title: Quantification of Blood Pressure Changes in the Vascular Compartment When Using an Anti-Reflux Catheter during Chemoembolization versus Radioembolization: A Retrospective Case Series.
abstract: OBJECTIVE
  To assess whether blood pressure changes in the downstream vascular compartment are greater with transarterial chemoembolization than transarterial radioembolization (TARE) when using an anti-reflux catheter.
  
  
  METHODS
  The Surefire Infusion System (Surefire Medical, Inc, Westminster, Colorado) was used for lobar and sublobar administration in 51 drug-eluting embolic transarterial chemoembolization and 55 TARE procedures (22 with resin microspheres [TARE/resin] and 33 with glass microspheres [TARE/glass]). Of patients receiving transarterial chemoembolization and TARE/glass, 97% had hepatocellular carcinomas; 87% of patients receiving TARE/resin had metastases. The absolute (mm Hg) and relative (%) changes in the systemic-hepatic arterial pressure difference (SHAPD) were calculated from simultaneous blood pressure measurements obtained from the femoral artery vascular sheath and the antireflux catheter before, after, and, when feasible, during transarterial chemoembolization or TARE.
  
  
  RESULTS
  Transarterial chemoembolization was associated with a significant reduction in SHAPD compared with TARE (13 mm Hg ± 1.7 vs -4.3 mm Hg ± 1.5; P < .001). A reduction in SHAPD led to early termination of 55.6% of lobar and 53.3% of sublobar transarterial chemoembolization procedures compared with only 5.5% of lobar TARE/resin and no TARE/glass procedures. TARE/resin procedures were associated with a significantly greater change in SHAPD compared with TARE/glass procedures (0.9 mm Hg ± 2.7 vs -8.0 mm Hg ± 1.5; P = .0035).
  
  
  CONCLUSIONS
  Hepatic arterial pressures in the treated vascular compartment increased more after transarterial chemoembolization than after TARE, suggesting that transarterial chemoembolization resulted in more embolic obstruction of the targeted vascular compartment than TARE.
authors.affiliation: Department of Radiology MIS 8756, UC San Diego School of Medicine, 200 West Arbor Drive, San Diego, CA 92103-8756. Electronic address: scrose@ucsd.edu.
authors.forename: Steven C
authors.initials: SC
authors.lastname: Rose
authors.affiliation: Department of Radiology MIS 8756, UC San Diego School of Medicine, 200 West Arbor Drive, San Diego, CA 92103-8756.
authors.forename: Kazim H
authors.initials: KH
authors.lastname: Narsinh
authors.affiliation: Department of Radiology MIS 8756, UC San Diego School of Medicine, 200 West Arbor Drive, San Diego, CA 92103-8756.
authors.forename: Isabel G
authors.initials: IG
authors.lastname: Newton
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D062186:Arterial Pressure; D001795:Blood Pressure Determination / Q000295:instrumentation*; D006528:Carcinoma, Hepatocellular / Q000098:blood supply / Q000473:pathology / Q000628:therapy*; D016461:Chemoembolization, Therapeutic / Q000009:adverse effects / Q000295:instrumentation*; D004621:Embolization, Therapeutic / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods; D004867:Equipment Design; D005260:Female; D005898:Glass; D006499:Hepatic Artery / Q000503:physiopathology*; D006801:Humans; D008113:Liver Neoplasms / Q000098:blood supply / Q000473:pathology / Q000628:therapy*; D008297:Male; D008863:Microspheres; D008875:Middle Aged; D011237:Predictive Value of Tests; D019275:Radiopharmaceuticals / Q000008:administration & dosage* / Q000009:adverse effects; D012117:Resins, Synthetic; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D062666:Vascular Access Devices
chemical_list: D019275:Radiopharmaceuticals; D012117:Resins, Synthetic