title: Risk factors for the development of pulmonary oil embolism after transcatheter arterial chemoembolization of hepatic tumors.
abstract: Pulmonary oil embolism (POE) is a rare fatal complication after transcatheter arterial embolization (TAE) and transcatheter arterial chemoembolization (TACE). As risk factors have not been clearly delineated, the aim of the present study was to identify the risk factors for development of POE after TACE. A retrospective analysis was carried out on patients with unresectable hepatocellular carcinoma who received TAE or TACE at the Tri-Service General Hospital (Taiwan) between January 2005 and December 2008. The diagnosis of TAE-induced or TACE-induced POE was based on development of respiratory signs and symptoms relatively soon after the procedure, as well as based on characteristic radiographic findings. Of the 219 enrolled patients in this study, 20 were diagnosed with POE after TAE or TACE. On univariate logistic regression analysis, patients developing POE were found to be older (67.95±15.95 vs. 61.44±12.59 years, P=0.033), with a lower serum albumin level (3.25±0.58 vs. 3.62±0.57 g/dl, P=0.009), a higher grade of liver cirrhosis as classified on the basis of Child's criteria (P<0.006), a larger tumor size (8.55±4.52 vs. 4.78±3.97 cm in diameter, P<0.001), a higher lipioidol dose (22.35±11.01 vs. 13.69±7.66 ml, P=0.003), and a higher doxorubicin dose (50.27±7.05 vs. 40.75±13.61 mg, P<0.001). Following multivariate logistic regression analysis, only lipiodol dose was found to be a significant risk factor for POE (odds ratio=1.133, 95% confidence interval: 1.004, 1.279; P=0.044). The receiver operator characteristic curve cutoff point for lipiodol dose level was 14.5 ml, with a sensitivity of 80% and a specificity of 66.3%. In conclusion, the lipiodol dose could be considered as a predictive factor for POE after TAE or TACE in hepatic malignant tumor patients. On the basis of this retrospective study, the safe lipiodol dose to minimize the risk for POE is 14.5 ml or lower; however, larger, prospective studies are needed to determine the optimally safe and yet efficacious dose.
authors.affiliation: aDepartment of Internal Medicine, Division of Pulmonary Medicine, Taoyuan Armed Forces General Hospital, Lungtan, Taoyuan bSchool of Public Health , National Defense Medical Center cDepartment of Radiology dDepartment of Internal Medicine, Division of Gastroenterology eDepartment of Surgery, Division of Organ Transplantation fDepartment of Medicine, Division of Pulmonary and Critical Care Medicine, Tri-Service General Hospital, Nei-Hu, Taipei gDepartment of Medicine, Division of Pulmonary and Critical Care Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei, Taiwan, Republic of China hDivision of Pulmonary Sciences and Critical Care Medicine, Department of Medicine, University of Colorado Denver at Anschutz Medical Center iDenver Veterans Affairs Medical Center jDepartment of Medicine, Division of the Mycobacterial and Respiratory Infections, National Jewish Health, Denver, Colorado, USA.
authors.forename: Geng-Chin
authors.initials: GC
authors.lastname: Wu
authors.forename: Edward D
authors.initials: ED
authors.lastname: Chan
authors.forename: Yu-Ching
authors.initials: YC
authors.lastname: Chou
authors.forename: Chih-Yung
authors.initials: CY
authors.lastname: Yu
authors.forename: Tsai-Yuan
authors.initials: TY
authors.lastname: Hsieh
authors.forename: Chung-Bao
authors.initials: CB
authors.lastname: Hsieh
authors.forename: Chih-Feng
authors.initials: CF
authors.lastname: Chian
authors.forename: Fu-Chang
authors.initials: FC
authors.lastname: Ke
authors.forename: Yu-Ling
authors.initials: YL
authors.lastname: Dai
authors.forename: Wen-Lin
authors.initials: WL
authors.lastname: Su
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000008:administration & dosage; D006528:Carcinoma, Hepatocellular / Q000473:pathology / Q000628:therapy*; D016461:Chemoembolization, Therapeutic / Q000009:adverse effects*; D004317:Doxorubicin / Q000008:administration & dosage; D004998:Ethiodized Oil / Q000008:administration & dosage; D005260:Female; D006499:Hepatic Artery; D006801:Humans; D008113:Liver Neoplasms / Q000473:pathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis; D011655:Pulmonary Embolism / Q000209:etiology*; D012189:Retrospective Studies; D012307:Risk Factors; D047368:Tumor Burden
chemical_list: D000970:Antineoplastic Agents; D004998:Ethiodized Oil; D004317:Doxorubicin