Download PDF
CC BY 4.0 · The Arab Journal of Interventional Radiology 2023; 07(02): 088-093
DOI: 10.1055/s-0043-1774804
Original Article

The Incidence of Ischemic Cholecystitis after Prophylactic Cystic Artery Embolization: A Single-Center Retrospective Study

Benjamin J. Walker
1   Department of Radiology, University of Iowa Hospitals and Clinics, Iowa City, United States
,
Michael Lung
2   Department of Surgery, University of California, Davis, California, United States
,
Hanin Lataifeh
3   School of Medicine, Jordan University of Science and Technology, Ar-Ramtha, Jordan
,
Aditi Patel
1   Department of Radiology, University of Iowa Hospitals and Clinics, Iowa City, United States
,
Ibrahim Abukhiran
4   Pathology Department, University of Pittsburgh, Pittsburgh, Pennsylvania, United States
,
Mohammad Amarneh 
1   Department of Radiology, University of Iowa Hospitals and Clinics, Iowa City, United States
› Author Affiliations
› Further Information
Also available at
   Permissions and Reprints

Abstract

Background Prophylactic cystic artery embolization (CAE) is used to prevent radiation cholecystitis in patients undergoing transarterial radioembolization (TARE), but the incidence of ischemic cholecystitis following CAE remains unclear.

Purpose This retrospective study aimed to determine the incidence of ischemic cholecystitis after prophylactic CAE prior to TARE.

Methods The medical records of 22 patients who underwent CAE prior to TARE between 2002 and 2021 were reviewed. Patients were assessed for evidence of acute cholecystitis and gallbladder imaging changes after the procedure.

Results Four out of the 22 patients (18.2%) developed cholecystitis after CAE, and two of these patients showed evidence of microsphere deposition consistent with radiation cholecystitis. Excluding these two patients, the incidence of ischemic cholecystitis was 9.1%. Additionally, 8 out of 22 patients (36.4%) developed gallbladder imaging changes after the embolization.

Conclusion The incidence of ischemic cholecystitis following CAE is comparable, if not greater than the risk of radiation cholecystitis without prophylactic embolization. Further research is necessary to better understand the risk factors associated with the development of cholecystitis after CAE and to inform recommendations for future preventative measures.

Keywords

ischemic cholecystitis - cystic artery embolization - complications

Ethical Approval

Study informed consent is not required. Institutional Review Board (IRB) approval was obtained.


Informed Consent

This study has obtained IRB approval from The University of Iowa IRB and the need for informed consent was waived.




Publication History

Article published online:
13 November 2023

© 2023. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

Thieme Medical and Scientific Publishers Pvt. Ltd.
A-12, 2nd Floor, Sector 2, Noida-201301 UP, India

 

  • References

  • 1 Murthy R, Nunez R, Szklaruk J. et al. Yttrium-90 microsphere therapy for hepatic malignancy: devices, indications, technical considerations, and potential complications. Radiographics 2005; 25 (Suppl. 01) S41-S55
    CrossrefPubMedGoogle Scholar
  • 2 Miller FH, Keppke AL, Reddy D. et al. Response of liver metastases after treatment with yttrium-90 microspheres: role of size, necrosis, and PET. AJR Am J Roentgenol 2007; 188 (03) 776-783
    CrossrefPubMedGoogle Scholar
  • 3 Jakobs TF, Hoffmann RT, Dehm K. et al. Hepatic yttrium-90 radioembolization of chemotherapy-refractory colorectal cancer liver metastases. J Vasc Interv Radiol 2008; 19 (08) 1187-1195
    CrossrefPubMedGoogle Scholar
  • 4 Kang B, Kim HC, Chung JW. et al. Safety of chemotherapeutic infusion or chemoembolization for hepatocellular carcinoma supplied exclusively by the cystic artery. Cardiovasc Intervent Radiol 2013; 36 (05) 1313-1319
    CrossrefPubMedGoogle Scholar
  • 5 Sato KT, Lewandowski RJ, Mulcahy MF. et al. Unresectable chemorefractory liver metastases: radioembolization with 90Y microspheres–safety, efficacy, and survival. Radiology 2008; 247 (02) 507-515
    CrossrefPubMedGoogle Scholar
  • 6 Takayasu K, Moriyama N, Muramatsu Y. et al. Gallbladder infarction after hepatic artery embolization. AJR Am J Roentgenol 1985; 144 (01) 135-138
    CrossrefPubMedGoogle Scholar
  • 7 McWilliams JP, Kee ST, Loh CT, Lee EW, Liu DM. Prophylactic embolization of the cystic artery before radioembolization: feasibility, safety, and outcomes. Cardiovasc Intervent Radiol 2011; 34 (04) 786-792
    CrossrefPubMedGoogle Scholar
  • 8 Atassi B, Bangash AK, Lewandowski RJ. et al. Biliary sequelae following radioembolization with Yttrium-90 microspheres. J Vasc Interv Radiol 2008; 19 (05) 691-697
    CrossrefPubMedGoogle Scholar
  • 9 Parakh S, Gananadha S, Allen R, Yip D. Cholecystitis after yttrium-90 resin microsphere radioembolization treatment: clinical and pathologic findings. Asian J Surg 2016; 39 (03) 144-148
    CrossrefPubMedGoogle Scholar
  • 10 Sakamoto I, Aso N, Nagaoki K. et al. Complications associated with transcatheter arterial embolization for hepatic tumors. Radiographics 1998; 18 (03) 605-619
    CrossrefPubMedGoogle Scholar
  • 11 Topcuoglu OM, Alan Selcuk N, Sarikaya B, Toklu T. Safety of transarterial radioembolization with Yttrium-90 glass microspheres without cystic artery occlusion. Radiol Med (Torino) 2019; 124 (06) 575-580
    CrossrefPubMedGoogle Scholar
  • 12 Powerski M, Busse A, Seidensticker M. et al. Prophylactic embolization of the cystic artery prior to radioembolization of liver malignancies–an evaluation of necessity. Cardiovasc Intervent Radiol 2015; 38 (03) 678-684
    CrossrefPubMedGoogle Scholar
  • 13 Theysohn JM, Müller S, Schlaak JF. et al. Selective internal radiotherapy (SIRT) of hepatic tumors: how to deal with the cystic artery. Cardiovasc Intervent Radiol 2013; 36 (04) 1015-1022
    CrossrefPubMedGoogle Scholar
  • 14 Komatsu T, Matsui O, Kadoya M, Yoshikawa J, Gabata T, Takashima T. Cystic artery origin of the segment V hepatic artery. Cardiovasc Intervent Radiol 1999; 22 (02) 165-167
    CrossrefPubMedGoogle Scholar
  • 15 Michels NA. Newer anatomy of the liver and its variant blood supply and collateral circulation. Am J Surg 1966; 112 (03) 337-347
    CrossrefPubMedGoogle Scholar
  • 16 Piasecki P, Brzozowski K, Ziecina P. et al. Gallbladder radiation protection in SIRT-quantitative anatomical study of hepatic vasculature. J Clin Med 2019; 8 (10) 1531
    CrossrefPubMedGoogle Scholar
  • 17 Sag AA, Savin MA, Lal NR, Mehta RR. Yttrium-90 radioembolization of malignant tumors of the liver: gallbladder effects. AJR Am J Roentgenol 2014; 202 (05) 1130-1135
    CrossrefPubMedGoogle Scholar
  • 18 Maleux G, Albrecht T, Arnold D. et al; CIRT Principal Investigators. Predictive factors for adverse event outcomes after transarterial radioembolization with yttrium-90 resin microspheres in Europe: results from the prospective observational CIRT study. Cardiovasc Intervent Radiol 2023; 46 (07) 852-867
    CrossrefPubMedGoogle Scholar
  • 19 Schelhorn J, Theysohn J, Ertle J. et al. Selective internal radiation therapy of hepatic tumours: is coiling of the gastroduodenal artery always beneficial?. Clin Radiol 2014; 69 (05) e216-e222
    CrossrefPubMedGoogle Scholar
  • 20 Abdelmaksoud MH, Hwang GL, Louie JD. et al. Development of new hepaticoenteric collateral pathways after hepatic arterial skeletonization in preparation for yttrium-90 radioembolization. J Vasc Interv Radiol 2010; 21 (09) 1385-1395
    CrossrefPubMedGoogle Scholar