Abstract:

Introduction: the review is devoted to clinical results of the use of radiological and endovascular interventionsin intrahepatic cholangiocarcinoma: chemoinfusion, chemo- and radioembolization of the hepatic artery, preoperative embolization of right branch of portal vein.

Aim: was to evaluate and compare the effectiveness of methods of intravascular therapy for intrahepatic cholangiocarcinoma.

Materials and methods: article presents an analysis of 50 scientific literature sources in leading domestic and foreign scientific journals.

Results: it was found that intra-arterial treatment methods have approximately the same clinical efficacy. Chemoinfusion is a technically simple and effective method of treatment, prospects of which are associated with the creation of new chemotherapy drugs and therapeutic regimens. Chemoembolization is most effective for hypervascular cholangiocarcinoma. The question of its use in a neoadjuvant mode requires study, even in resectable cases, it helps to reduce the biological activity of the tumor. Radioembolization (RE) effectively slows down the growth of cholangiocarcinoma and is well tolerated by patients, but long-term results are little bit worse to those of infusion and embolization. The procedure seems to be technically difficult and requires expensive logistics. When solving these problems, ER can become one of the most important methods of treating cholangiocarcinoma, especially when the tumor is resistant to other methods of therapy.

Preoperative portal vein embolization is routinely used in clinical practice. However, operations performed after this procedure account for only 3-6% of all liver resections. The wider application of this technically simple and safe technique seems logical.

Conclusions: in the treatment of cholangiocarcinoma, a combined approach should be used with the use of surgical, X-ray endovascular and other methods of anticancer therapy: this makes it possible to expand possibilities of treating patients and achieve improved long-term results.

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Abstract:

Aim: was to estimate efficacy of methods of permanent or temporary blocking of blood flow through the gastroduodenal artery (GDA) during arterial chemoinfusion/chemoembolization of hepatic and pancreatic malignancies.

Materials and methods: for the period of 5 years (2015-2019), GDA embolization with coils was performed in 90 patients. Of them, 39 patients with liver tumors underwent occlusion of proximal GDA. GDA embolization distally to pancreatic branches (commonly on the level of gastroepiploic artery) was done in 51 patients with pancreatic head adenocarcinoma. Alternatively, in 12 patients with liver and 23 patients with pancreatic cancer, hand compression of GDA was used.

Results: technical success was 98% (88/90 patients). During embolization, coil migration into the hepatic artery developed in two patients with liver tumors: in one case stenting of the common hepatic artery was performed, the other case was asymptomatic and the presence of coil did not complicate the following arterial therapy. There were no other complications. Patients received multiple repeated courses of arterial chemotherapy.

Conclusion: methods of blocking of GDA blood flow are relatively safe, effective, simple and inexpensive. Both, embolization and hand compression, help to prevent non-target chemoinfusion and embolization.

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Abstract:

Between May 2005 and March 2007, catheter-port systems were placed in 20 pts for continuous hepatic artery infusion chemotherapy in the treatment of unresectable colorectal liver metastases. Carboplatin (or oxaliplatin) plus 5-fluorouracil and systemic leucovorin were administered. No complications occurred during the implantation procedures. The mean number of intrahepatic chemotherapy cycles per patient was 10 (4-25). The mean follow-up period was 412 (100-853) days. During the follow-up period, complications occurred in 9 patients (45%), but surgical or interventional radiological correction was successful in all but one case. At present, 14 patients are alive within 4 and 41 months and continue to receive intraarterial chemotherapy, while 6 patients died in 5 to 21 months from tumor progression. The common 1 -year survival is 90% (18 patients). Percutaneous implantation is potentially effective treatment for patients with CLM.

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Abstract:

Case report of successful endovascular treatment of pseudoaneurysm of common hepatic artery (patient underwent laparoscopic gastrectomy, cholecystectomy with lymph node dissection in treatment of gastric adenocarcinoma) is presented.

Materials and methods: patient E., 61 year. In anamnesis: ulcer disease for the period of 8 years. In 2013, gastric adenocarcinoma T4N0M0 had been revealed and in January 2014 patient underwent laparoscopic gastrectomy, cholecystectomy with lymph node dissection D2. Postoperative period was complicated by thrombosis of left branch of portal vein, external biliary fistula, left subdiaphragmatic abscess with further drainage. During CT-angiography - adenoma of left adrenal gland and aneurysm of proper hepatic artery were revealed. Selective angiography revealed aneurysm of common hepatic artery in middle third, sized 10x20 mm. Patient underwent double-staged treatment. Primary patient underwent embolization of aneurysm with Azur-18 coils, but aneurysm cavity had incomplete thrombosis. As a second stage patient underwent stent-graft implantation in hepatic artery.

Results: stent implantation was uncomplicated, aneurysm was excluded from blood flow. Patient was discharged in good condition, without any additional operation. Control angiography was performed in 3 months and thrombosis of stent with collateral blood flow were revealed. 

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