Name: transradial access chemoembolization for hepatocellular carcinoma patients
Uploaded: 2020-09-20T13:00:00
Description: Watch this Scientific Journal Video about Transradial Access Chemoembolization for Hepatocellular Carcinoma Patients at JoVE.com

Questo lavoro è stato supportato dal fondo speciale di ricerca clinica dell'ospedale di Zhongshan, Università di Fudan (2016ZSLC17). Gli autori sono molto grati al Dr. Xianglin Hu nell'ospedale Zhongshan dell'Università di Fudan per i suoi suggerimenti molto professionali alla scrittura inglese.

Questo studio retrospettivo mono-centro è stato approvato dal comitato di revisione istituzionale locale dell'ospedale di Zhongshan, l'Università di Fudan.
1. Ottenere il consenso informato
<ol><li>Prima degli interventi TRA, i radiologi interventisti (IRs) spiegano i benefici e le potenziali complicanze di TRA ai pazienti.</li>
</ol>2. Valutazione del paziente
<ol><li>Dopo aver ottenuto il consenso informato, valutare l'RA per la fattibilità di ...

<ol>
	<li>Yoon, S. M., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Efficacy+and+Safety+of+Transarterial+Chemoembolization+Plus+External+Beam+Radiotherapy+vs+Sorafenib+in+Hepatocellular+Carcinoma+with+Macroscopic+Vascular+Invasion+A+Randomized+Clinical+Trial.">Efficacy and Safety of Transarterial Chemoembolization Plus External Beam Radiotherapy vs Sorafenib in Hepatocellular Carcinoma with Macroscopic Vascular Invasion A Randomized Clinical Trial.</a> JAMA Oncology. 4 (5), 661-669 (2018).</li><li>Global Burden of Disease. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+Global+Burden+of+Cancer+2013.">The Global Burden of Cancer 2013.</a> JAMA Oncology. 1 (4), 505-527 (2015).</li><li>Iezzi, R., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Transradial+versus+Transfemoral+Access+for+Hepatic+Chemoembolization:+Intrapatient+Prospective+Single-Center+Study.">Transradial versus Transfemoral Access for Hepatic Chemoembolization: Intrapatient Prospective Single-Center Study.</a> Journal of Vascular and Interventional Radiology. 28 (9), 1234-1239 (2017).</li><li>Rao, S. V., Cohen, M. G., Kandzari, D. E., Bertrand, O. F., Gilchrist, I. C. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+transradial+approach+to+percutaneous+coronary+intervention:+historical+perspective,+current+concepts,+and+future+directions.">The transradial approach to percutaneous coronary intervention: historical perspective, current concepts, and future directions.</a> Journal of the American College of Cardiology. 55 (20), 2187-2195 (2010).</li><li>Hamon, M., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Consensus+document+on+the+radial+approach+in+percutaneous+cardiovascular+interventions:+position+paper+by+the+European+Association+of+Percutaneous+Cardiovascular+Interventions+and+Working+Groups+on+Acute+Cardiac+Care+and+Thrombosis+of+the+European+Society+of+Cardiology.">Consensus document on the radial approach in percutaneous cardiovascular interventions: position paper by the European Association of Percutaneous Cardiovascular Interventions and Working Groups on Acute Cardiac Care and Thrombosis of the European Society of Cardiology.</a> EuroIntervention. 8 (11), 1242-1251 (2013).</li><li>Feldman, D. N., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Adoption+of+radial+access+and+comparison+of+outcomes+to+femoral+access+in+percutaneous+coronary+intervention:+an+updated+report+from+the+national+cardiovascular+data+registry+(2007-2012).">Adoption of radial access and comparison of outcomes to femoral access in percutaneous coronary intervention: an updated report from the national cardiovascular data registry (2007-2012).</a> Circulation. 127 (23), 2295-2306 (2013).</li><li>Jolly, S. S., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Radial+versus+femoral+access+for+coronary+angiography+and+intervention+in+patients+with+acute+coronary+syndromes+(RIVAL):+a+randomised,+parallel+group,+multicentre+trial.">Radial versus femoral access for coronary angiography and intervention in patients with acute coronary syndromes (RIVAL): a randomised, parallel group, multicentre trial.</a> Lancet. 377 (9775), 1409-1420 (2011).</li><li>Valgimigli, M., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Radial+versus+femoral+access+in+patients+with+acute+coronary+syndromes+undergoing+invasive+management:+a+randomised+multicentre+trial.">Radial versus femoral access in patients with acute coronary syndromes undergoing invasive management: a randomised multicentre trial.</a> Lancet. 385 (9986), 2465-2476 (2015).</li><li>Du, N., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Transradial+access+chemoembolization+for+hepatocellular+carcinoma+in+comparation+with+transfemoral+access.">Transradial access chemoembolization for hepatocellular carcinoma in comparation with transfemoral access.</a> Translational Cancer Research. 8 (5), 1795-1805 (2019).</li><li>Galyfos, G., Sigala, F., Filis, K. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Transradial+versus+Transfemoral+access+in+patients+undergoing+peripheral+artery+angioplasty/stenting:+A+meta-analysis.">Transradial versus Transfemoral access in patients undergoing peripheral artery angioplasty/stenting: A meta-analysis.</a> Cardiovascular Revascularization Medicine. 19 (4), 457-465 (2018).</li><li>Barbeau, G. R., Arsenault, F., Dugas, L., Simard, S., Lariviere, M. M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Evaluation+of+the+ulnopalmar+arterial+arches+with+pulse+oximetry+and+plethysmography:+comparison+with+the+Allen's+test+in+1010+patients.">Evaluation of the ulnopalmar arterial arches with pulse oximetry and plethysmography: comparison with the Allen's test in 1010 patients.</a> American Heart Journal. 147 (3), 489-493 (2004).</li><li>Kiemeneij, F., Laarman, G. J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Percutaneous+transradial+artery+approach+for+coronary+Palmaz-Schatz+stent+implantation.">Percutaneous transradial artery approach for coronary Palmaz-Schatz stent implantation.</a> American Heart Journal. 128 (1), 167-174 (1994).</li><li>Achenbach, S., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Transradial+versus+transfemoral+approach+for+coronary+angiography+and+intervention+in+patients+above+75+years+of+age.">Transradial versus transfemoral approach for coronary angiography and intervention in patients above 75 years of age.</a> Catheterization and Cardiovascular Interventions. 72 (5), 629-635 (2008).</li><li>Agostoni, P., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Radial+versus+femoral+approach+for+percutaneous+coronary+diagnostic+and+interventional+procedures;+Systematic+overview+and+meta-analysis+of+randomized+trials.">Radial versus femoral approach for percutaneous coronary diagnostic and interventional procedures; Systematic overview and meta-analysis of randomized trials.</a> Journal of the American College of Cardiology. 44 (2), 349-356 (2004).</li><li>Caputo, R. P., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Transradial+cardiac+catheterization+in+elderly+patients.">Transradial cardiac catheterization in elderly patients.</a> Catheterization and Cardiovascular Interventions. 51 (3), 287-290 (2000).</li><li>Cox, N., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Comparison+of+the+risk+of+vascular+complications+associated+with+femoral+and+radial+access+coronary+catheterization+procedures+in+obese+versus+nonobese+patients.">Comparison of the risk of vascular complications associated with femoral and radial access coronary catheterization procedures in obese versus nonobese patients.</a> American Journal of Cardiology. 94 (9), 1174-1177 (2004).</li><li>Titano, J. J., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Safety+and+Feasibility+of+Transradial+Access+for+Visceral+Interventions+in+Patients+with+Thrombocytopenia.">Safety and Feasibility of Transradial Access for Visceral Interventions in Patients with Thrombocytopenia.</a> Cardiovascular and Interventional Radiology. 39 (5), 676-682 (2016).</li><li>Mortensen, C., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Prospective+Study+on+Total+Fluoroscopic+Time+in+Patients+Undergoing+Uterine+Artery+Embolization:+Comparing+Transradial+and+Transfemoral+Approaches.">Prospective Study on Total Fluoroscopic Time in Patients Undergoing Uterine Artery Embolization: Comparing Transradial and Transfemoral Approaches.</a> Cardiovascular and Interventional Radiology. 42 (3), 441-447 (2019).</li><li>Iezzi, R., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Operator+learning+curve+for+transradial+liver+cancer+embolization:+implications+for+the+initiation+of+a+transradial+access+program.">Operator learning curve for transradial liver cancer embolization: implications for the initiation of a transradial access program.</a> Diagnostic and Interventional Radiology. 25 (5), 368-374 (2019).</li><li>Mounsey, C. A., Mawhinney, J. A., Werner, R. S., Taggart, D. P. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Does+Previous+Transradial+Catheterization+Preclude+Use+of+the+Radial+Artery+as+a+Conduit+in+Coronary+Artery+Bypass+Surgery.">Does Previous Transradial Catheterization Preclude Use of the Radial Artery as a Conduit in Coronary Artery Bypass Surgery.</a> Circulation. 134 (9), 681-688 (2016).</li><li>Hibbert, B., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Transradial+versus+transfemoral+artery+approach+for+coronary+angiography+and+percutaneous+coronary+intervention+in+the+extremely+obese.">Transradial versus transfemoral artery approach for coronary angiography and percutaneous coronary intervention in the extremely obese.</a> JACC: Cardiovascular Interventions. 5 (8), 819-826 (2012).</li><li>Fischman, A. M., Swinburne, N. C., Patel, R. S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=A+Technical+Guide+Describing+the+Use+of+Transradial+Access+Technique+for+Endovascular+Interventions.">A Technical Guide Describing the Use of Transradial Access Technique for Endovascular Interventions.</a> Techniques in Vascular and Interventional Radiology. 18 (2), 58-65 (2015).</li><li>Caputo, R. P., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Transradial+arterial+access+for+coronary+and+peripheral+procedures:+executive+summary+by+the+Transradial+Committee+of+the+SCAI.">Transradial arterial access for coronary and peripheral procedures: executive summary by the Transradial Committee of the SCAI.</a> Catheterization and Cardiovascular Interventions. 78 (6), 823-839 (2011).</li><li>Shiozawa, S., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Transradial+approach+for+transcatheter+arterial+chemoembolization+in+patients+with+hepatocellular+carcinoma+-+Comparison+with+conventional+transfemoral+approach.">Transradial approach for transcatheter arterial chemoembolization in patients with hepatocellular carcinoma - Comparison with conventional transfemoral approach.</a> Journal of Clinical Gastroenterology. 37 (5), 412-417 (2003).</li><li>Mitchell, M. D., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Systematic+review+and+cost-benefit+analysis+of+radial+artery+access+for+coronary+angiography+and+intervention.">Systematic review and cost-benefit analysis of radial artery access for coronary angiography and intervention.</a> Circulation: Cardiovascular Quality and Outcomes. 5 (4), 454-462 (2012).</li><li>Shoji, S., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Stroke+After+Percutaneous+Coronary+Intervention+in+the+Era+of+Transradial+Intervention.">Stroke After Percutaneous Coronary Intervention in the Era of Transradial Intervention.</a> Circulation: Cardiovascular Interventions. 11 (12), 006761 (2018).</li><li>Jurga, J., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Cerebral+microembolism+during+coronary+angiography:+a+randomized+comparison+between+femoral+and+radial+arterial+access.">Cerebral microembolism during coronary angiography: a randomized comparison between femoral and radial arterial access.</a> Stroke. 42 (5), 1475-1477 (2011).</li><li>Bishay, V. 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La terapia interventistica TRA è cresciuta significativamente in tutto il mondo negli ultimi anni, specialmente nelle procedure diagnostiche e di cardiologiainterventistica 12. Inoltre, vi è stata una crescente attenzione all'intervento periferico sulle malattie vascolari. Senza compromettere i tassi di successo procedurale, TRA all'intervento cardiaco può ridurre efficacemente i tassi di sanguinamento e complicanze vascolari rispetto al TFA13,<sup class="xref...

Il carcinoma epatocellulare (HCC) è una malignità molto comune, con il sesto più alto tasso di incidenza in tutto il mondo. È anche la seconda causa principale di mortalità per cancro in tutto il mondo1. Poiché solo il 5-20% dei pazienti può ricevere una terapia curativa, la chemioembolizzazione transarteriale (TACE) è il trattamento palliativo più popolare per i pazienti con HCC2 nonsecabile. Il TACE è stato riconosciuto come l'approccio terapeutico più comunemente usato ed efficace per i pazienti con HCC nella faseintermedia 3. La chemioembolizzazione dell'accesso transfemorale (TFA) è l'approccio più comune per TACE4. Tuttavia, ci sono rischi associati all'intervento di TFA, tra cui sanguinamento nel sito di accesso e principali complicazioni vascolari5. Queste complicazioni portano a un ricovero prolungato e a un aumento dei costi. Inoltre, il TFA richiede l'immobilizzazione per almeno 6 ore, il che aumenta il disagio e l'insoddisfazione per i pazienti.
L'accesso transradiale (TRA) è un approccio alternativo che è stato utilizzato nell'intervento coronarica percutaneo (PCI) perpiù di due decenni 5,6. TRA PCI ha diversi vantaggi: maggiore comfort della procedura, riduzione del sanguinamento legato al sito di accesso, diminuzione delle principali complicanze vascolari ediminuzione della mortalità 7,8. L'arteria radiale (RA) è di facile accesso e foratura grazie alla sua posizione superficiale7. L'emostasi è facile da condurre dopo l'intervento e non esiste una rigida immoblizzazione9. Nonostante le incoraggianti prove dell'intervento di TRA nella cateterizzazione cardiaca, ad oggi solo alcuni studi hanno utilizzato TRA nell'intervento sulle malattie periferiche. Gli interventi TRA per tumori maligni del fegato sono ancora più rari. Qui vengono analizzate la fattibilità clinica e la sicurezza dell'embolizzazione epatica TRA. Viene inoltre descritta l'esperienza di un istituto con il protocollo TRA passo-passo fornito.

<table border="0" cellpadding="0" cellspacing="0" style="width:553px;" width="553">
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	<tbody>
		<tr height="21">
			<td height="21" style="height:21px;width:141px;">Reagents</td>
			<td style="width:127px;"></td>
			<td style="width:123px;"></td>
			<td style="width:163px;"></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:141px;">Embosphere</td>
			<td style="width:127px;">Merit</td>
			<td style="width:123px;">20173776165</td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:141px;">Gelfoam</td>
			<td style="width:127px;">Alicon</td>
			<td style="width:123px;">20143771056</td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:141px;">Heparin</td>
			<td style="width:127px;">Hepatunn</td>
			<td style="width:123px;">H51021209</td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:141px;">Injection syringe</td>
			<td style="width:127px;">KDL</td>
			<td style="width:123px;">20163150518</td>
			<td></td>
		</tr>
		<tr height="63">
			<td height="63" style="height:63px;width:141px;">Iodinated oil</td>
			<td style="width:127px;">Yantai Luyin Pharmaceutical Co.Ltd</td>
			<td style="width:123px;">H37022398</td>
			<td></td>
		</tr>
		<tr height="63">
			<td height="63" style="height:63px;width:141px;">Lidocaine</td>
			<td style="width:127px;">Shandong Hualu Pharmaceutical Co.Ltd</td>
			<td style="width:123px;">H37022147</td>
			<td></td>
		</tr>
		<tr height="84">
			<td height="84" style="height:84px;width:141px;">Lobaplatin</td>
			<td style="width:127px;">Hainan Changan International Pharmaceutical Co.Ltd</td>
			<td style="width:123px;">H20050308</td>
			<td></td>
		</tr>
		<tr height="63">
			<td height="63" style="height:63px;width:141px;">Nitroglycerin</td>
			<td style="width:127px;">Brijing Yimin Pharmaceutical Co.Ltd</td>
			<td style="width:123px;">H11020289</td>
			<td></td>
		</tr>
		<tr height="63">
			<td height="63" style="height:63px;width:141px;">Normal saline</td>
			<td style="width:127px;">Anhui Shuanghe Pharmaceutical Co.Ltd</td>
			<td style="width:123px;">H34023609</td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:141px;">Pharmorubicin</td>
			<td style="width:127px;">Pfizer</td>
			<td style="width:123px;">H20000496</td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:141px;">Ultravist 370</td>
			<td style="width:127px;">Bayer</td>
			<td style="width:123px;">H20171333</td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:141px;">Material</td>
			<td></td>
			<td></td>
			<td></td>
		</tr>
		<tr height="42">
			<td height="42" style="height:42px;width:141px;">Hydrophilic Guide Wire</td>
			<td style="width:127px;">Merit</td>
			<td style="width:123px;">LWSTDA38180</td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:141px;">Injection syringe</td>
			<td style="width:127px;">KDL</td>
			<td style="width:123px;">20163150518</td>
			<td></td>
		</tr>
		<tr height="42">
			<td height="42" style="height:42px;width:141px;">Maestro Microcatheter</td>
			<td style="width:127px;">Merit</td>
			<td style="width:123px;">28MC24150SN</td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;">MPA1 (I) catheter</td>
			<td style="width:127px;">Cordis</td>
			<td style="width:123px;">451-406P0</td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:141px;">Sheath Introducer</td>
			<td style="width:127px;">Merit</td>
			<td style="width:123px;">PSI-4F-11-035</td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:141px;">Steerable Guidewire</td>
			<td style="width:127px;">Merit</td>
			<td style="width:123px;">TNR2411</td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:141px;">TR Band</td>
			<td style="width:127px;">Terumo</td>
			<td style="width:123px;">XX*RF06</td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:141px;">Equipment</td>
			<td></td>
			<td></td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:141px;">DSA</td>
			<td style="width:127px;">Toshiba</td>
			<td style="width:123px;">INFX-9000V</td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:141px;">Ultrasonic machine</td>
			<td style="width:127px;">SonoScape</td>
			<td style="width:123px;">20172231180</td>
			<td></td>
		</tr>
	</tbody>
</table>

transradial access chemoembolization for hepatocellular carcinoma patients

La chemioembolizzazione transarteriale (TACE) è la modalità più comune per il trattamento del carcinoma epatocellulare (HCC) nella fase intermedia. Il TACE viene in genere eseguito tramite accesso transfemorale (TFA). Tuttavia, l'accesso transradiale (TRA) è preferito negli interventi dell'arteria coronarica a causa della diminuzione delle complicanze e della mortalità. Se i vantaggi di TRA possono essere applicati all'indagine richiesta dal TACE.
I pazienti che ricevevano TRA TACE in un singolo centro sono stati iscritti retroattivamente per lo studio. Sono stati valutati i dettagli procedurali, il successo tecnico, il tasso di occlusione dell'arteria radiale (RAO) e le complicanze di sanguinamento legate al sito di accesso. Da ottobre 2017 a ottobre 2018, 112 pazienti sono stati sottoposti a 160 procedure TRA TACE. Il tasso complessivo di successo tecnico è stato del 95,0% (152/160). Il tasso di crossover da TRA a TFA è stato dell'1,9%. In nessun caso sono state riscontrate complicazioni emorragiche legate al sito di accesso. L'occlusione asintomatica della RA si è verificata in tre pazienti (2,7%). Rispetto al TFA, TRA può aumentare la sicurezza e la soddisfazione del paziente riducendo al contempo le complicanze di sanguinamento legate al sito di accesso. Inoltre, gli interventi TRA possono avvantaggiare i pazienti con età avanzata, obesità o un alto rischio di complicanze emorragiche.

Da ottobre 2017 a ottobre 2018, 112 pazienti sono stati sottoposti a 160 procedure TRA TACE e il tasso complessivo di successo tecnico è stato del 95,0% (152/160). Otto casi sono stati accolti con un guasto tecnico. Di questi, cinque casi sono stati causati da un fallimento della puntura RA sinistra e successivamente sono stati sottoposti a TACE di successo con accesso RA destro. Gli altri tre casi sono stati causati da un fallimento della cannulazione e hanno subito un successivo intervento riuscito da parte del crosso...

Watch this Scientific Journal Video about Transradial Access Chemoembolization for Hepatocellular Carcinoma Patients at JoVE.com

Transradial Access Chemoembolization for Hepatocellular Carcinoma Patients

La chemioembolizzazione transarteriale (TACE) è la terapia standard per i pazienti nella fase intermedia del carcinoma epatocellulare ed è tipicamente eseguita attraverso l'accesso all'arteria femorale. Rispetto all'accesso transfemorale, l'accesso transradiale (TRA) può ridurre il tasso di complicanze emorragiche e migliorare la tolleranza del paziente. Qui viene presentato un metodo per eseguire la chemioembolizzazione transarteriale tramite l'accesso all'arteria radiale.

Chemioembolizzazione ad accesso transradiale per pazienti con carcinoma epatocellulare

Transarterial chemoembolization (TACE) is the most common modality for treatment of hepatocellular carcinoma (HCC) at the intermediate stage. TACE is ...

Repetitive TACE is a common effective treatment for unresectable hepatocellular carcinoma, and is often performed via femoral artery access. However, the clinical feasibility or repeated transradial artery usage has not been confirmed. This technique reduces the risk bleeding, facilitates easier hemostasis, is easier to monitor, does not require lying in bed, enhances safety and improves patient comfort.Demonstrating the procedure will be Dr.Zhang and Dr.Yang. For radial artery access, first place the patient in a supine position on the angiography table, and position the left arm parallel to the body, close to the left waist. Locate the distal radial artery by palpation, and clean the skin surface with 10%povidone iodine surgical scrub solution.When the solution is air dried, cover the left arm with a surgical drape. In case of potential left radial artery puncture failure, sterilize and drape the right arm or right inguinal region to prepare an alternative access route. Apply topical anesthesia, proximal to the styloid process along the axis of the most powerful pulsation of the left radial artery, and extend the wrist.Using a 20-gauge needle and modified Seldinger technique, puncture the radial artery. When pulsatile arterial blood return is observed, gently introduce a 0.021-inch hydrophilic guidewire into the vessel. Once access is obtained, remove the needle, and use the guidewire to introduce a four French hydrophilic sheath.After sheath insertion, use a syringe to gently pump back a small amount of arterial blood to confirm that the sheath tip is located within the vessel, and inject the cocktail. To perform a superselective catheterization and chemoembolization, use a high pressure injector to perform an angiogram through the common catheter to confirm an adequate embolization and the location of the catheter tip within the common hepatic artery, then inject nine to 12 milliliters of the contrast agent at a three-to-four milliliter per second flow rate, and a fluoroscopy time of about 15 seconds, and remove the catheter of the guidewire to avoid damage to radial artery. To induce radial artery hemostasis, remove the catheter over the guidewire to avoid damage to the radial artery, and administer the remaining two milliliters of vasodilation cocktail solution through the radial artery sheath.Immediately after all of the solution has been delivered, retract the sheath about five centimeters, and place a TR band over the radial access site on the left wrist, use the accompanying syringe to adequately inflate the TR band air bag with air, and completely remove the sheath. Slowly deflate the air bag when leaking is observed at the access site at one milliliter of air back into the cuff, then confirm that there is no bleeding or leakage while also checking that the distal radial artery pulse is palpable during hemostasis, and using a pulse oximeter to confirm the arterial wave form on the left thumb. In this table, the baseline clinical data of representative cases with technical success or failure are compared.An increased number of catheters were required for patients suffering radial artery access technical failure. No significant correlations were found between the technical success or failure of the procedure and patient age, sex, or combined medical comorbidities. In this table, the numbers of transradial access transarterial chemoembolization procedures were compared.Due to the low frequency of radial artery occlusions, no significant correlation was found between the increased rate of occlusion and the number of transradial access procedures. It is important to stay calm and collected while performing the procedure. After watching this video, you should have the confidence and ability to perform that technique.We use ultrasound to improve the efficiency of the radial archery location, especially when the vessel is particularly small.

Research

JoVE Journal

Cancer Research

Study of Viral Vectors in a Three-dimensional Liver Model Repopulated with the Human Hepatocellular Carcinoma Cell Line HepG2

Studio di vettori virali in un tridimensionale fegato Modello ripopolata con l&#39;Umano carcinoma epatocellulare Linea cellulare HepG2

This protocol describes the generation of a three-dimensional (3D) ex vivo liver model and its application to the study and development of viral vector ...

Ricerca

Ricerca sul cancro

A Model for Perineural Invasion in Head and Neck Squamous Cell Carcinoma

Un modello per perineurale Invasion in testa e del collo carcinoma a cellule squamose

Perineural invasion (PNI) is found in approximately 40% of head and neck squamous cell carcinomas (HNSCC). Despite multimodal treatment with surgery, ...

Automated Multiplex Immunofluorescence Panel for Immuno-oncology Studies on Formalin-fixed Carcinoma Tissue Specimens

Pannello di immunofluorescenza Multiplex automatizzato per gli studi di Immuno-oncologia su campioni di tessuto in formalina Carcinoma

Continued developments in immuno-oncology require an increased understanding of the mechanisms of cancer immunology. The immunoprofiling analysis of ...

Multidimensional Coculture System to Model Lung Squamous Carcinoma Progression

Sistema di cocultura multidimensionale per modellare la progressione del carcinoma squamoso polmonare

Tumor-stroma interactions play a critical role in the development of lung squamous carcinoma (LUSC). However, understanding how these dynamic interactions ...

Analysis of Liver Microenvironment During Early Progression of Non-Alcoholic Fatty Liver Disease-Associated Hepatocellular Carcinoma in Zebrafish

Analisi del microambiente epatico durante la progressione precoce del carcinoma epatocellulare associato alla steatosi epatica non alcolica nel pesce zebra

Liver cancer is currently the third&#160;leading cause of cancer related death worldwide, and Hepatocellular Carcinoma (HCC) accounts for 75-90% of all ...

A Three-Dimensional Spheroid Model to Investigate the Tumor-Stromal Interaction in Hepatocellular Carcinoma

Un modello sferoide tridimensionale per studiare l'interazione tumore-stromale nel carcinoma epatocellulare

The aggressiveness and lack of well-tolerated and widely effective treatments for advanced hepatocellular carcinoma (HCC), the predominant form of liver ...

Non-Invasive PET/MR Imaging in an Orthotopic Mouse Model of Hepatocellular Carcinoma

Imaging PET/RM non invasivo in un modello murino ortotopico di carcinoma epatocellulare

Preclinical experimental models of hepatocellular carcinoma (HCC) that recapitulate human disease represent an important tool to study tumorigenesis and ...

Establishment and Characterization of Patient-Derived Xenograft Models of Anaplastic Thyroid Carcinoma and Head and Neck Squamous Cell Carcinoma

Definizione e caratterizzazione di modelli di xenotrapianto derivati dal paziente di carcinoma anaplastico della tiroide e carcinoma a cellule squamose della testa e del collo

Patient-derived xenograft (PDX) models faithfully preserve the histological and genetic characteristics of the primary tumor and maintain its ...

Ottimizzazione della formazione di organoidi HCC per l'identificazione di bersagli e lo sviluppo di farmaci

Development and Optimization of A Human Hepatocellular Carcinoma Patient-Derived Organoid Model for Potential Target Identification and Drug Discovery

Autore in primo piano: Indagine sulla patogenesi del cancro al fegato utilizzando organoidi derivati da pazienti 

Sviluppo e ottimizzazione di un modello di organoide derivato da pazienti affetti da carcinoma epatocellulare umano per l'identificazione di potenziali bersagli e la scoperta di farmaci

Hepatocellular carcinoma (HCC) is a highly prevalent and lethal tumor worldwide and its late discovery and lack of effective specific therapeutic agents ...