Radiological catheter placement for transcatheter arterial steroid injection therapy to treat severe acute hepatic failure

Technical feasibility and efficacy

yasuhiro ushijima, Tsuyoshi Tajima, Kengo Yoshimitsu, Hiroyuki Irie, Akihiro Nishie, Masakazu Hirakawa, Kosei Ishigami, daisuke okamoto, Kazuhiro Kotoh, Hiroshi Honda

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Background: Severe acute hepatic failure (SAHF), which progresses to fulminant form in some cases, is a life-threatening disease. Purpose: To assess the technical feasibility and the efficacy of transcatheter arterial steroid injection therapy (TASIT) for SAHF. Material and Methods: Twenty-seven patients with SAHF, 10 of whom had variant anatomy of the hepatic artery, underwent radiologic placement of an indwelling catheter in the hepatic artery, and TASIT was subsequently performed for three days. The tips of the catheters were inserted as follows: common hepatic artery (n = 18), proper hepatic artery (n = 4), and replaced right hepatic artery (n = 5). The clinical success rate of TASIT and the prognosis after TASIT were evaluated. Results: In one patient, intimal injury of the left hepatic artery was encountered; however, TASIT could be resumed and completed via intrahepatic arterial collaterals. In two patients, the catheter tip placement was corrected on the following day because of dislocation. Finally, TASIT could be carried out in all patients. Twenty-two patients (81.5%) responded to TASIT but five patients (18.5%) did not. Among the five nonresponders, two patients were transferred to liver transplantation and survived, and three patients died. There was no significant difference in the response rates to TASIT among locations of catheter tip (P > 0.05) and extent of drug distribution in the liver (P > 0.05). Conclusion: TASIT is a feasible and efficient treatment option for SAHF regardless of the anatomic variation of the hepatic artery. Careful manipulation during the procedure to prevent injury of the hepatic artery may be the most essential factor not only for successful TASIT but also for liver transplantation, which may be performed on TASIT non-responders.

Original languageEnglish
Pages (from-to)140-146
Number of pages7
JournalActa Radiologica
Volume53
Issue number2
DOIs
Publication statusPublished - Mar 1 2012

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Acute Liver Failure
Catheters
Hepatic Artery
Steroids
Injections
Therapeutics
Liver Transplantation
Tunica Intima
Anatomic Variation
Indwelling Catheters
Wounds and Injuries
Anatomy

All Science Journal Classification (ASJC) codes

  • Radiological and Ultrasound Technology
  • Radiology Nuclear Medicine and imaging

Cite this

Radiological catheter placement for transcatheter arterial steroid injection therapy to treat severe acute hepatic failure : Technical feasibility and efficacy. / ushijima, yasuhiro; Tajima, Tsuyoshi; Yoshimitsu, Kengo; Irie, Hiroyuki; Nishie, Akihiro; Hirakawa, Masakazu; Ishigami, Kosei; okamoto, daisuke; Kotoh, Kazuhiro; Honda, Hiroshi.

In: Acta Radiologica, Vol. 53, No. 2, 01.03.2012, p. 140-146.

Research output: Contribution to journalArticle

ushijima, yasuhiro ; Tajima, Tsuyoshi ; Yoshimitsu, Kengo ; Irie, Hiroyuki ; Nishie, Akihiro ; Hirakawa, Masakazu ; Ishigami, Kosei ; okamoto, daisuke ; Kotoh, Kazuhiro ; Honda, Hiroshi. / Radiological catheter placement for transcatheter arterial steroid injection therapy to treat severe acute hepatic failure : Technical feasibility and efficacy. In: Acta Radiologica. 2012 ; Vol. 53, No. 2. pp. 140-146.
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T2 - Technical feasibility and efficacy

AU - ushijima, yasuhiro

AU - Tajima, Tsuyoshi

AU - Yoshimitsu, Kengo

AU - Irie, Hiroyuki

AU - Nishie, Akihiro

AU - Hirakawa, Masakazu

AU - Ishigami, Kosei

AU - okamoto, daisuke

AU - Kotoh, Kazuhiro

AU - Honda, Hiroshi

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AB - Background: Severe acute hepatic failure (SAHF), which progresses to fulminant form in some cases, is a life-threatening disease. Purpose: To assess the technical feasibility and the efficacy of transcatheter arterial steroid injection therapy (TASIT) for SAHF. Material and Methods: Twenty-seven patients with SAHF, 10 of whom had variant anatomy of the hepatic artery, underwent radiologic placement of an indwelling catheter in the hepatic artery, and TASIT was subsequently performed for three days. The tips of the catheters were inserted as follows: common hepatic artery (n = 18), proper hepatic artery (n = 4), and replaced right hepatic artery (n = 5). The clinical success rate of TASIT and the prognosis after TASIT were evaluated. Results: In one patient, intimal injury of the left hepatic artery was encountered; however, TASIT could be resumed and completed via intrahepatic arterial collaterals. In two patients, the catheter tip placement was corrected on the following day because of dislocation. Finally, TASIT could be carried out in all patients. Twenty-two patients (81.5%) responded to TASIT but five patients (18.5%) did not. Among the five nonresponders, two patients were transferred to liver transplantation and survived, and three patients died. There was no significant difference in the response rates to TASIT among locations of catheter tip (P > 0.05) and extent of drug distribution in the liver (P > 0.05). Conclusion: TASIT is a feasible and efficient treatment option for SAHF regardless of the anatomic variation of the hepatic artery. Careful manipulation during the procedure to prevent injury of the hepatic artery may be the most essential factor not only for successful TASIT but also for liver transplantation, which may be performed on TASIT non-responders.

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