Retrograde embolization technique of the right gastric artery during the implantation of port-catheter system for hepatic arterial infusion chemotherapy

Jungang Hu; Guang Cao; Liang Xu; Kanglian Zheng; Xu Zhu; Renjie Yang; Xiao Wang; Xiaodong Wang

doi:10.1016/j.jimed.2020.10.004

Retrograde embolization technique of the right gastric artery during the implantation of port-catheter system for hepatic arterial infusion chemotherapy

J Interv Med. 2020 Oct 12;4(1):27-31. doi: 10.1016/j.jimed.2020.10.004. eCollection 2021 Feb.

Authors

Jungang Hu^{1

2}, Guang Cao², Liang Xu², Kanglian Zheng², Xu Zhu², Renjie Yang², Xiao Wang³, Xiaodong Wang²

Affiliations

¹ Department of Radiology, Civil Aviation General Hospital, Beijing, 100123, China.
² Department of Interventional Radiology, Peking University Cancer Hospital & Institute, Key Laboratory of Carcinogenesis and Translational Research(Ministry of Education), Beijing, 100142, China.
³ Department of Epidemiology and Biostatistics, Peking University Sixth Hospital, Beijing, 100191, China.

Abstract

Objective: This study aimed to introduce and evaluate a new embolization technique for the right gastric artery (RGA) during percutaneous implantation of a port-catheter system for hepatic arterial infusion chemotherapy (HAIC).

Methods: From January 2013 to January 2017, 159 patients with unresectable advanced liver cancer underwent percutaneous implantation of a port-catheter system. In 86 of these patients (56 men; aged 28-88 years; mean: 60.6 ± 12.0 years), in whom the RGA was obvious on arteriography, embolization of RGA was attempted using microcoils to protect the gastric mucosa during HAIC. In the first phase (first three years), antegrade embolization of the RGA using a 2.7 Fr microcatheter was performed in 55 patients. In the second phase (next two years), embolization of the RGA was attempted by combining antegrade embolization and retrograde embolization through the left gastric artery (LGA) in 31 patients. The success rates and the incidence of acute gastroduodenal mucosal toxicity (AGMT) in these two groups were compared.

Results: The total success rate of the RGA embolization was 70.9%. The success rate was 83.9% in 31 patients who underwent combined antegrade and retrograde embolization, which was significantly higher than that of antegrade embolization alone (63.6%) performed in 55 patients (p = 0.047). No complications related to embolization of RGA were documented. The incidence of AGMT was 29.1% (16/55) in patients in the first phase, which was significantly higher than that in the patients in the second phase (9.7%, 3/31) (p = 0.037).

Conclusion: A combination of retrograde embolization via LGA could increase the success rates of RGA embolization and reduce the incidence of AGMT after HAIC.

Keywords: Acute gastroduodenal mucosal toxicity; Hepatic arterial infusion chemotherapy; Left gastric artery; Port-catheter system; Right gastric artery embolization.