Y90 Radioembolization of Liver Tumors via Radial approach – Correlation Between Common Femoral artery and Radial Artery Size

PurposeTypically, before Y90 radioembolization procedure undergoes, a CT is completed and the Barbeau test followed by radial artery ultrasound is used to determine if the artery is sufficiently large for vascular access [1-4]. 2.5 mm is the average radial artery diameter, and a vessel measurement of 2.0 mm is the recommended minimum diameter for safe vessel access, but a diameter of 1.5–2.0 mm can be accessed [4-9]. Our study explores using common femoral artery measurements from the pre-procedure CT abdomen/pelvis to assess in a binary manner if the vessel is sufficiently large to use for radial artery access. Materials and MethodsAll computed tomography scans of yttrium-90(Y90) radioembolization of the liver tumor procedures from January 1, 2015 - December 31, 2019 were retrospectively reviewed. Medical records were used from 47 procedures to gather patients' age, gender, Avastin use, femoral artery size (mm), administer Y90 (%), history of diabetes, and smoking status were recorded. ResultsThe minimum femoral artery size in patients who underwent transradial artery Y90 liver tumor radioembolization was 6 mm, with a mean femoral artery size of 10 mm. A comparative analysis of Y90 liver tumor uptake revealed no significant difference in radioembolization tumor uptake based on the initial site of procedure, transfemoral or transradial artery, (p > 0.81229). ConclusionThe study suggests that femoral arteries can predict radial artery diameter and that a femoral artery diameter of 10 mm should yield high confidence that the patient will be a candidate for transradial approach.

Biliary-Caval Fistula following Y90 Radioembolization

The safety of radioembolization with yttrium-90 (90Y) is well documented and major complications are rare. Previous studies have demonstrated that biliary complications following 90Y, including bile duct injury and hepatic abscess formation, occur at an increased rate in patients who have had prior biliary surgery and interventions. This article reviews a case of a patient who developed recurrent cholangitis and sepsis as well as a biliary-caval fistula following radioembolization. Additionally, we review current data regarding biliary complications following radioembolization in patients with prior biliary intervention.

Radiation Lobectomy: An Overview of Concept and Applications, Technical Considerations, Outcomes

Surgical resection has long been considered curative for patients with early-stage hepatocellular carcinoma (HCC). However, inadequate future liver remnant (FLR) renders many patients not amenable to surgery. Recently, lobar administration of yttrium-90 (Y90) radioembolization has been utilized to induce FLR hypertrophy while providing disease control, eventually facilitating resection in patients with hepatic malignancy. This has been termed “radiation lobectomy (RL).” The concept is evolving, with modified approaches combining RL and high-dose curative-intent radioembolization (radiation segmentectomy) to achieve tumor ablation. This article provides an overview of the concept and applications of RL, including technical considerations and outcomes in patients with hepatic malignancies.

Standard Radiation Dosimetry Models: What Interventional Radiologists Need to Know

Thoughtful and accurate dosimetry is critical to obtain the safest and most efficacious yttrium-90 (Y90) radioembolization of primary and secondary liver cancers. Three dosimetry models are currently used in clinical practice, namely, body surface area model, medical internal radiation dose model, and the partition model. The objective of this review is to briefly outline the history behind Y90 dosimetry and the difference between the aforementioned models. When applying these three models to a single case, the differences between them are further demonstrated. Each dosimetry model in clinical practice has its own benefits and limitations. Therefore, it is incumbent upon practicing interventional radiologists to be aware of these differences to optimize treatment outcomes for their patients.

Radioembolization in the Setting of Systemic Therapies

90Yttrium (Y90) radioembolization has been shown to improve outcomes for primary and metastatic liver cancers, but there is limited understanding of the optimal timing and safety of combining systemic therapies with Y90 treatment. Both therapeutic effects and toxicities could be synergistic depending on the timing and dosing of different coadministration paradigms. In particular, patients with liver-only or liver-dominant metastatic disease progression are often on systemic therapy when referred to interventional radiology for consideration of Y90 treatment. Interventional radiologists are frequently asked to offer insight into whether or not to hold systemic therapy, and for how long, prior to and following transarterial therapy. This study reviews the current evidence regarding the timing and safety of systemic therapy with Y90 treatment for hepatocellular carcinoma, metastatic colorectal carcinoma, intrahepatic cholangiocarcinoma, metastatic neuroendocrine tumors, and other hepatic metastases. A particular focus is placed on the timing, dosing, and toxicities of combined therapy.