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| 1 | The history of interventional therapy for liver cancer in China显示文摘In China interventional therapy of liver cancer started in the 1980s. It is well-known that Professor Lin Gui is the founding father of Interventional radiology. Under the leadership of Lin Gui and other professors, interventional therapy of liver cancer has swiftly progressed in China. Indeed, TAI, TAE, TACE and ablation therapy have witnessed great innovations in hardware facil ities, technical means, and therapeutic philosophy, while incorporating Chinese characteristics. As with the development of combined interventional therapy in China, interventional treatment of liver cancer has gradually started the process of precision and individualization. Actually, multidisciplinary, multimodal, and polymorphic treatments will be the most suitable pattern for liver cancer in the future, among which combination of interventional therapy with targeted, immunological treatments and information technology(IT) tools may bring a revolutionary breakthrough in liver cancer treatment. | Mengxuan Zuo Jinhua Huang | 2018 | Journal of Interventional Medicine2018，1，2： | 59 |
| 2 | Partial splenic artery embolization in cirrhotic patients显示文摘Splenomegaly is a common sequela of cirrhosis, and is frequently associated with decreased hematologic indices including thrombocytopenia and leukopenia. Partial splenic artery embolization(PSE) has been demonstrated to effectively increase hematologic indices in cirrhotic patients with splenomegaly. This is particularly valuable amongst those cirrhotic patients who are not viable candidates for splenectomy. Although PSE was originally developed decades ago, it has recently received increased attention. Presently, PSE is being utilized to address a number of clinical concerns in the setting of cirrhosis, including: decreased hematologic indices, portal hypertension and its associated sequela, and splenic artery steal syndrome. Following PSE patients demonstrate significant increases in platelets and leukocytes. Though progressive decline of hematologic indices occur following PSE, they remain improved as compared to pre-procedural values over long-term follow-up. PSE, however, is not without risk and complications of the procedure may occur. The most common complication of PSE is post-embolization syndrome, which involves a constellation of symptoms including fever, pain, and nausea/vomiting. The rate of complications has been shown to increase as the percent of total splenic volume embolized increases. The purpose of this review is to explore the current literature in re-gards to PSE in cirrhotic patients and to highlight their techniques, and statistically summarize their results and associated complications. | Tyson A Hadduck Justin P McWilliams | 2014 | World Journal of Radiology2014，6，5： | 31 |
| 3 | Recent advances in endovascular techniques for management of acute nonvariceal upper gastrointestinal bleeding显示文摘Over the past two decades,transcatheter arterial embolization has become the first-line therapy for the management of upper gastrointestinal bleeding that is refractory to endoscopic hemostasis.Advances in catheter-based techniques and newer embolic agents, as well as recognition of the effectiveness of minimally invasive treatment options,have expanded the role of interventional radiology in the management of hemorrhage for a variety of indications,such as peptic ulcerbleeding,malignant disease,hemorrhagic Dieulafoy lesions and iatrogenic or trauma bleeding.Transcatheter interventions include the following:selective embolization of the feeding artery,sandwich coil occlusion of the gastroduodenal artery,blind or empiric embolization of the supposed bleeding vessel based on endoscopic findings and coil pseudoaneurysm or aneurysm embolization by three-dimensional sac packing with preservation of the parent artery.Transcatheter embolization is a fast,safe and effective,minimally invasive alternative to surgery when endoscopic treatment fails to control bleeding from the upper gastrointestinal tract.This article reviews the various transcatheter endovascular techniques and devices that are used in a variety of clinical scenarios for the management of hemorrhagic gastrointestinal emergencies. | Romaric F Loffroy Basem A Abualsaud Ming D Lin Pramod P Rao | 2011 | World Journal of Gastrointestinal Surgery2011，3，7： | 28 |
| 4 | The current role of neoadjuvant/adjuvant/chemoprevention therapy in partial hepatectomy for hepatocellular carcinoma:a systematic review显示文摘BACKGROUND:Following curative treatment for hepato-cellular carcinoma(HCC),50%-90% of postoperative death is due to recurrent disease.Intra-hepatic recurrence is frequently the only site of recurrence.Thus,any neoadjuvant or adjuvant therapy,which can decrease or delay the incidence of intra-hepatic recurrence,or any cancer chemoprevention which can prevent a new HCC from developing in the liver remnant,will improve the results of liver resection.This article systematically reviewed the current evidence of neoadjuvant,adjuvant, and chemoprevention in partial hepatectomy of HCC. DATA SOURCES:Studies were identified by searching MEDLINE and PubMed databases for articles from January 1990 to November 2008 using the keywords 'hepatocellular carcinoma','hepatectomy','adjuvant therapy','neoadjuvant therapy',and'regional therapy'. Additional papers and book chapters were identified by a manual search of the references from the key articles. RESULTS:Neoadjuvant transarterial chemoembolization or adjuvant regional transarterial chemotherapy± embolization+systemic chemotherapy did not add benefit. Both adjuvant transarterial radioembolization with 131 I-lipiodol and adjuvant systemic interferon showed promising results.However,there were only a limited number of such studies.CONCLUSIONS:Further randomized controlled studies need to be carried out.Currently,there is no consensus on a standard neoadjuvant/adjuvant/chemoprevention therapy in partial hepatectomy for HCC. | Wan-Yee Lau Eric C.H.Lai Stephanie H.Y.Lau | 2009 | Hepatobiliary & Pancreatic Diseases International2009，8，2： | 24 |
| 5 | Survival outcome of patients with spontaneously ruptured hepatocellular carcinoma treated surgically or by transarterial embolization显示文摘AIM: To evaluate clinical outcomes of patients that underwent surgery, transarterial embolization (TAE), or supportive care for spontaneously ruptured hepatocellular carcinoma (HCC). METHODS: A consecutive 54 patients who diagnosed as spontaneously ruptured HCC at our institution between 2003 and 2012 were retrospectively enrolled. HCC was diagnosed based on the diagnostic guidelines issued by the 2005 American Association for the Study of Liver Diseases. HCC rupture was defined as disruption of the peritumoral liver capsule with enhanced fluid collection in the perihepatic area adjacent to the HCC by dynamic liver computed tomography, and when abdominal paracentesis showed an ascitic red blood cell count of > 50000 mm 3 /mL in bloody fluid. RESULTS: Of the 54 patients, 6 (11.1%) underwent surgery, 25 (46.3%) TAE, and 23 (42.6%) supportive care. The 2-, 4and 6-mo cumulative survival rates at 2, 4 and 6 mo were significantly higher in the surgery (60%, 60% and 60%) or TAE (36%, 20% and 20%) groups than in the supportive care group (8.7%, 0% and 0%), respectively (each, P < 0.01), and tended to be higher in the surgical group than in the TAE group. Multivariate analysis showed that serum bilirubin (HR = 1.09, P < 0.01), creatinine (HR = 1.46, P = 0.04), and vasopressor requirement (HR = 2.37, P = 0.02) were significantly associated with post-treatment mortality, whereas surgery (HR = 0.41, P < 0.01), and TAE (HR = 0.13, P = 0.01) were inversely associated with posttreatment mortality. CONCLUSION: Post-treatment survival after surgery or TAE was found to be better than after supportive care, and surgery tended to provide better survival benefit than TAE. | Young-Joo Jin Jin-Woo Lee Seoung-Wook Park Jung Il Lee Don Haeng Lee Young Soo Kim Soon Gu Cho Yong Sun Jeon Kun Young Lee Seung-Ik Ahn | 2013 | World Journal of Gastroenterology2013，19，28： | 23 |
| 6 | Drug-eluting beads transarterial chemoembolization for hepatocellular carcinoma: Current state of the art显示文摘Transarterial chemoembolization(TACE) represents the current gold standard for hepatocellular carcinoma(HCC) patients in intermediate stage. Conventional TACE(c TACE) is performed with the injection of an emulsion of a chemotherapeutic drug with lipiodol into the artery feeding the tumoral nodules, followed by embolization of the same vessel to obtain a synergistic effect of drug cytotoxic activity and ischemia. Aim of this review is to summarize the main characteristics of drug-eluting beads(DEB)-TACE and the clinical results reported so far in the literature. A literature search was conducted using Pub Med until June 2017. In order to overcome the drawbacks of c TACE, namely lack of standardization and unpredictability of outcomes, non-absorbable embolic microspheres charged with cytotoxic agents(DEBs) have been developed. DEBs are able to simultaneously exert both the therapeutic components of TACE, either drug-carrier function and embolization, unlike c TACE in which applying the embolic agent is a second moment after drug injection. This way, risk of systemic drug release is minimal due to both high-affinity carrier activity of DEBs and absence of a time interval between injection and embolization. However, despite promising results of preliminary studies, clear evidence of superiority of DEB-TACE over c TACE is still lacking. A number of novel technical devices are actually in development in the field of loco-regional treatments for HCC, but only a few of them have entered the clinical arena. In absence of well-designed randomized-controlled trials, the decision on whether use DEB-TACE or c TACE is still controversial. | Antonio Facciorusso | 2018 | World Journal of Gastroenterology2018，24，2： | 21 |
| 7 | Comparison of modified percutaneous transhepatic variceal embolization and endoscopic cyanoacrylate injection for gastric variceal rebleeding显示文摘AIM:To compare the efficacy of modified percutaneous transhepatic variceal embolization(PTVE)with 2-octyl-cyanoacrylate(2-OCA)and endoscopic variceal obturation(EVO)with an injection of 2-OCA for prophylaxis of gastric variceal rebleeding. METHODS:In this retrospective study,the medical records of liver cirrhosis patients with gastric variceal bleeding who underwent either endoscopic 2-OCA(EVO) or modified PTVE using 2-OCA at Shandong Provincial Hospital from January 2006 to December 2008 were reviewed.Patient demographics,rebleeding rate,survival rate,and complications were compared between the two groups(PTVE and EVO).All results were expressed as mean±SD,or as a percentage.Quantitative variables were compared by two sample Student t tests, and qualitative variables were compared by the Fisher exact test or theχ 2 test(with Yates correction)where appropriate.A P value less than 0.05 was considered significant.Statistical computation was performed using SPSS 13.0 software. RESULTS:A total of 77 patients were included;45 patients who underwent EVO and 32 patients who received PTVE.During the follow-up(19.78±7.70 mo in the EVO group,vs 21.53±8.56 mo in the PTVE group) rebleeding occurred in 17 patients in the EVO group and in 4 patients in the PTVE group(37.78%vs 12.5%, P=0.028).The cumulative rebleeding-free rate was 75%,59%,and 49%in 1,2,and 3 years respectively for EVO,and 93%,84%,and 84%for PTVE(P=0.011). Cox analysis was used to identify independent factors that predicted rebleeding after treatment.Variables including age,gender,cause,Child-Pugh classification, size of gastric varices(GV),location of GV,and treatment methods were analyzed.It was revealed that Child-Pugh classification[risk ratio(RR)2.10,95%CI:1.03-4.28,P=0.040],choice of treatment(RR 0.25, 95%CI:0.08-0.80,P=0.019),and size of GV(RR 2.14, 95%CI:1.07-4.28,P=0.032)were the independent factors for predicting rebleeding.Follow-up computed tomography revealed that cyanoacrylate was retained in the varices and in the feeding veins of PTVE patients. During the follow-up,eight patients in the EVO group and four patients in the PTVE group died.The cumulative survival rates at 1,2,and 3 years were 93%,84%, and 67%respectively in the EVO group,and 97%, 88%,and 74%respectively in the PTVE group.The survival rates were not significantly different between the two groups(P=0.432).Cox analysis showed that the Child-Pugh classification was the most significant prognostic factor of survival(RR 2.77,95%CI:1.12-6.80,P=0.027).The incidence of complications was similar in both groups. CONCLUSION:With extensive and permanent obliteration of gastric varices and its feeding veins,PTVE with 2-OCA is superior to endoscopic 2-OCA injection for preventing gastric variceal rebleeding. | Jing Wang Xiang-Guo Tian Yan Li Chun-Qing Zhang Fu-Li Liu Yi Cui Ji-Yong Liu | 2013 | World Journal of Gastroenterology2013，19，5： | 21 |
| 8 | Preoperative portal vein embolization for hepatocellular carcinoma: consensus and controversy显示文摘Thirty years have passed since the first report of portal vein embolization(PVE),and this procedure is widely adopted as a preoperative treatment procedure for patients with a small future liver remnant(FLR).PVE has been shown to be useful in patients with hepatocellular carcinoma(HCC)and chronic liver disease.However,special caution is needed when PVE is applied prior to subsequent major hepatic resection in cases with cirrhotic livers,and volumetric analysis of the liver segments in addition to evaluation of the liver functional reserve before PVE is mandatory in such cases.Advances in the embolic material and selection of the treatment approach,and combined use of PVE and transcatheter arterial embolization/chemoembolization have yielded improved outcomes after PVE and major hepatic resections.A novel procedure termed the associating liver partition and portal vein ligation for staged hepatectomy has been gaining attention because of the rapid hypertrophy of the FLR observed in patients undergoing this procedure,however,application of this technique in HCC patients requires special caution,as it has been shown to be associated with a high morbidity and mortality even in cases with essentially healthy livers. | Taku Aoki Keiichi Kubota | 2016 | World Journal of Hepatology2016，8，9： | 19 |
| 9 | Effect of partial splenic embolization on the immune function of cirrhosis patients with hypersplenism显示文摘Objective:To discover the effect of partial splenic embolization on the immune function of cirrhotic patients with hypersplenism.Methods:Patients involved in the study were enrolled and divided into three groups,including control group,experimental group,and complication group.Numbers of CD3^+,CD4^+ and CD8^+ T cells and CD4^+CD25^+CDl27^(low/-) Treg cells in the peripheral blood of patients before surgery,1 month,6 months,1 year,and 2 years after surgery were analyzed by fluorescence active cell sorting(FACS).Contents of immunoglobulins(IgA,IgG and IgM) were analyzed by auto immunoassay analyzer.Results:In the peripheral blood of patients from experimental group,numbers of CD3^+,CD4^+ and CD8^+ T cells initially declined,but afterwards increased to normal level;in the peripheral blood of patients from complication group,CD3^+ and CD8^+ T cells showed the same trend,but the number of CD4^+ T cells was below normal level at all detection times.Furthermore,CD3^+,CD4^+ and CD8^+ T cells in the peripheral blood of patients from complication group were initially less than those in experimental group,and afterwards were comparable between two groups.In patients from both experimental group and complication group,the number of CD4^+CD25^+CDl27^(low/-)Treg cells increased 1 month and 6 months after surgery,and gradually restored to normal level.CD4^+CD25^+CDl27^(low/-)Treg cell counts in patients from complication group were initially more than those in patients from experimental group 1 month and 6 months after surgery,but then they were comparable.Furthermore,contents of immunoglobulins(IgA,IgG and IgM) were comparable in three groups at all detection times.Conclusion:Partial splenic embolization influenced the immune function of cirrhotic patients with hypersplenism in the short term but the immune function could afterwards gradually restore to normal.Our results implicated that measures that prevent infection and improve immune function were necessary in early stage after undergoing PSE in order to reduce complications. | Gui-Yun Jin Chuan-Zhu Lv Tang Deng Shao-Wen Cheng Chao-Qian Li | 2016 | Asian Pacific Journal of Tropical Medicine2016，9，7： | 18 |
| 10 | Portal vein embolization by fine needle ethanol injection :experimental and clinicalstudies显示文摘AIM To improve the technique of intraportal embolization (PVE) therapy, a new embolic method, was devised and the safety, effectiveness and feasibility were evaluated. METHODS PVE with intraportal ethanol injection via a fine needle was performed in 28 normal dogs, 22 SD rats, and 24 cirrhotic SD rats. After PVE, portography, histological and functional alteration of the liver were evaluated in dogs and rats, and the changes in portal hemodynamics as well as hepatic anatomy were observed in rats. In the clinical study, PVE by ethanol injection was performed in 61 patients with hepatocellular carcinoma under the guidance of portoechography with intraportal injection of CO 2. The effect of PVE was evaluated by ultrasonography and laparotomy. RESULTS The effectiveness and toxicity were dependent on the dose of ethanol. In the dogs, 0 25*!mg/*!kg of ethanol caused incomplete embolization with least liver damage, while 1 0*!mg/*!kg induced complete embolization with a high mortality of 57 1% (4/*!7) due to respiratory arrest. The dose of 0 5*!mg/*!kg resulted in complete embolization with slight toxicity to the liver. In the rats, the survival rate was 100% in normal group but 40 9% in cirrhotic models after ethanol injection by dose of 0 05*!mg/*!100*!g . PVE for cirrhotic rats with 0 03*!mg/*!100*!g of ethanol induced satisfactory embolization with significant hypertrophy in nonembolized lobes, and only slight damage to the hepatic parenchyma, and transient alteration in liver function, portal pressure and portal flow. In the clinical study, 12 cases with reverse portal flow were excluded judged by portoechography. Satisfactory embolization was gained in 90 2% (55/*!61) of the remaining patients determined by ultrasonography and surgery. All cases ran an uneventful postembolization course with no aberrant embolization. CONCLUSION PVE with intraportal ethanol injection of appropriate dosage via a fine needle is safe and effective and has several advantages comparing with transcatheter method. Portoechography is a mandatory approach for the prevention of aberrant embolization. | Lu MD Chen JW Xie XY Liang LJ Huang JF | 1999 | World Journal of Gastroenterology1999，5，6： | 15 |
| 11 | Locoregional treatments for hepatocellular carcinoma: Current evidence and future directions显示文摘Liver cancers are the second most frequent cause of global cancer-related mortality of which 90%are attributable to hepatocellular carcinoma(HCC).Despite the advent of screening programmes for patients with known risk factors,a substantial number of patients are ineligible for curative surgery at presentation with limited outcomes achievable with systemic chemotherapy/external radiotherapy.This has led to the advent of numerous minimally invasive options including but not limited to trans-arterial chemoembolization,radiofrequency/microwave ablation and more recently selective internal radiation therapy many of which are often the first-line treatment for select stages of HCC or serve as a conduit to liver transplant.The authors aim to provide a comprehensive overview of these various image guided minimally invasive therapies with a brief focus on the technical aspects accompanied by a critical analysis of the literature to assess the most up-to-date evidence from comparative systematic reviews and meta-analyses finishing with an assessment of novel combination regimens and future directions of travel. | Riccardo Inchingolo Alessandro Posa Martin Mariappan Stavros Spiliopoulos | 2019 | World Journal of Gastroenterology2019，25，32： | 14 |
| 12 | MDCT angiography to evaluate the therapeutic effect of PTVE for esophageal varices显示文摘Abstract AIM:To evaluate the role of multi-detector row computed tomography(MDCT) angiography for assessing the therapeutic effects of percutaneous transhepatic variceal embolization(PTVE) for esophageal varices(EVs).METHODS:The subjects of this prospective study were 156 patients who underwent PTVE with cyanoacrylate for EVs.Patients were divided into three groups according to the filling range of cyanoacrylate in EVs and their feeding vessels:(1) group A,complete obliteration,with at least 3 cm of the lower EVs and peri-/EVs,as well as the adventitial plexus of the gastric cardia and fundus filled with cyanoacrylate;(2) group B,partial obliteration of varices surrounding the gastric cardia and fundus,with their feeding vessels being obliterated with cyanoacrylate,but without reaching lower EVs;and(3) group C,trunk obliteration,with the main branch of the left gastric vein being filled with cyanoacrylate,but without reaching varices surrounding the gastric cardia or fundus.We performed chart reviews and a prospective follow-up using MDCT images,angiography,and gastrointestinal endoscopy.RESULTS:The median follow-up period was 34 mo.The rate of eradication of varices for all patients was 56.4%(88/156) and the rate of relapse was 31.3%(41/131).The rates of variceal eradication at 1,3,and 5 years after PTVE were 90.2%,84.1% and 81.7%,respectively,for the complete group;61.2%,49% and 42.9%,respectively,for the partial group;with no varices disappearing in the trunk group.The relapsefree rates at 1,3 and 5 years after PTVE were 91.5%,86.6% and 81.7%,respectively,for the complete group;71.1%,55.6% and 51.1%,respectively,for the partial group;and all EVs recurred in the trunk group.Kaplan-Meier analysis showed P values of 0.000 and 0.000,and odds ratios of 3.824 and 3.603 for the rates of variceal eradication and relapse free rates,respectively.Cyanoacrylate in EVs disappeared with time,but those in the EVs and other feeding vessels remained permanently in the vessels without a decrease with time,which is important for the continued obliteration of the feeding vessels and prevention of EV relapse.CONCLUSION:MDCT provides excellent visualization of cyanoacrylate obliteration in EV and their feeding veins after PTVE.It confirms that PTVE is effective for treating EVs. | Aitao Sun Yong-Jun Shi Zhuo-Dong Xu Xiang-Guo Tian Jin-Hua Hu Guang-Chuan Wang Chun-Qing Zhang | 2013 | World Journal of Gastroenterology2013，19，10： | 13 |
| 13 | Selective embolization for bleeding visceral artery pseudoaneurysms in patients with pancreatitis显示文摘BACKGROUND:Pancreatitis is associated with arterial complications in 4%-10%of patients,with untreated mortality approaching 90%.Timely intervention at a specialist center can reduce the mortality to 15%.We present a single institution experience of selective embolization as first line management of bleeding pseudoaneurysms in pancreatitis. METHODS:Sixteen patients with pancreatitis and visceral artery pseudoaneurysms were identified from searches of the records of interventional angiography from January 2000 to June 2007.True visceral artery aneurysms and pseudoaneurysms arising as a result of post-operative pancreatic or biliary leak were excluded from the study. RESULTS:In 50%of the patients,bleeding complicated the initial presentation of pancreatitis.Alcohol was the offending agent in 10 patients,gallstones in 3,trauma,drug-induced and idiopathic pancreatitis in one each.All 16 patients had a contrast CT scan and 15 underwent coeliac axis angiography. The pseudoaneurysms ranging from 0.9 to 9.0 cm affected the splenic artery in 7 patients:hepatic in 3,gastroduodenal and right gastric in 2 each,and left gastric and pancreatico-duodenal in 1 each.One patient developed spontaneous thrombosis of the pseudoaneurysm.Fourteen patients had effective coil embolization of the pseudoaneurysm.One patient needed surgical exclusion of the pseudoaneurysm following difficulty in accessing the coeliac axis radiologically.There were no episodes of re-bleeding and no in-hospital mortality. CONCLUSIONS:Pseudoaneurysms are unrelated to the severity of pancreatitis and major hemorrhage can occur irrespective of their size.Co-existent portal hypertension and sepsis increase the risk of surgery.Angiography and selective coil embolization is a safe and effective way to arrest the hemorrhage. | Harsheet Sethi Praveen Peddu Andreas Prachalias Pauline Kane John Karani Mohamed Rela Nigel Heaton | 2010 | Hepatobiliary & Pancreatic Diseases International2010，9，6： | 12 |
| 14 | Evaluation of selective hepatic angiography and embolization in patients with massive hemobilia显示文摘BACKGROUND: Massive hemobilia is a rare but potential- ly life-threatening cause of upper gastrointestinal hemor- rhage. Transarterial embolization is considered the first line of intervention to stop the bleeding for most causes of he- mobilia. This study was conducted to evaluate selective he- patic angiography and embolization in the diagnosis and treatment of patients with massive hemobilia. METHODS: The clinical data of 16 patients with massive hemobilia were analyzed retrospectively. These patients un- derwent emergency celiac and selective right or left hepatic artery angiography and treated by embolization using Gel- foam particles and/or coils. RESULTS: Hepatic artery angiography revealed hepatic ar- tery pseudoaneurysms in 6 patients, cystic artery pseudoa- neurysms in 2, diffuse hemorrhage of hepatic artery bran- ches in 5, and right hepatic artery-bile duct fistulae in 3. The patients were diagnosed rapidly by angiography and treated successfully by embolization of the hepatic artery branch proximal to the bleeding point, and hemorrhage was stopped immediately. Two patients were embolized the second time for rebleeding. Neither recurrence of bleeding nor serious complication was found during the fol- low-up for 3 months to 2 years. The other 2 patients whose hemorrhage failed to be controlled died several days later. CONCLUSION: Being safe, reliable and minimally inva- sive , selective hepatic artery angiography and embolization are effective in the diagnosis and treatment of massive he- mobilia. | Zeng-Bin Xu, Xian-Yong Zhou, Zhi-Yi Peng, Shun-Liang Xu and Ling-Xiang Ruan Hangzhou, China Department of Radiology, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China | 2005 | Hepatobiliary & Pancreatic Diseases International2005，4，2： | 12 |
| 15 | Prognostic factors of spontaneously ruptured hepatocellular carcinoma显示文摘AIM: To evaluate the prognostic factors in patients with spontaneously ruptured hepatocellular carcinoma(HCC). METHODS: Seventy-nine patients experiencing spontaneous rupture of HCC between April 2004 and August 2014 were enrolled in this study. The clinical features, treatment modalities and outcomes were reviewed. The statistical methods used in this work included univariate analysis, Kaplan-Meier survival analysis with log-rank tests, and multivariate analysis using a Cox regression hazard model. RESULTS: Of the 79 patients with HCC rupture, 17(21.5%) underwent surgery, 32(40.5%) underwent transarterial embolization(TAE), and 30(38%) received conservative treatment. The median survival time was 125 d, and the mortality rate at 30 d was 27.8%. Multivariate analysis revealed that lesion length(HR = 1.46, P < 0.001), lesion number(HR = 1.37, P = 0.042), treatment before tumor rupture(HR = 4.36, P = 0.019), alanine transaminase levels(HR = 1.0, P = 0.011), bicarbonate levels(HR = 1.18, P < 0.001), age(HR = 0.96, P = 0.026), anti-tumor therapy during the followup period(HR = 0.21, P = 0.008), and albumin levels(HR = 0.89, P = 0.010) were independent prognostic factors of survival after HCC rupture. The BarcelonaClinic Liver Cancer(BCLC) stage was also an important prognostic factor; the median survival times for BCLC stages A, B and C were 251, 175 and 40 d, respectively(P < 0.001).CONCLUSION: Anti-tumor therapy during the followup period, without a history of anti-tumor therapy prior to HCC rupture, small tumor length and number, and early BCLC stage are the most crucial predictors associated with satisfactory overall survival. Other factors play only a small role in overall survival. | Xiang-Jun Han Hong-Ying Su Hai-Bo Shao Ke Xu | 2015 | World Journal of Gastroenterology2015，21，24： | 11 |
| 16 | Embolization of liver tumors:Past,present and future显示文摘Curative therapies for hepatocellular carcinoma(HCC),such as resection and liver transplantation,can only be applied in selected patients with early tumors.More advanced stages require local or systemic therapies.Resection of HCC offers the only hope for cure.Even in patients undergoing resection,recurrences are common.Chemoembolization,a technique combining intraarterial chemotherapy with selective tumor ischemia,has been shown by randomized controlled trials to be efficacious in the palliative setting.There is now renewed interest in transarterial embolization/transarterial chemoembolization(TACE) with regards to its use as a palliative tool in a combined modality approach,as a neoadjuvant therapy,in bridging therapy before transplantation,for symptomatic indications,and even as an alternative to resection.There have also been rapid advances in the agents being embolized trans-arterially(genes,biological response modifiers,etc.).The current review provides an evidence-based overview of the past,present and future trends of TACE in patients with HCC. | Ashwin Rammohan Jeswanth Sathyanesan Sukumar Ramaswami Anand Lakshmanan Perumal Senthil-Kumar Ulagendra Perumal Srinivasan Ravi Ramasamy Palaniappan Ravichandran | 2012 | World Journal of Radiology2012，4，9： | 11 |
| 17 | Endovascular treatment of nonvariceal acute arterial upper gastrointestinal bleeding显示文摘Transcatheter arterial embolization as treatment of upper nonvariceal gastrointestinal bleeding is increasingly being used after failed primary endoscopic treatment.The results after embolization have become better and surgery still has a high mortality.Embolization is a safe and effective procedure,but its use is has been limited because of relatively high rates of rebleeding and high mortality,both of which are associated with gastrointestinal bleeding and non-gastrointestinal related mortality causes.Transcatheter arterial embolization is a valuable minimal invasive method in the treatment of early rebleeding and does not involve a high risk of treatment associated complications.A multidisciplinary approach is necessary in the treatment of these patients and should comprise gastroenterologists,interventional radiologists,anaesthesiologists,and surgeons to achieve the best possible results. | Poul Erik Andersen Stevo Duvnjak | 2010 | World Journal of Radiology2010，2，7： | 11 |
| 18 | Endovascular management of visceral artery aneurysms: When to watch, when to intervene?显示文摘Visceral artery aneurysms(VAA) include splanchnic and renal artery aneurysms. They represent a rare clinical entity, although their detection is rising due to an increased use of cross-sectional imaging. Rupture is the most devastating complication, and is associated with a high morbidity and mortality. In addition, increased percutaneous endovascular interventions have raised the incidence of iatrogenic visceral artery pseudoaneurysms(VAPAs). For this reason, elective repair is preferable in the appropriately chosen patient. Controversy still exists regarding their treatment. Over the past decade, there has been steady increase in the utilization of minimally invasive, non-operative interventions, for vascular aneurysmal disease. All VAAs and VAPAs can technically be fixed by endovascular techniques but that does not mean they should. These catheter-based techniques constitute an excellent approach in the elective setting. However, in the emergent setting it may carry a higher morbidity and mortality. The decision for intervention has to take into account the size and the natural history of the lesion, the risk of rupture, which is high during pregnancy, and the relative risk of surgical or radiological intervention. For splanchnic artery aneurysms, we should recognize that we are not, in reality, well informed about their natural history. For most asymptomatic aneurysms, expectant treatment is acceptable. For large, symptomatic or aneurysms with a high risk of rupture, endovascular treatment has become the firstline therapy. Treatment of VAPAs is always mandatory because of the high risk of rupture. We present our point of view on interventional radiology in the splanchnic arteries, focusing on what has been achieved and the remaining challenges. | Romaric Loffroy Sylvain Favelier Pierre Pottecher Pierre-Yves Genson Louis Estivalet Sophie Gehin Jean-Pierre Cercueil Denis Krausé | 2015 | World Journal of Radiology2015，7，7： | 11 |
| 19 | Management of bleeding from pseudoaneurysms following pancreaticoduodenectomy显示文摘AIM:To review the clinical course and the management of pseudoaneurysms post-pancreaticoduodenectomy.METHODS: Medical records of 907 patients who underwent pancreaticoduodenectomies from January 1995 to May 2007 were evaluated retrospectively. The clinical course, management strategy, and outcome of ruptured pseudoaneurysms cases were analyzed.RESULTS: Twenty-seven (3.0%) of 907 cases had post-operative hemorrhage from ruptured pseudoan-eurysms. Pancreatic fistula was evident in 12 (44%) cases. Sentinel bleeding appeared in 21 (77.8%) cases. Of the 27 cases, 11 (41%) cases demonstrated bleeding pseudoaneurysm of the ligated gastroduodenal artery, 8 (30%) of the right, proper, common hepatic artery, 2 (7%) of the right gastric artery, and 4 (15%) of the peripancreatic arteries. The remaining two patients died due to sudden-onset massive hemorrhage and pseudoaneurysm rupture was suspected. Emergent operation was performed on 2 cases directly without angiography. Angiography was attempted in 23 cases. Eighteen (78.2%) cases succeeded to hemostasis; the five failed cases were explored. After embolization of the hepatic artery, five cases developed liver abscesses or infarction and a single case of hepatic failure expired. Gastroduodenal artery embolization with common hepatic artery stent insertion was performed to enhance hepatic artery flow in a single case and was successfully controlled.CONCLUSION: Bleeding pseudoaneurysms are among the most serious and fatal complications following pancreaticoduodenectomy. Diagnostic angiography has been preferred over endoscopy and is rapidly becoming the standard therapeutic treatment for bleeding pseudoaneurysms. | Hyung Geun Lee Jin Seok Heo Seong Ho Choi Dong Wook Choi | 2010 | World Journal of Gastroenterology2010，16，10： | 10 |
| 20 | Transarterial embolization for massive gastrointestinal hemorrhage following abdominal surgery显示文摘AIM:To evaluate the clinical results of angiography and embolization for massive gastrointestinal hemorrhage after abdominal surgery.METHODS:This retrospective study included 26 patients with postoperative hemorrhage after abdominal surgery. All patients underwent emergency transarterial angiography,and 21 patients underwent emergency embolization. We retrospectively analyzed the angiographic features and the clinical outcomes of transcatheter arterial embolization.RESULTS:Angiography showed that a discrete bleeding focus was detected in 21(81%) of 26 patients.Positive angiographic findings included extravasations of contrast medium(n = 9),pseudoaneurysms(n =9),and fusiform aneurysms(n = 3). Transarterial embolization was technically successful in 21(95%) of 22patients. Clinical success was achieved in 18(82%) of 22 patients. No postembolization complications were observed. Three patients died of rebleeding.CONCLUSION:The positive rate of angiographic findings in 26 patients with postoperative gastrointestinal hemorrhage was 81%. Transcatheter arterial embolization seems to be an effective and safe method in the management of postoperative gastrointestinal hemorrhage. | Chun-Gao Zhou Hai-Bin Shi Sheng Liu Zheng-Qiang Yang Lin-Bo Zhao Jin-Guo Xia Wei-Zhong Zhou Lin-Sun Li | 2013 | World Journal of Gastroenterology2013，19，40： | 10 |
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