title: Embolisation of the gastroduodenal artery is not necessary in the presence of reversed flow before yttrium-90 radioembolisation.
abstract: BACKGROUND
  The gastroduodenal artery (GDA) is usually embolised to avoid nontarget dispersal before yttrium-90 (Y(90)) radioembolisation to treat liver metastases. In a minority of patients, there is retrograde flow in the GDA. The purpose of this study was to determine if there is any increased risk from maintaining a patent GDA in patients with reversed flow.
  
  
  METHODS
  A retrospective review was performed of all patients undergoing Y(90) radioembolisation at our institution. The incidence of toxicities arising from nontarget radioembolisation by way of the GDA (gastric/duodenal ulceration, gastric/duodenal bleeding, and pancreatitis) and death occurring within 2 months of treatment were compared between the reversed and the antegrade GDA groups.
  
  
  RESULTS
  Ninety-two patients underwent preliminary angiography. Reversed GDA flow was found on angiography in 14.1% of cases; the GDA was not embolised in these patients. The GDA was coiled in 55.7% of patients with antegrade GDA flow to prevent inadvertent dispersal of radioembolic material. There was no increased toxicity related to nontarget dispersal by way of the GDA, or increased early mortality, in patients with reversed GDA flow (P > 0.05).
  
  
  CONCLUSIONS
  In patients with reversed GDA flow, maintenance of a patent GDA before administration of Y(90) radioembolisation does not increase the risk of toxicity from nontarget dispersal. Therapeutic injection, with careful monitoring to identify early vascular stasis, may be safely performed beyond the origin of the patent GDA. A patent GDA with reversed flow provides forward drive for infused particles and may allow alternative access to the hepatic circulation.
authors.affiliation: Department of Radiology, Imperial College Healthcare NHS Trust, London, UK. ahmeddaghir@doctors.net.uk
authors.forename: Ahmed A
authors.initials: AA
authors.lastname: Daghir
authors.forename: Hatice
authors.initials: H
authors.lastname: Gungor
authors.forename: Ali A
authors.initials: AA
authors.lastname: Haydar
authors.forename: Harpreet S
authors.initials: HS
authors.lastname: Wasan
authors.forename: Nicholas P
authors.initials: NP
authors.lastname: Tait
mesh_terms: D000792:Angiography; D003430:Cross-Sectional Studies; D004307:Dose-Response Relationship, Radiation; D004386:Duodenum / Q000098:blood supply*; D004621:Embolization, Therapeutic / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008863:Microspheres; D008875:Middle Aged; D009369:Neoplasms / Q000000981:diagnostic imaging / Q000532:radiotherapy*; D019275:Radiopharmaceuticals; D012189:Retrospective Studies; D013270:Stomach / Q000098:blood supply*; D013668:Technetium Tc 99m Aggregated Albumin; D015899:Tomography, Emission-Computed, Single-Photon; D016896:Treatment Outcome; D051598:Whole Body Imaging; D015021:Yttrium Radioisotopes / Q000627:therapeutic use*
chemical_list: D019275:Radiopharmaceuticals; D013668:Technetium Tc 99m Aggregated Albumin; D015021:Yttrium Radioisotopes