title: Interventional management of gastroduodenal lesions complicating intra-arterial hepatic chemotherapy.
abstract: Herein we report the efficacy of embolization of small patent gastric or duodenal vessels for treating gastroduodenal complications after hepatic arterial infusion therapy (HAIC). Catheter ports were implanted percutaneously from a femoral approach in three cases or surgically in the gastroduodenal artery in two cases. Acute abdominal pain developed on average after four HAIC courses of 5FU-oxaliplatin, mytomycin, oxaliplatin or fotemustine. Esophagogastroduodenoscopy showed gastroduodenal lesions (gastroduodenitis with or without ulcerations) in all cases. Despite the interruption of the HAIC, symptoms persisted and led to selective hepatic arteriography showing a patent right gastric artery (n = 4) or a recanalized gastroduodenal artery (n = 1) responsible for gastroduodenal misperfusion. Successful embolizations of the arteries responsible for gastroduodenal misperfusion (right gastric artery in four cases and gastroduodenal artery in one case) using 0.018 platinium coils relieved the patients' symptoms and allowed the HAIC to continue. In gastroduodenal complications of HAIC, a selective hepatic arteriography should be performed to search any artery responsible for the misperfusion of the toxic agent in the gastroduodenal area. Embolization of these arteries allowed the HAIC to be restored.
authors.affiliation: Department of Radiology, Centre Hospitalier , Universitaire Vaudois, 46 rue du Bugnon, 1011 Lausanne, Switzerland. stefania.proietti@chuv.ch
authors.forename: Stefania
authors.initials: S
authors.lastname: Proietti
authors.forename: Thierry
authors.initials: T
authors.lastname: De Baere
authors.forename: Bertrand
authors.initials: B
authors.lastname: Bessoud
authors.forename: Francesco
authors.initials: F
authors.lastname: Doenz
authors.forename: Salah Dine
authors.initials: SD
authors.lastname: Qanadli
authors.forename: Pierre
authors.initials: P
authors.lastname: Schnyder
authors.forename: Alban
authors.initials: A
authors.lastname: Denys
mesh_terms: D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage* / Q000009:adverse effects*; D004381:Duodenal Ulcer / Q000139:chemically induced* / Q000628:therapy; D004386:Duodenum / Q000098:blood supply; D004621:Embolization, Therapeutic; D016099:Endoscopy, Gastrointestinal; D005260:Female; D005263:Femoral Artery; D006801:Humans; D007261:Infusions, Intra-Arterial; D008113:Liver Neoplasms / Q000188:drug therapy* / Q000556:secondary; D008297:Male; D008875:Middle Aged; D016685:Mitomycin / Q000008:administration & dosage / Q000009:adverse effects; D009607:Nitrosourea Compounds / Q000008:administration & dosage / Q000009:adverse effects; D009943:Organophosphorus Compounds / Q000008:administration & dosage / Q000009:adverse effects; D009944:Organoplatinum Compounds / Q000008:administration & dosage / Q000009:adverse effects; D000077150:Oxaliplatin; D013270:Stomach / Q000098:blood supply; D013276:Stomach Ulcer / Q000139:chemically induced* / Q000628:therapy; D016896:Treatment Outcome
chemical_list: D009607:Nitrosourea Compounds; D009943:Organophosphorus Compounds; D009944:Organoplatinum Compounds; D000077150:Oxaliplatin; D016685:Mitomycin; C054368:fotemustine