases prior to embolization.
Conclusions:
- Embolization is a viable treatment for gastroduodenal misperfusion secondary to HAIC.
- Selective arteriography followed by embolization can effectively manage these complications and permit continued HAIC therapy.
Abstract:
Herein we report the efficacy of embolization of small patent gastric or duodenal vessels for treating gastroduodenal complications after hepatic arterial infusion therapy (HAIC). Catheter ports were implanted percutaneously from a femoral approach in three cases or surgically in the gastroduodenal artery in two cases. Acute abdominal pain developed on average after four HAIC courses of 5FU-oxaliplatin, mytomycin, oxaliplatin or fotemustine. Esophagogastroduodenoscopy showed gastroduodenal lesions (gastroduodenitis with or without ulcerations) in all cases. Despite the interruption of the HAIC, symptoms persisted and led to selective hepatic arteriography showing a patent right gastric artery (n = 4) or a recanalized gastroduodenal artery (n = 1) responsible for gastroduodenal misperfusion. Successful embolizations of the arteries responsible for gastroduodenal misperfusion (right gastric artery in four cases and gastroduodenal artery in one case) using 0.018 platinium coils relieved the patients' symptoms and allowed the HAIC to continue. In gastroduodenal complications of HAIC, a selective hepatic arteriography should be performed to search any artery responsible for the misperfusion of the toxic agent in the gastroduodenal area. Embolization of these arteries allowed the HAIC to be restored.
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