The Application Of KMG Microballoon In The Aterial Embolization

Part 1 Clinical application of TACE with Sodium Alginate(KMG)Microballoon in the treatment of hepatocellular carcinomaBackgroudHepatocellular carcinoma(HCC)is the third highest cause of cancer-associated mortality worldwide.A total of-82%of liver cancer cases occur in developing countries,with 55%occurring in China alone.-20%of patients in the China are eligible at diagnosis for potentially curative treatments,including resection or liver transplantation and radiofrequency ablation.In many centers,transcatheter arterial chemoembolization(TACE),a common and well recognized treatment shown to have a significant impact on patient survival for patients in whom curative treatment options are not applicable.Transcatheter arterial embolization preceded by the infusion of a mixture of lipiodol(Laboratoire Andre Guerbet,Aulnaysous-Bois,France)and an anticancer drug via the proper hepatic artery,after then embolization of the tumor feeding artery with gelfoam or other embolic agents is needed.After TACE,the recanalization of the tumor feeding artery embolizated in the TACE results in the missing of lipiodol-anticancer drug mixture and which will lead to the low necrosis of tumor and also the main causes of the progress of the tumor.Because embolization is a vital in TACE,an understanding of embolization efficacy in these treatments will allow evaluation of the effectiveness of these treatments.TACE with KMG microballoon has been shown to be an effective treatment for intrahepatic lesions of HCC,although it is not widely used.The aims of the present study are to compare the embolization efficacy and treatment effectiveness of TACE with KMG microballoon versus those of transcatheter arterial chemoembolization with Gelfoam particle for the treatment of patients with unresectable HCC or patients with HCC who rejected the resection,and to evaluate the correlation between embolization efficacy of TACE and treatment effectiveness of these treatments in transarterial treatment of patients with HCC.PurposeTo compare the embolization efficacy and treatment effectiveness of transarterial chemoembolization with KMG microballoon versus those of TACE with Gelfoam particles and evaluate the correlation between embolization efficacy and treatment effectiveness of these treatments for hepatocellular carcinoma(HCC).Materials and MethodsA case-controlled study was undertaken with 50 patients admitted to the The First Affiliated Hospital of Guangxi Traditional Chinese Medical University(Nanning,China)between January 2010 to December 2012 in each group matched based on tumor characteristics,performance status and Child-Pugh grade.Overall survival time was defined as the duration from the first date of Lipiodol-ethanol treatment to the date of death from any cause or the date of last follow-up.Primary endpoints of this study were overall survival,embolization efficacy(Lipiodol retention within tumor at 1 month after the 1st TACE)and treatment effectiveness evaluated by tumor response,disease progression,progression-free survival,and overall survival.The secondary endpoint was correlation between embolization efficacy and treatment effectiveness.Survival curves were calculated by Kaplan-Meier method and compared by log-rank test.Univariate analysis was performed to select potentially explanatory variables.Continuous variables were expressed as means with SDs or medians with ranges.Categoric variables were expressed as percentages.To determine statistically significant difference between two groups,the t-test or the ?2 test was used.A two-tailed P value lower than 0.05 was considered statistically significant.Data were analyzed with IBM SPSS statistics version 22.ResultLipiodol retention was greater in the KMG-TACE group(81.32%±13.322%vs 50.78%±19.723%;P<.0001).The Intrahepatic disease progression at 2 year was higher in the Gelfoam-TACE group(68%vs 48%;P=0.043)and the progression-free survival at 2 year was higher in the KMG-TACE group(46%VS 26%;P=0.037).One-and 2-year overall survival rates were higher in the KMG-TACE group(82%and 72%,respectively,vs 60%and 38%,respectively;P<0.05).One-and 2-year extrahepatic disease progression rates were lower in the KMG-TACE group(P<0.005).There were no differences in progression-free survival and intrahepatic disease progression rates at 1 year between two groups.Patients with greater Lipiodol retention(>60%)had better treatment outcomes at 1 year than those with lesser retention,with higher overall survival rates(82.2%vs 33.3%;P<0.001),lower intrahepatic disease progression rates(4.1%vs 29.6%;P<0.001),lower extrahepatic disease progression rates(0.31%vs 35.5%;P<0.001),and higher progression-free survival rates(74.0%vs 30.4%;P=0.009).Conclusion1.The results of our study show that TACE using KMG microblloon is safe and useful to patients with HCC.In comparison with TACE using gelfoam particles,TACE using KMG microballoon can overcome the loss of iodinated oil to reinforce the effect of vascular embolism and improve curative effect,which lead to better vascular embolic efficiency and,better short-term and long-term efficacy.2.Embolization efficacy as represented by the degree of Lipiodol retention is a useful early predictor of treatment effectiveness.The patients with HCC get higher lipiool retention after TACE probably get better prognosis to those of with poorer lipiool retention.Part 2 Clinical application of PSE with Sodium Alginate Microballoon(KMG)in the treatment of hypersplenismBackgroundPartial splenic embolization(PSE)which was widely used for the treatment of leukocytopenia and thrombocytopenia caused by hypersplenism since the report of Maddison in 1973,and it has been thought to be an effective alternative to splenectomy for its milder injury and fewer complications.In PSE,the embolic agents commonly used are gelfoam particles,steel coil and polyvinyl alcohol(PVA)particles;of with gelfoam particles were more frequentl used.Many reports have showed that the gelfoam particles used for PSE as embolic agents could improve the blood cell counts and blood plate counts.In comparison with gelfoam particles,the KMG microballoon is permanent embolic agent with smaller diameter,with could reach closer to the sinus than the gelfoam particles in PSE,which may mean that PSE with KMG microballoon maybe could effectively improve the effects in alleviating hypersplenism than gelfoam particles.So far,only few reports about KMG microballoon used in PSE have been published,and also all of these reports only show the short time follow-up data.The purpose of this study is to estimate the efficiency and safety of PSE with KMG microballoon to treat the patients with hypersplenism in cirrhosis,in comparison with who underwent PSE with gelfoam particlesPurposeRetrospectively evaluate the efficacy and safety of partial splenic embolization(PSE)using Sodium Alginate Microballoon(KMG)particles for hypersplenism in cirrhosis,as compared to PSE using gelfoam particles.Materials and methodsA case-controlled study was taken in 65 patients with hypersplenism caused by cirrhosis which PSE was performed.The patients were assigned into 2 groups:gelfoam group,32 patients received PSE using gelfoam particles as the embolic material;KMG group,33 patients received PSE using KMG microballoon.The follow-up contents included peripheral blood cell counts(leukocyte,platelet)and complications associated with PSE.ResultsPrior to PSE,there was no significant difference between the two groups in sex,age,Child-Pugh grade,the extent of embolization and peripheral blood cell counts.After PSE,no matter in which group,leukocyte and platelet counts kept significantly higher than pre-PSE duringThe 3-year follow-up period(P<.0001),but the post-PSE improvement of leukocyte and platelet counts was significantly better in PVA group than in gelfoam group(P<.05).Severe complications occurred in7 patients(21.2%)in gelfoam group and 5 patients(16.7%)in KMG group(P>.05).Among 16 patients who received more than 70%embolization of spleen,10(62.5%)developed severe complications,while among 49 patients who received 70%or less embolization of spleen,only 2(4.3%)had severe complications.This difference was statistically significant(P<.05).To determine statistically significant difference between two groups,the t-test or the ?2 test was used.The pairedt-test was used to determine difference before and after PSE.All statistical data were analyzed on the IBM SPSS statistics version 22.Significance was established at P<.05.Conclusion1.The results of our study show that PSE using KMG microblloon is a safe and useful alternative to splenectomy in patients with hypersplenism caused by cirrhosis.in comparison with PSE using gelfoam particles,PSE using KMG microballoon can achieve better short-term and long-term efficacy in alleviating leukocytopenia and thrombocytopenia caused by hypersplenism.2.PSE using KMG microblloon may cause more severe postoperative complications especially in who the extent of embolization more than 70%of splenic volume.So the operater should pay more attention to the extent of embolization.Part 3 Clinical application of Sodium Alginate Microballoon(KMG)in Bronchial artery embolization for the treatment of massive hemoptysisBackgroundBronchial artery embolization(BAE),which has been thought to be an effective alternative to surgery for massive and recurrent hemoptysis because of its milder injury and fewer complications.However,because BAE does not treat the underlying disease,recurrence of hemoptysis is common and requires repeat embolization.Although improvement in embolic agents and embolization techniques have led to technical improvements,there has been no substantial change in the overall recurrence rates since the 1970s.Therefore,there is no consensus on which embolic material is best;so far,absorbable gelfoam particles or polyvinyl alcohol(PVA)particles are most widely used because they are inexpensive,easy to handle.In comparison with gelfoam particles,the KMG microballoon is permanent embolic agent be controlled with regard to embolic size.which may mean that BAE with KMG microballoon maybe could effectively improve the control of hemoptysis of BAE.so far,only few reports about KMG microballoon used in BAE have been published.Therefore,the purpose of our study was to retrospectively analyze the safety and effectiveness of embolic agents KMG microballoon for BAE for control of hemoptysis.PurposeHemoptysis is always a life-threatening respiratory disease and requires emergency management.This study is to evaluate the clinical efficacy and safety of bronchial artery embolization BAE by using Sodium Alginate Microballoon(KMG)in the management of massive hemoptysis and repeated hemoptysis.MethodsThirty patients with massive hemoptysis or repeated hemoptysis who had failed to respond to medical management received BAE.The causative diseases included bronchiectasis n=23 bronchogenic carcinoma n=5 bronchiectasis complicated with tuberculosis n=2.Embolization with sodium alginate microballoon KMG was performed in all patients and additional use of microcoils was carried out in patients complicated with bronchial-pulmonary fistulae.All patients were followed up for at least 1 year after BAE.ResultsBAE was successfully accomplished in all patients.The cessation of hemoptysis was immediately obtained in all patients with a success rate of 100%.Recurrence of hemoptysis within one month after BAE was seen in 2 patients 6.7%(2/30).No serious complications occurred and the mean postoperative hospitalization days of the patients were 9 days.Conclusion1.BAE accepted as an alternative for massive and recurrent hemoptysis who Failure in emostasis with medical treatment for because of its safety,and effectiveness.2.BAE with KMG microballoon provided better hemostasis,higher hemoptysis-free survival rates and no obvious complications,So KMG microballoon can be a alternative agent in BAE.