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.

References

1.     Generalov Ml, Balakhnin PV, Tsurkan VA, et al. Percutaneously implanted «port-catheter» systems for long-lasting regional chemotherapy in patients with metastatic liver disease. Diagnosticheskaja i Intervenzionnaya Radiologiya. 2007; 1(4): 51-59 [In Russ].

2.     Arybzhanov DT, Gantsev SH, Kulakeev OK, et al. Results of endovascular methods of treatment in liver tumors in South Kazakhstan. Diagnosticheskaya i Intervenzionnaya Radiologiya. 2009; 3(1): 15-19 [In Russ].

3.     Popov AA, Skupchenko AV, Polarush NF. Colorectal liver metastases after chemoembolization with microspheres: comparison of the different criteria for tumor response assessment. Diagnosticheskaya i Intervenzionnaya Radiologiya. 2014; 8(1): 37-46 [In Russ].

4.     Dolgushin Bl, Virshke ER, KosyrevVJ. Interventional radiological technologies in treatment of intermediate stage HCC (BCLC B). Onkologicheskiy Zhurnal. 2018. 1(1): 60-62 [In Russ].

5.     Kozlov AV, Granov DA, Tarazov PG et al. Intra-arterial chemotherapy in patients with unresectable pancreatic cancer. Annaly Khirurgicheskoy Gepatologii. 2019; 24(3): 73-86 [In Russ].

6.     Pavlovskij AV, Stacenko AA, Popov SA et al. The first experience of selective intra-arterial injection of albuminbound paclitaxel (Abraxane) in patients with pancreatic adenocarcinoma. Diagnosticheskaya i Intervenionnaya Radiologiya. 2019; 13(1): 59-64 [In Russ].

7.     Bagdasarov W, Bagdasarova EA, Chernookov Al et al. Endovascular arterial embolization in duodenal bleeding - alternative to surgical treatment. Khirurgiya. 2016; (2): 45-50 [In Russ].

8.     Musinov IM, Chikin AE, Ganin AS, Kachesov EYu. Transcatheter arterial embolization in treatment of gastroduodenal ulcers with bleeding. Vestnik Khirugii. 2018; 177(6): 27-30 [In Russ].

9.     Tibilov AM, BaymatovMS. Endovascular intervention in the treatment of recurrent gastroduodenal hemorrhage. Diagnosticheskaya i Intervenzionnaya Radiologiya. 2009; 3(3): 45-48 [In Russ].

10.   Tarazov PG, Granov DA, Polikarpov AA et al. Endovascular control of arterial bleeding after major surgery in pancreatic cancer. Vestnik Khirugii. 2012; 171(1): 24-30 [In Russ].

11.   Chuang VP, Wallace S, Stroehlen J et al. Hepatic artery infusion chemotherapy: gastroduodenal complications. American Journal o f Roentgenology. 1981; 137(2): 347-350.

12.   Granmayeh M, Wallace S, Schwarten D. Transcatheter occlusion of the gastroduodenal artery. Radiology. 1979; 131(1): 59-62.

13.   Kuribayashi S, Phillips D, Harrington DP et al. Therapeutic embolization of the gastroduodenal artery in hepatic artery infusion chemotherapy. American Journal of Roentgenology. 1981; 137(6): 1169-1172.

14.   Kuyumcu G, Latich I, Hardman RLet al. Gastroduodenal embolization: indications, technical pearls, and outcomes. Journal o f Clinical Medicine. 2018; 7(5): pii E101.

http://doi.org/10.3390/icm7050101

15.   Desai GS, Pande PM. Gastroduodenal artery: Singe key for many locks (review). Journal of Hepatobiliary and Pancreatic Surgery. 2019; 26(7): 281-291.

16.   Tarazov PG, Polikarpov AA, Ivanova AA. Arterial radioembilzation of liver malignancies with glass yttrium-90 microspheres: first experience. Diagnosticheskaya i Intervenzionnaya Radiologiya. 2014; 8(4): 59-66 [In Russ].

17.   Tarazov PG, Ryzhkov VK. Gastroduodenal artery embolization during endovascular interventions in cirrhosis and tumors of the liver. Vestnik Khirugii. 1988; 140(1): 83- 85 [In Russ].

18.   Lopez-Benitez R, Hallscheidt P, Kratochwil C et al. Protective embolization of the gastroduodenal artery with a one HydroCoil technique in radioembolization procedures. Cardiovascular and Interventional Radiology. 2013; 36(1): 105-110.

19.   Enriquez J, Javadi S, Murthy R et al. Gastroduodenal artery recanalization after transcatheter fibered coil embolization for prevention of hepatoenteric flow: incidence and predisposing technical factors in 142 patients. Acta Radiologica. 2013; 54(7): 790-794.

20.   Kubota H, Nimura X Hayakawa N, Shionoya S. Hepatic transcatheter arterial embolization with gastroduodenal artery blocking by finger compression. Radiology. 1989; 170(2): 562-563.

21.   Tarazov PG, Pavlovskij AV, Granov DA. Oily chemoembolization of pancreatic head adenocarcinoma. Cardiovascular Interventional Radiology. 2001; 24(6): 424-426.

22.   Karimov Shi, Borovskiy SP, Khakimov MSh, Adylkhodzhaev AA. Regional chemotherapy in the treatment of unresectable pancreatic tumors. Annaly Khirurgicheskoy Gepatologii. 2010; 15(3): 105-109 [In Russ].

23.   Khayrutdinov ER, Tsurkan VA, Arablinskiy AV, Gromov DG. First experience in using transradial arterial approach in selective chemoembolization of malignant pancreatic tumor. Diagnosticheskaya i Intervenzionnaya Radiologiya. 2017; 11(4): 81-85 [In Russ].

Abstract

Background: pancreatic cancer (PC) - oncologic disease with nonsignificant clinics on early stages and tendention of spreadind in population, as a result - late diagnosis and low rate of radical treatment (10-25%). Carried radical treatment, such as pancreaticoduodenectomy (PDE) - has a high risk of postoperative complications (30-70%) due to its difficulty Most often and dangerous complications are: bleeding, anastomotic leakage, postoperative pancreatitis, purulent complications. Bleeding occurs in 5-10% of cases, mortality varries between 30,7% and 58,5% according to moderd literature. "Sentinel bleeding" - term that meand non-fatal bleeding through drainage or gastrointestinal bleeding (GIB) that follows PDE, and is a predictor of further massive fatal bleeding. Material and methods: article presents data of patient (male, 64y) who underwent gastropancreaticoduodenectomy (GPDE) through bilateral hypochondriacal access as treatment of moderate differentiated (MD) ductal adenocarcinoma of pancreatic head. On 21st day after surgery - massive GIB with source of bleeding as pseudoaneurysm of right hepatic artery Taking into consideration "adverse anatomy", impossibility of stent-graft implantation and failure of primary embolization with "front-to-back-door" technique - against the background of reccurent bleeding, patient undewent coiling of pseudoaneurysm and subseqent coil implantation into right hepatic artery anc common hepatic artery Against the background of second reccurency of GIB - patient underwent successful "front-to-back-door" embolization with combinaton of coils and Onyx.

Results: technique of «front-to-back-door» embolization led to stable hemostasis and patient's discharge in satisfactory condition without recurrence of bleeding.

Conclusions: surgical hospital, carrying on resections of pancreas as a routine, should have a CathLab unit, equipped with wide specter of angiografic instruments and 24/7 surgical team with experience of hemostatic interventions. Bleeding after PDE should be considered as «sentinel bleeding». In case of side-injury of large vessels - stent-graft implantation is preferable, if it is impossible - "front-to-back-door" embolization should be used. 

References

1.      Barannikov AYU, Sahno VD. Actual problems of the surgical treatment of diseases of organs of the biliopancreatoduodenal region. Kubanskij nauchnyj medicinskij vestnik. 2018; 25(1): 143-154. DOI: 10.25207/1608-62282018-25-1-143-154. [In Russ.]

2.      Kubyshkin VA, Vishnevskij VA. Pancreatic cancer. M.: ID Medpraktika-M; 2003. 386 s. [In Russ.]

3.      Egorov VI. Treatment of pancreatic cancer. V kn.: Gal'perin E.I., Dyuzheva T.G., redaktory. Lekcii po gepatopankreatobiliarnoj hirurgii. M.: Vidar-M; 2011. 449478. [In Russ.]

4.      Putov NV, Artem'eva NN, Kohanenko NYU. Pancreatic cancer.SPb.: Piter; 2005, 416 s. [In Russ.]

5.      Rasulov RI, Hamatov RK, Songolov GI, Zemko MV. Complex treatment of patients with locally spread cancer of pancreatic head. Annaly hirurgicheskoj gepatologii. 2013; 18(2): 75-89. [In Russ.]

6.      Malignant neoplasms in Russia in 2013 (incidence and mortality) pod red. A.D. Kaprina, V.V. Starinskogo, G.V. Petrovoj M., 2015. p. 36. [In Russ.]

7.      Malignant neoplasms in Russia in 2014 (incidence and mortality) pod red. A.D. Kaprina, V.V. Starinskogo, G.V. Petrovoj M., 2016. p. 36. [In Russ.]

8.      Malignant neoplasms in Russia in 2015 (incidence and mortality) pod red. A.D. Kaprina, V.V. Starinskogo, G.V. Petrovoj M., 2017. p. 36. [In Russ.]

9.      Malignant neoplasms in Russia in 2016 (incidence and mortality) pod red. A.D. Kaprina, V.V. Starinskogo, G.V. Petrovoj M., 2018. p. 36. [In Russ.]

10.    Malignant neoplasms in Russia in 2017 (incidence and mortality) pod red. A.D. Kaprina, V.V. Starinskogo, G.V. Petrovoj M., 2018. p. 36. [In Russ.]

11.    Onopriev VI, Korot'ko GF, Rogal' ML, Voskanyan SE. Pancreatoduodenal resection. Aspects of surgical technique, functional implications. Krasnodar: OOO «Kachestvo»; 2005. 135 s. [In Russ.]

12.    Patyutko YUI, Kotel'nikov AG. Surgery for cancer of organs of biliopancreatoduodenal zone. M.: Medicina; 2007. 448 c. [In Russ.]

13.    Patyutko YUI, Kudashkin NE, Kotel'nikov AG. Various types of pancreatodigestive anastomoses in pancreatoduodenal resection. Annaly hirurgicheskoj gepatologii. 2013; 18 (3): 9-14. [In Russ.]

14.    Propp AR. Diagnosis and surgical treatment of chronic pancreatitis with damage to the head of the pancreas. Annaly hirurgicheskoj gepatologii. 2013; 18(1): 103-151.

15.    Winter JM, Cameron JL, Campbell KA, et al. 1423 pancreaticoduodenectomies for pancreatic cancer: A single-institution experience. J. Gastrointest. Surg. 2006; 10(9): 1199-1210. DOI: 10.1016/j.gassur. 2006.08.018.

16.    Veligockij NN, Veligockij AN, Arutyunov SE. Experience of 200 pancreatoduodenectomy - assessment of various options for anastomoses. Annaly hirurgicheskoj gepatologii. 2015; 20(1): 100-105. [In Russ.]

17.    Egorov VI, Vishnevskij VA, Kozlov IA, et al Results of standard and expanded pancreatoduodenal resection with ductal adenocarcinoma of the pancreas. Annaly hirurgicheskoj gepatologii. 2008; 13(4): 19-32. [In Russ.]

18.    Rogal' ML, YArcev PA, Vodyasov AV. Distal loop pancreatoenteroanastomosis in pancreatoduodenal resection.2014; 19(2): 14-18. [In Russ.]

19.    Lai ECH, Lau SHY, Lau WY. Measures to prevent pancreatic fistula after pancreatoduodenectomy: a comprehensive review. Arch. Surg. 2009; 144(11): 1074-1080. DOI: 10.1001/archsurg.2009.193. 70.

20.    McEvoy SH, Lavelle LP, Hoare SM, et al. Pancreaticoduodenectomy: expected post-operative anatomy and complications. Br. J. Radiol. 2014. Vol. 87. P. 1-8.

21.    Kabanov MYU, Semencov KV, YAkovleva DM, Alekseev VV. The state of the development of pancreatic fistula in patients who underwent pancreatoduodenal resection. VestnikNMHC im. Pirogova N.I. 2017 T. 12 № 2. S. 112-116. [In Russ.]

22.    Darnis B, Lebeau R, Chopin-Laly X, Adham M. Postpancreatectomy hemorrhage (PPH): predictors and management from a prospective database. Langenbecks Arch. Surg. 2013. Vol. 398. P. 441-448.

23.    Kabanov MYU, Semencov KV, YAkovleva DM, Alekseev VV. Bleeding after pancreatoduodenal resections. Vestnik Nacional'nogo mediko-hirurgicheskogo Centra im. N.I. Pirogova 2018, t. 13, № 2. C138-140. [In Russ.]

24.    Rogal' ML, Ivanov PA, YArcev PA, et al. Results of pancreatoduodenal resection in a specialized department of a multidisciplinary hospital. Zhurnal im. N.V. Sklifosovskogo Neotlozhnaya medicinskaya pomoshch'. 2016. №1. S. 54-58. [In Russ.]

25.    Wente, M.N., Veit, J.A., Bassi, C . et al. Postpancreatectomy hemorrhage (PPH)-An International Study Group of Pancreatic Surgery (ISGPS) definition. Surgery. 2007. Vol. 142. P. 20-25.

26.    Ramacciato, G., Mercantini, P., N. Petrucciani, G.R., Nigri, A., Kazemi, M., Muroni, M., Del Gaudio, A,. Balesh, M., Cescon, A., Cucchetti, and M. Ravaioli (2011). Risk factors of pancreatic fistula after pancreaticoduodenectomy: a collective review. The American surgeon 77, 257-69.

27.    Brodsky JT, Turnbull AD. Arterial hemorrhage after pancreatoduodenectomy. The ‘sentinel bleed’. Arch Surg 1991;126 (8):1037-1040.

28.    Treckmann J1, Paul A, Sotiropoulos GC, et al. Sentinel bleeding after pancreaticoduodenectomy: a disregarded sign. J Gastrointest Surg. 2008 Feb;12(2):313-8. Epub 2007 Oct 20.

29.    Kriger AG, Kubyshkin VA, Karmazanovskij GG, et al. Postoperative pancreatitis during surgical interventions on the pancreas. Hirurgiya 2012; 4: 14-19.2. [In Russ.]

30.    Kubyshkin VA, Kriger AG, Vishnevskij VA, et al. Pancreatectomy for pancreatic tumors. Hirurgiya. 2013. №3.   S. 11-16. [In Russ.]

31.    Lai EC, Lau SH, Lau WY Measures to prevent pancreatic fistula after pancreatoduodenectomy: a comprehensive review. Arch Surg 2009; 144: 11: 1074-1180.

32.    de Castro S, Kuhlmann KFD, Busch ORC, et al. (2005) Delayed massive hemorrhage after pancreatic and biliary surgery: embolization or surgery? Ann Surg 241: 85-91.

33.    Iatrogenic and non-iatrogenic trauma. Casebased discussion. Marie Cerna. Cirse 2015.

Abstract:

Aim: was to analyze the first experiment and estimate the tolerability of intra-arterial use of the Abraxane in oil chemoembolization in patients with pancreatic adenocarcinoma.

Material and methods: for the period January 2018 - August 2018 г on the basis of the FSCU RIS RHT named after academician A.M. Granov, 19 patients with histologically verified ductal adenocarcinoma of the pancreas received treatment: intra-arterial oil chemoembolization with the use of the Abraxane.

Results: in 14 (73.6%) patients appeared mild pain syndrome that was not accompanied by marked laboratory changes, against the background of standard conservative prophylaxy. In 5 (26.4%) cases, patients had clinical and laboratory signs of postembolization syndrome, which was regarded as adverse events of grade 3 antitumor therapy, manifested by clinical and laboratory signs of mild acute pancreatitis, treated in all cases conservatively

The treatment of the postembolization syndrome lasted up to 7 days, until complete laboratory markers normalization, consisting in reducing the activity of blood amylase and urinary diastase to normal values. In all cases, postembolization syndrome was stopped conservatively In described 5 (26.4%) patients, adverse events of intra-arterial oil chemoembolization were regarded as mild postembolization pancreatitis. After treatment, a decrease in the tumor marker CA 19-9 was observed in 9 (90%) patients.

At the next stage, all patients with localized forms of the tumor underwent surgical treatment in the volume of pylorus-preserving pancreatoduodenal resection (n = 13) from 7 to 15 days after intra- arterial oil chemoembolization.

Conclusion: the procedure of oil chemoembolization with Abraxane can be considered as safe if dosages of the oil radiopaque drug Lipiodol are adeqate. There was a tendency to a decrease in the level of the tumor marker CA 19-9 in the blood of patients after the procedure. 

References

1.      Davydov MI, Aksel' EM. Statistics of malignant tumors in Russia and the CIS countries in 2012. Izdatel'skaya gruppa RONTs. 2014; 4: 226 [In Russ].

2.      Siegel R.L., Jemal А. Cancer statistics. CA. Cancer J Clin. 2018; 68: 7-30.

3.      Kaprin AD, Starinsky VV, Petrova GV. Statistics of malignant tumors in Russia 2016 (morbidity and mortality) M.: MNIOI im. PA. Gertsena filial FGBU «NMITs radiologii» Minzdrava Rossii. 2018; 250 p [In Russ].

4.      Alexakis N. Current standards of surgery for pancreatic cancer. Br J Surg. 2004; (11) 91: 1410-27.

5.      Dennison AR. Laparoscopic pancreatic surgery: a review of present results and future prospects. HPB (Oxford). 2010; 4(12): 239-43.

6.      Yang ZYYuan JQ, Di MY Zheng DY Chen JZ, Ding H, Wu XY, Huang YF, Mao C, Tang J.L. Gemcitabine plus erlotinib for advanced pancreatic cancer: a systematic review with meta-analysis. PLoS One. 2013;8(3):e57528. doi: 10.1371/journal.pone.0057528. Epub 2013 Mar 5.

7.      Hidalgo M. Pancreatic cancer. N Engl j med. 2010; 362: 1605-17.

8.      Burris H.A. Improvements in survival and clinical benefit with gemcitabine as first-line therapy for patients with advanced pancreas cancer: a randomized trial. J ClinOncol. 1997; 2403-13.

9.      Popova AS, Pokataev I A, Tyulyandin S.A. Combined chemotherapy regimens for pancreatic cancer. Zhurnal Meditsinskii sovet, Izdatel'stvo «GRUPPA REMEDIUM». 6: 62-70 [In Russ].

10.    Pokataev I A, Bazin I S, Popova A S, Podluzhnyi D V. Efficacy and safety of induction chemotherapy according to the FOLFIRINOX scheme with borderline resectable and unresectable pancreatic cancer. Nauchno-prakticheskii zhurnal po onkologii «Zlokachestvennye opukholi». 2018; 8(1): 38-47[ In Russ].

11.    Conroy T, Desseigne F, Ychou M. FOLFIRINOX versus gemcitabine for metastatic pancreatic cancer. N Engl J Med. 2011; 19(364): 1817-25.

12.    Stocken DD. Meta-analysis of randomised adjuvant therapy trials for pancreatic cancer. Br J Cancer. 2005; 8(92): 1372-81.

13.    Desai N, Trieu V, Yao Z. Increased antitumor activity, intratumor paclitaxel concentrations, and endothelial cell transport of cremophor-free, albumin-bound paclitaxel, ABI-007, compared with cremophor-based paclitaxel. Clin Cancer Res. 2006; 1(4): 1317-24.

14.    Dranitsaris G, Yu B, Wang L. Abraxane versus Taxol for patients with advanced breast cancer: A prospective time and motion analysis from a Chinese health care perspective. J Oncol Pharm Pract. 2016; 2: 205-11

15.    Giordano G, Pancione M, Olivieri N. Nano albumin bound-paclitaxel in pancreatic cancer: Current evidences and future directions. World J Gastroenterol. 2017; 23(32): 5875-5886.

16.    Ottaiano A. Nab-Paclitaxel and Gemcitabine in Advanced Pancreatic Cancer: The One-year Experience of the National Cancer Institute of Naples. Anticancer Res. 2017; 4(37): 1975-1978.

17.    Von Hoff DD. Gemcitabine plus nab-paclitaxel is an active regimen in patients with advanced pancreatic cancer: a phase I/II trial. ClinOncol. 2011; 29(34): 454854.

18.    Granov DA, Polikarpov AA, Pavlovskij AV, Moiseenko VE, Popov SA. Evaluation of the safety of intra-arterial chemotherapy with gemcitabine and oxaliplatin in the combined treatment of pancreatic head adenocarcinoma. Annaly khirurgicheskoy gepatologii. 2017; 22 (2): 54-59 [InRuss].

19.    Granov DA., Pavlovskij AV, Suvorova JuV, Gulo AS, Popov SA, Shapoval SV, Tlostanova MS. Neoadjuvant intra-arterial oil chemoembolization and adjuvant regional chemoinfusion in combined treatment of pancreatic cancer. Voprosioncologii. 2008; 54(4): 501-503.

Abstract:

Pancreatic cancer (PC) is one of the most aggressive malignant neoplasms, results of treatment of which remain extremely unsatisfactory, in view of the low (20%) possibility of tumor resectability A relatively new method of treatment of pancreatic cancer, which showed in practice an increase in tumor resectability in patients with borderline resectable forms of the disease and an increase ir survival mediana of inoperable patients is transartorial chemoembolization (TACE).of pancreatic arteries.

Authors first used transradial vascular access for TACE of a malignant pancreatic tumor.

As the first stage of the intervention - performed redistribution embolization of the right gastroomental artery distally to branches feeding the tumor, with two pushable coils Azur (Terumo) sized 4x60 mm and 5x60 mm in order to prevent embolization of non-target vessels and achieve total embolization of the tumor.

The second stage - performed chemoembolization with lipiodol - 5 ml and gemcitabine - 1000 mg, as a result - accumulation of chemotherapy in the head of the pancreas.

The duration of the procedure and the radiation dose in the patient were 52 minutes, respectively and 0.57 mSv and were comparable to those for similar interventions through transfemoral access. At the same time, all the main advantages of access through the radial artery remained, including: a higher level of psychological and functional comfort for the patient, its early activation and a minimal risk of vascular complications. The patient's discharge was made on the 10th day after the intervention. 

References

1.    Kubyshkin V.A., Vishnevskiy V.A. Rak podzheludochnoi zhelezy [Pancreatic cancer]. Moscow. 2003: 375 [In Russ].

2.     Nitecki S.S., Sarr M.G., Colby T.V. et al. Long-term survival after resection for ductal adenocarcinoma of the pancreas. Is it really improving? Ann. of Surg. 1995; 221(1):59-66

3.     Ishikawa O., Ohigashi H., Imaoka S. et al. Is the longterm survival rate improved by preoperative irradiation prior to Whipple’s procedure for adenocarcinoma of the pancreatic head? Arch. Surg. 1994; 129(10):1075-1080.

4.     Pavlovskiy A.V. Maslyanaya khimioembolizatsiya arteriy podzheludochnoi zhelezy pri mestnorasprostranennom rake. [Oily chemoembolization of pancreatic arteries in patients with locally advanced cancer]. Prakticheskaya onkologiya. 2004; 5(2):108-114 [In Russ].

5.     A.A., Tarazov P.G., Ivanova A.A., Alejnikova O.V. Diagnostika I lechenie toksicheskih oslozhnenij regionarnoj himioterapii, provodimoj cherez chreskozhno implantiruemye sistemy. [Diagnostics and treatment of toxic complications of regional chemotherapy through port-system] Diagnosticheskaya i intervencionnaya radiologiya. 2007; 1 (3): 46-51. [In Russ].

6.     Chandrasekar B., Doucet S., Bilodeau L. et al. Complications of cardiac catheterization in the current era: a single-center experience. Catheter Cardiovasc. Interv. 2001; 52(3):289-295.

7.     Sherev D.A., Shaw R.E., Brent B.N. Angiographic predictors of femoral access site complications: implication for planned percutaneous coronary intervention. Catheter Cardiovasc. Interv. 2005; 65(2): 196-202.

8.     Tavris D.R., Gallauresi B.A., Lin B. et al. Risk of local adverse events following cardiac catheterisation by hemostasis device use and gender. J. Invasive Cardiol. 2004; 16(9):459-464.

9.     Mclvor J., Rhymer J.C. 245 transaxillary arteriograms in arteriopathic patients: success rate and complications. Gin. Radiol. 1992; 45: 390-394.

10.   Jolly S.S., Yusuf S., Cairns J. et al. Radial versus femoral access for coronary angiography and intervention in patients with acute coronary syndromes (RIVAL): a randomised, parallel group, multicentre trial. Lancet. 2011; 377(9775):1409-1420.

11.   Kanei Y, Kwan T.,  NakraN.C. et al. Transradial cardiac catheterization: A review of access site complications. Catheter Cardiovasc. Interv. 2011.

12.   Caputo R.P., Tremmel J.A., Rao S. et al. Transradial arterial access for coronary and peripheral procedures: Executive summary by the transradial committee of the SCAI. Catheter Cardiovasc. Interv. 2011.

Abstract:

Since 2001 to 2006 38 patients with inoperable cancer of the pancreas have been treated. They had pancreatic cancer of stage T2-4 N1 MO-l(HEP). Patients with mechanical jaundice (n=28) had beforehand undergone transdermic transhepatic external- internal drainage of the bile ducts. Patients with cancer, which gets its basic source of blood supply out of gastroduodenal artery, got cathete-rization of the celiac trunk with the following intravascular chemotherapy within 2 days. If the basic source of blood supply to pancreas was the inferior pancreatoduodenal artery, then its selective catheterization was carried out together with bolus injection of cytostatics. Chemotherapy was carried out with the help of Gemzar (1 g), Cisplatin (1 OOmg), 5- FU (4g). The level of bilirubin normalized in the blood of the patients with mechanical jaundice due to transdermic endobiliary intervention. As a result of regional chemotherapy, the intensity of the patients' pain syndrome reduced considerably and resumed only in case of the tumor progression.

The best treatment results were achieved in the group of patients with the programmed injections of regional chemotherapetic drugs that enabled to prolong survival of patients up to 19 months and more. Conclusion. The transfemoral selective catheterization of the pancreatic arteries is a simple, non-traumatic and safe operation. The use of programmed regional endarterial chemoinfusion in patients with inoperable pancreatic cancer is a promising method of treatment of these pathology. 

Reference 

1.     Путов Н.В., Артемьева Н.Н., Коханенко Н.Ю. Ракподжелудочной железы. Санкт-Петербург: «Питер». 2005; 15.

2.     Гранов Д.А., Павловский А.В., Таразов П.Г. Новые возможности регионарной химиотерапии рака поджелудочной железы. Материалы конференции. X Российский онкологический конгресс. М. 2006; 29-31.

3.     Гранов Д.А., Павловский А.В., Таразов П.Г. Масляная артериальная химиоэмболизация: новый способ терапии рака поджелудочной железы. Вопросы онкологии. Санкт-Петербург. 2003; (49) 5: 579-583.

4.     Павловский А.В. Обоснование селективной артериальной рентгеноконтрастной масляной химиоэмболизации в лечении рака поджелудочной железы. Автореф. дис. дра мед. наук. Санкт-Петербург. 2006; 16.

5.     Долгушин Б.И., Авалиани М.В., Буйденок Ю.В. и др. Эндобилиарная интервенционная радиология. М. Медицинское информационное агентство. 2004; 113.

6.     Гранов A.M., Полысалов В.Н.,Таразов П.Г., Гранов Д.А., Карелин М.И. Интервенционная радиология в онкологической клинике: обзор научных исследований в ЦНИРРИ. Вопросы онкологии. Санкт-Петербург. 2003; (49) 5: 537-539.

7.     Гарин A.M. Рак поджелудочной железы: состояние, проблемы. Материалы конференции. X Российский онкологический конгресс. М. 2006; 35-37.