Jornal Vascular Brasileiro
https://www.jvascbras.org/article/doi/10.1590/1677-5449.180090
Jornal Vascular Brasileiro
Therapeutic Challenge

Quimioembolização arterial transcateter de carcinoma hepatocelular em paciente com oclusão de tronco celíaco: um desafio terapêutico

Transcatheter arterial chemoembolization of hepatocellular carcinoma in a patient with celiac trunk occlusion: a therapeutic challenge

Altino Ono Moraes; Ecio Alves do Nascimento; Tiago Francisco Meleiro Zubiolo; Marcos Fábio Maximiano de Paula; Augusto Felipe Bruchez Brito; Bruno Filipe Viotto Petta; Gustavo Martini Perini; Dariane Rosa Martins

Downloads: 0
Views: 137

Resumo

Resumo: A quimioembolização arterial transcateter consiste em promover isquemia e ação citotóxica por meio da injeção de microesferas contendo quimioterápicos aplicada seletivamente nos vasos que nutrem o tumor. Paciente do sexo feminino, com 87 anos, em tratamento paliativo para carcinoma hepatocelular com indicação de quimioembolização, foi submetida a angiografia pré-procedimento, a qual identificou oclusão do tronco celíaco. A opção foi a cateterismo seletiva da artéria hepática própria por uma via alternativa para lançamento do agente quimioterápico, através da artéria mesentérica superior com comunicação utilizando a arcada pancreatoduodenal. Evidências de aumento da sobrevida demonstrados em estudos após a quimioembolização foram relatados, bem como redução da taxa de crescimento tumoral; entretanto, dificuldades em acessar e cateterizar a artéria nutrícia tumoral através do acesso alternativo tornam o procedimento um desafio, devido à tortuosidade da arcada pancreatoduodenal.

Palavras-chave

quimioembolização, carcinoma hepatocelular, tratamento paliativo

Abstract

Abstract: Transcatheter arterial chemoembolization is a technique for provoking ischemia and cytotoxic activity by selectively injecting microspheres containing chemotherapy drugs into vessels supplying a tumor. An 87-year-old female patient on palliative treatment for hepatocellular carcinoma and with indications for chemoembolization underwent preparatory angiography, which revealed celiac trunk occlusion. The treatment option chosen was selective catheterization of the hepatic artery proper to release the chemotherapy agent via an alternative route through the superior mesenteric artery with communication using the pancreaticoduodenal arcade. Studies have reported evidence showing increased survival after chemoembolization and also reduced tumor growth rate. However, difficulties with accessing and catheterizing the artery feeding the tumor via the alternative access make the procedure a challenge, because of the tortuosity of the pancreaticoduodenal arcade.
 

Keywords

chemoembolization, hepatocellular carcinoma, palliative treatment

References

Gaba RC, Lokken RP, Hickey RM, et al. Quality improvement guidelines for transarterial chemoembolization and embolization of hepatic malignancy. J Vasc Interv Radiol. 2017;28(9):1210-23. http://dx.doi.org/10.1016/j.jvir.2017.04.025. PMid:28669744.

Kwon JW, Chung JW, Song S-Y, et al. Transcatheter arterial chemoembolization for hepatocellular carcinomas in patients with celiac axis occlusion. J Vasc Interv Radiol. 2002;13(7):689-94. http://dx.doi.org/10.1016/S1051-0443(07)61845-4. PMid:12119327.

Attia NM, Othman MH. Transcatheter arterial chemoembolization of hepatocellular carcinoma in patients with celiac axis occlusion using pancreaticoduodenal arcade as a challenging alternative route. Eur J Radiol Open. 2017;4:53-74. http://dx.doi.org/10.1016/j.ejro.2017.04.002. PMid:28516133.

Lencioni R, de Baere T, Soulen MC, Rilling WS, Geschwind JF. Lipiodol transarterial chemoembolization for hepatocellular carcinoma: A systematic review of efficacy and safety data. Hepatology. 2016;64(1):106-16. http://dx.doi.org/10.1002/hep.28453. PMid:26765068.

Varela M, Real MI, Burrel M, et al. Chemoembolization of hepatocellular carcinoma with drug eluting beads: Efficacy and doxorubicin pharmacokinetics. J Hepatol. 2007;46(3):474-81. http://dx.doi.org/10.1016/j.jhep.2006.10.020. PMid:17239480.

Basile A, Carrafiello G, Ierardi AM, Tsetis D, Brountzos E. Quality-improvement guidelines for hepatic transarterial chemoembolization. Cardiovasc Intervent Radiol. 2012;35(4):765-74. http://dx.doi.org/10.1007/s00270-012-0423-z. PMid:22648700.

Li X, Wang X, Gao P. Diabetes Mellitus and Risk of Hepatocellular Carcinoma. BioMed Res Int. 2017;20:5202684. http://dx.doi.org/10.1155/2017/5202684. PMid:29379799.

Mantovani A, Targher G. Type 2 diabetes mellitus and risk of hepatocellular carcinoma: spotlight on nonalcoholic fatty liver disease. Ann Transl Med. 2017;5(13):270. http://dx.doi.org/10.21037/atm.2017.04.41. PMid:28758096.

Yoo RE, Kim HC, Chung JW. Microcatheter looping technique for catheterization of the proper hepatic artery through pancreaticoduodenal arcades and gastroduodenal artery in celiac axis occlusion. Gastrointest Interv. 2013;2(2):118-20. http://dx.doi.org/10.1016/j.gii.2013.10.001.

Geiger MA, Callaert J, Deloose K, Bosiers M. Percutaneous retrograde crossing of a near-occluded celiac trunk via the superior mesenteric artery as an adjuvant maneuver for antegrade stenting. J Vasc Bras. 2016;15(1):61-5. http://dx.doi.org/10.1590/1677-5449.002415.
 

5cebf9c60e8825564aa63c0f jvb Articles

J Vasc Bras

Share this page
Page Sections