Читать книгу Veterinary Surgical Oncology - Группа авторов - Страница 69

Several liquid agents are available for use in vascular occlusion including biological glues (such as cyanoacrylate), sclerosing agents, and gelling solutions (Loffroy et al. 2009). Liquids are not commonly used in the vascular occlusion of tumors. Cyanoacrylate embolizes very quickly upon contact with blood and endothelium (Greenfield 1980; Loewe et al. 2002; Patel and Soulen 2006). In cases of hepatocellular carcinoma that have been deemed nonresectable, glue has been used as an embolic agent (Loewe et al. 2002; Rand et al. 2005). Additionally, humans with liver or biliary neoplasia are sometimes treated by glue embolization of a portal vein branch preoperatively; this induces hypertrophy of the remaining liver (Nagino et al. 1995; de Baere et al. 2010). This hypertrophy of normal tissue may prevent liver failure after resection of the primary tumor (Nagino et al. 1995; de Baere et al. 2010). Sclerosing agents such as ethanol are used for embolotherapy. These agents cause necrosis of the blood vessel wall, and the resulting protein denaturation that occurs results in thrombus formation. Disadvantages of ethanol usage are the associated toxicities such as skin lesions, peripheral nerve palsy, renal failure, thrombophlebitis, lack of radiopacity, and postoperative pain (Wojtowycz 1990b; Valji 2006; Loffroy et al. 2009). In humans, ethanol has been successfully used in several reports for the embolization of renal neoplasia (Wojtowycz 1990b; Munro et al. 2003; Schwartz et al. 2006; Maxwell et al. 2007; Ginat et al. 2009). Gelling solutions consist of a polymer in a solvent, and the commercially available form is PVA copolymer in dimethylsulfoxide (Loffroy et al. 2009). These solutions have been used for treating arteriovenous malformations and endoleaks (persistent aneurysmal sac perfusion after endovascular repair); however, further investigation is necessary to elucidate the role of these agents in the treatment of neoplastic disease (Ginat et al. 2009; Lv et al. 2009; Stiefel et al. 2009; Nevala et al. 2010).