SIR 2024
Embolization
Brendan Cline, MD
Assistant Professor of Radiology
Duke University Medical Center
Financial relationships: Full list of relationships is listed on the CME information page.
Robert R. Meyerhoff, MD, PhD
Resident, Diagnostic and Interventional Radiology
Duke University
Financial relationships: Full list of relationships is listed on the CME information page.
Charles Y. Kim, MD, FSIR
Professor and Chief of Interventional Radiology
Duke University
Financial relationships: Full list of relationships is listed on the CME information page.
While transarterial therapies including embolization are central to the management of hepatic and other malignancies, no embolization-based strategies for pancreatic tumors have been reported, presumably due to concern for ischemic injury inciting pancreatitis. The purpose of this study was to evaluate the safety and endocrine sequelae of pancreatic particle embolization in a swine model.
Materials and Methods:
Approval from the local IACUC was obtained for this study. Fourteen Yorkshire pigs were obtained and housed in the university vivarium for at least two days prior to intervention. Baseline glucose tolerance testing and serum amylase/lipase levels were obtained followed immediately by particle embolization of the dorsal pancreatic artery to stasis using 100-300-micron particles under general anesthesia. Swine were observed over a period of two weeks to assess for behavioral signs of pain/distress and changes to intake/output. Repeat amylase/lipase values were obtained at 24 and 48 hours. After two weeks, each animal underwent repeat glucose tolerance test and amylase/lipase assay followed by euthanasia and necropsy with gross evaluation and resection of the pancreas, followed by detailed pathologic evaluation.
Results:
Pancreatic embolization was technically successful in all fourteen pigs. All animals survived the two-week follow up without behavioral changes to suggest pain or distress. After one day, activity levels returned to normal in all pigs with normal food intake and average daily weight gain of 0.66 kg. There was a significant increase in amylase and lipase at 24 and 48 hours, which normalized by two weeks. There was no significant difference in glucose tolerance testing results at 2 weeks, consistent with preserved endocrine function. At necropsy, all examined pancreata had fibrosis in the distal body and tail, without gross evidence of inflammation or necrosis elsewhere. On pathologic evaluation, all examined pancreata had fibrosis in the embolized portions with no evidence of inflammation or necrosis in adjacent tissue.
Conclusion:
Particle embolization of the pancreas was well tolerated by all tested swine without clinical evidence of pancreatitis or adverse effect on food intake or endocrine function. Pathologic analysis confirmed lack of active pancreatic inflammation at two weeks post embolization. These results suggest that pancreatic embolization strategies may be worth further investigation for the treatment of pancreatic malignancies.