Polyvinyl alcohol foam embolization particles

TACE was performed by one of four physicians. TACE was performed by placing a 5-F catheter (Cook, Bloomington, Indiana) or a 2.8-F microcatheter (Renegade Hi-Flo Straight, Boston Scientific, Natick, Mass; Progreat, Terumo, Tokyo, Japan) as superselectively as possible into tumor-feeding arteries. Initially, a lobaplatin solution with a concentration of 0.5 mg/mL was infused into the tumor-feeding vessels. The total lobaplatin level was 20-50 mg and depended on the patient’s body weight. Then, an emulsion of 3–10 mL lipiodol (Lipiodol Ultrafluide; Guerbet, Aulnay-Sous-Bois, France) and 20–60 mg doxorubicin hydrochloride was administered into the feeder vessels. Finally, polyvinyl alcohol particles 300 μm in diameter (Polyvinyl Alcohol Foam Embolization Particles; Cook) mixed with contrast material were administered into the tumor-feeding vessels until arterial flow stasis was achieved. After embolization, angiography of the feeding artery was performed to determine the extent of vascular occlusion. If the feeding artery was not completely occluded, polyvinyl alcohol particle embolism was performed again.

TACE was performed using a 5-Fr RH catheter or microcatheter (Terumo, Tokyo, Japan) as selectively as possible based on the tumor distribution. Initially, an emulsion of 2–20ml lipiodol (Ultrafluide, Guerbet, France) and 20–40 mg doxorubicin hydrochloride was administered into the feeder vessels. The dosages of lipiodol and doxorubicin were determined according to tumor size, vascularity, presence of arterioportal shunt, and the status of liver function. Next, gelatin sponge particles were administered into the feeder vessels until stasis of arterial flow was achieved. In patients with an arterioportal shunt, embolization with polyvinyl alcohol particles (Polyvinyl Alcohol Foam Embolization Particles; Cook Medical Inc, Bloomington, IN, USA) was performed to occlude the shunt.

As has previously been reported (22 (link)), TACE was performed by administering doxorubicin mixed with 5–20 mL lipiodol (Lipiodol Ultrafluide, Laboratoire Guerbet, France) to both groups. The dose of doxorubicin was 50–75 mg/m² (Haizheng Pharmaceutical Co. Ltd., China) adjusted based on patient liver function, tumor size, vascularity, presence of an arterioportal shunt, and body surface area. All tumor-feeding arteries were superselected by a microcatheter (Terumo, Tokyo, Japan), and the mixture was injected at a rate of 1 mL/min until stagnation of blood flow was observed under fluoroscopic guidance. Gelatin sponge particles with a 500–700-um size was used to block feeding arteries of tumors. If an artery–portal vein shunt was performed, it was occluded before mixture embolization by big-size polyvinyl alcohol (Polyvinyl Alcohol Foam Embolization Particles; Cook Medical Inc., Bloomington, IN, USA) or a spiral steel ring based on angiography images and the doctor’s experience.