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. 2016 Jun;39(6):824-30.
doi: 10.1007/s00270-016-1296-3. Epub 2016 Jan 27.

Novel Software-Assisted Hemodynamic Evaluation of Pelvic Flow During Chemoperfusion of Pelvic Arteries for Bladder Cancer: Double- Versus Single-Balloon Technique

Kiyohito Yamamoto  1 , Kazuhiro Yamamoto  2 , Go Nakai  2 , Haruhito Azuma  3 , Yoshifumi Narumi  2
Affiliations

Novel Software-Assisted Hemodynamic Evaluation of Pelvic Flow During Chemoperfusion of Pelvic Arteries for Bladder Cancer: Double- Versus Single-Balloon Technique

Kiyohito Yamamoto et al. Cardiovasc Intervent Radiol. 2016 Jun.

Abstract

Purpose: Approximately 83 % of patients with bladder cancer have achieved a complete response after undergoing a novel bladder preservation therapy involving balloon-occluded intra-arterial infusion chemotherapy (BOAI) using a four-lumen double-balloon catheter, known as the Osaka Medical College regimen. This study aimed to show the quantitative difference in hemodynamics of the bladder arteries using syngo iFlow (Siemens Healthcare, Erlangen, Germany), which provides an automatic tool for quantitative blood flow analysis between double BOAI (D-BOAI) and conventional single BOAI (S-BOAI).

Materials and methods: Fifty patients were included. The catheters were introduced into both posterior trunks of the internal iliac arteries via contralateral femoral artery access. A side hole between the distal and proximal balloons was placed at the origin of each bladder artery to allow clear visualization of angiographic flow of the injected agent into the urinary bladder. Digital subtraction angiography was used during analysis with the syngo iFlow to evaluate the hemodynamics of the contrast medium in the pelvic arteries during BOAI. The comparative change in the amount of contrast medium in the bladder arteries between D-BOAI and S-BOAI was assessed using syngo iFlow.

Results: One-hundred pelvic sides were analyzed. The amount of contrast medium in the bladder arteries using D-BOAI was more than twice that using S-BOAI (right, 3.03-fold; left, 2.81-fold).

Conclusion: The amount of contrast medium in the bladder arteries using D-BOAI was higher than that using conventional S-BOAI. This may increase the anticancer drug concentration in the affected bladder, leading to a good clinical response.

Keywords: Double balloon-occluded arterial infusion; Invasive bladder cancer; Syngo iFlow.

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Figures

Fig. 1
Fig. 1
Four-lumen double-balloon catheter. Two of the four lumens are used for balloon inflation. The distance between the two balloons is 4 cm. The diameter of the balloon is 12 mm. An anticancer drug or contrast medium is injected through the side hole
Fig. 2
Fig. 2
Schema of the four-lumen double-balloon catheter. The first lumen is the tip hole used to insert the guide wire. The second lumen is a side hole used to inject the anticancer drug or contrast medium. The third lumen is used to inflate the distal balloon. The fourth lumen is used to inflate the proximal balloon
Fig. 3
Fig. 3
Schema of double and single balloon-occluded arterial infusion (BOAI). A Angiography with both distal and proximal balloons inflated [double BOAI (D-BOAI)]. B Angiography with only the proximal balloon inflated [single BOAI (S-BOAI)]. Double balloon catheters (6 Fr) are introduced into both superior gluteal arteries via contralateral femoral artery access. Side holes between the distal and proximal balloons are placed at the origin of each bladder artery to allow clear visualization of angiographic flow of the injected agent into the urinary bladder. Rt right, Lt left
Fig. 4
Fig. 4
Two patterns of BOAI angiography in a 52-year-old man with invasive urothelial carcinoma. A Angiography with both distal and proximal balloons inflated (D-BOAI). B Angiography with only the proximal balloon inflated (S-BOAI). Angiography confirms greater accumulation of contrast medium in the bladder arteries with D-BOAI than with S-BOAI (arrows)
Fig. 5
Fig. 5
Color-coded images after postprocessing of digital subtraction angiography images of the same patient as shown in Fig. 4 using syngo iFlow. A Angiography with both distal and proximal balloons inflated (D-BOAI). B Angiography with only the proximal balloon inflated (S-BOAI). The amount of blood flow into the bladder arteries using D-BOAI is quantitatively greater than that using S-BOAI (right, 1.44-fold; left, 1.92-fold)
Fig. 6
Fig. 6
Color-coded images and time–intensity curves after injection of contrast medium. A Angiography with both distal and proximal balloons inflated (D-BOAI). B Angiography with only the proximal balloon inflated (S-BOAI). Red, pink, blue, and green regions of interest (ROIs) were placed on the ipsilateral side hole of the catheter, bladder artery, inferior gluteal artery, and superior gluteal artery, respectively. The red ROI (on the side hole of the catheter) was defined as the reference point. The area under the curve was calculated as the sum of the relative density to that of the reference point at each time point divided by the frame rate
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References

    1. Azuma H, Kotake Y, Yamamoto K, et al. Effect of combined therapy using balloon-occluded arterial infusion of cisplatin and hemodialysis with concurrent radiation for locally invasive bladder cancer. Am J Clin Oncol. 2008;31(1):11–21. doi: 10.1097/COC.0b013e318136e27a. - DOI - PubMed
    1. Azuma H, Yamamoto K, Inamoto T, et al. Total cystectomy versus bladder preservation therapy for locally invasive bladder cancer: effect of combined therapy using balloon-occluded arterial infusion of anticancer agent and hemodialysis with concurrent radiation. Am J Clin Oncol. 2009;32(6):592–606. doi: 10.1097/COC.0b013e318199fb42. - DOI - PubMed
    1. Azuma H, Inamoto T, Takahara K, et al. Effect of a novel bladder preservation therapy, BOAI-CDDP-radiation (OMC-regimen) Int J Oncol. 2013;43(1):79–87. - PubMed
    1. Azuma H, Inamoto T, Takahara K, et al. A great option for elderly patients with locally invasive bladder cancer, BOAI-CDDP-radiation (OMC regimen) Int J Oncol. 2013;43(4):1087–1094. - PubMed
    1. Azuma H, Inamoto T, Takahara K, et al. The novel bladder preservation therapy BOAI-CDDP-radiation (OMC-regimen): a new treatment option for invasive bladder cancer patients with lymph node metastasis. Int J Oncol. 2014;44(6):1895–1903. - PubMed

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