Iatrogenic celiac and hepatic artery dissections during intra-arterial regional tumor therapies: a 16-year retrospective review
To identify the incidence and outcomes of iatrogenic celiac and hepatic artery dissections during transarterial therapies, including bland embolization, chemoembolization, radioembolization (TARE), and pre-TARE scintigraphic mapping.
The institution’s quality assessment database, electronic medical record, and picture archiving and communication system were reviewed to identify all patients who underwent transarterial locoregional therapy from 1/2001 to 7/2017 and to determine the incidence of iatrogenic dissection, to assess patency of the arteries after dissection, and to assess the ability to complete therapy.
2253 patients underwent 3776 transarterial hepatic oncology procedures. Among 3776 procedures, 40 (1.1%) were associated with dissection of the visceral vasculature, affecting 39 patients (1.7%). The incidence of flow-limiting dissections was 0.3% (13/3776) and non-flow-limiting dissections was 0.7% (27/3776). After dissection, 68% (27/40) of treatments were completed the same day. Among the 13 aborted treatments, 8 (62%) were completed on a subsequent encounter. Follow-up imaging was obtained in 26 of 40 cases at median time of 63 days. Complete resolution of the dissection was seen in 15/26 cases (58%), near complete resolution (< 30% luminal narrowing) in 3/26 (12%), unchanged appearance of a non-flow-limiting dissection in 4/26 (15%), progressive luminal narrowing in 3/26 (12%), and complete occlusion in 1/26 (4%).
Iatrogenic dissections of visceral arteries rarely occur during tumor embolization procedures. 35/39 (90%) of patients underwent successful treatment despite the dissection.
KeywordsArterial dissection Transarterial chemoembolization Transarterial radioembolization Bland embolization
Compliance with ethical standards
Conflict of interest
Erica Alexander declares that she has no conflicts of interest. Gregory Nadolski receives research support from Guerbet LCC and Teleflex. Michael Soulen receives research support from Guerbet LCC and BTG International, is a consultant for Guerbet LCC and Genentech, and is a proctor for Sirtex. S. William Stavropoulos is a consultant for Becton–Dickinson and receives research support from Cook and Sillajen. Stephen Hunt is a consultant for BTG and receives research grants from BTG, SIO, SIR, and RSNA. Terence Gade is a consultant for Trisalus and received an investigator initiation grant from Guerbet LLC. Max Itkin has no related conflicts to declare. Susan Shamimi-Noori is a proctor for Sirtex.
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