Superiority of Proximal Embolization of the Gastroduodenal Artery with the Amplatzer Vascular Plug 4 Before Yttrium-90 Radioembolization: A Retrospective Comparison with Coils in 134 Patients
Superiority of Proximal Embolization of the Gastroduodenal Artery with the Amplatzer Vascular Plug 4 Before Yttrium-90 Radioembolization: A Retrospective Comparison with Coils in 134 Patients
复制标题
在钇 90 放射栓塞之前使用 Amplatzer 血管塞 4 进行胃十二指肠动脉近端栓塞的优越性：与弹簧圈在 134 名患者中的回顾性比较
DOI：
--
复制
发表时间：
2014
影响因子：
2.9
通讯作者：
O. Dudeck
中科院分区：
文献类型：
--
作者：
K. Bulla;Sebastian Hubich;M. Pech;D. Löwenthal;J. Ricke;O. Dudeck
目的比较Amplatzer血管塞4 （avp4）与可推线圈栓塞胃十二指肠动脉（GDA）近端栓塞的效果，避免GDA残端出现肝enteric侧支，为非靶栓塞提供途径。材料与方法回顾性分析134例GDA闭塞患者行90-钇放射栓塞（Y-90 RE），分别使用栓子（n = 67）或标准线圈（n = 67）。记录GDA残端灌注长度、装置到GDA原点的距离、栓塞后近侧分支灌注长度、Y-90 re血管闭塞的持续时间等参数。结果avp4残端灌注长度为3.89±2.86 mm，明显短于线圈的5.78±3.85 mm （p = 0.005）。塞到GDA原点的距离为1.41±2.60 mm，也明显短于线圈的4.73±3.44 mm （p < 0.001）。这导致avp4组（n = 2; 3.0%）与线圈组（n = 18; 26.9%; p < 0.001）相比，avp4组侧分支残留灌注的患者显著减少。在Y-90 RE时，栓子栓塞后无GDA再灌注，而线圈栓塞后2例（3.0%;p = 0.156）。只有1例患者线圈栓塞后出现放射性十二指肠溃疡，而栓塞后未发现y -90相关毒性。结论与螺旋栓塞相比，avp4栓塞GDA可获得最佳的近端靶血管闭塞效果，可避免Y-90微球通过近侧残余血流分支在肝外胃肠道沉积引起的并发症。
PurposeTo evaluate the effectiveness of proximal embolization of the gastroduodenal artery (GDA) using the Amplatzer Vascular Plug 4 (AVP 4) compared with pushable coils to avoid hepaticoenteric collaterals of the GDA stump, which may serve as pathways for nontarget embolization.Materials and MethodsOne hundred thirty-four patients scheduled for 90-yttrium radioembolization (Y-90 RE) using either plugs (n = 67) or standard coils (n = 67) for GDA occlusion were retrospectively analyzed. Parameters recorded were length of the perfused GDA stump, distance device to the GDA origin, perfused proximal side branches after embolization, and durability of vessel occlusion at Y-90 RE.ResultsLength of the residually perfused GDA stump was 3.89 ± 2.86 mm for the AVP 4, which was significantly shorter compared with 5.78 ± 3.85 mm for coils (p = 0.005). Distance of the plug to the GDA origin was 1.41 ± 2.60 mm, which was also significantly shorter than 4.73 ± 3.44 mm for coils (p < 0.001). This resulted in significantly fewer patients with residually perfused side branches in the AVP 4 group (n = 2; 3.0 %) compared with the coil group (n = 18; 26.9 %; p < 0.001). At Y-90 RE, no GDA reperfusion was found after plug embolization compared with 2 cases after coil embolization (3.0 %; p = 0.156). Only one patient had a radiation-induced duodenal ulcer after coil embolization, whereas no Y-90-related toxicity was identified after plug embolization.ConclusionUse of the AVP 4 for embolization of the GDA allowed an optimal proximal and more effective target vessel occlusion compared with coil embolization, which can avoid complications caused by extrahepatic gastrointestinal deposition of Y-90 microspheres by way of residually perfused proximal side branches.