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To evaluate the self-expandable metallic stent therapy for inferior vena caval obstruction (IVCO) secondary to malignant liver tumors, changes in caval pressure, the symptoms and hemobiochemical values were observed. Among 16 IVCO cases with higher caval pressure than 20 cmH2O at the peripheral caval lumen to the stenosis, nine cases consisting of five extracaval compression cases and four intravenous tumor thrombi cases subjected the stent therapy. Other three subjected radiotherapy and the other four cases inactive supportive care. Immediately after the Z-stent implantation, the averaged caval pressure distal to the stenosis decreased from 27.7 +/- 3.5 cmH2O to 14.7 +/- 2.6 cmH2O. One case developed 8 cmH2O increase of right atrial pressure but no lung edema. The urine excretion volume increased after stent. The decrease in caval pressure correlated with the urine volume of the day after the stenting (gamma = 0.83), symptomatic improvements of leg edema (gamma = 0.68), ascites (gamma v 0.51) and scrotal edema (gamma = 0.70). Five cases showed gradual increase in platelet number. All elevated LDH and elevated fibrinogen value decreased. These changes would suggest physiologic benefits of the IVC stent therapy. Compression cases showed better improvements and courses than the thrombi cases. Two thrombi cases endured severe conditions suspected of triggered by the procedure. Conclusively, the stent therapy to the IVC obstruction was thought to effect hemodynamically and hematobiochemically.

To evaluate the efficacy of Z-stent therapy for SVC syndrome, we studied changes in the pressure, the diameter of stenotic lumen and the symptoms in the cases of SVC syndrome with higher pressure than 30 cmH2O at distal to the stenosis. The symptoms were classified and graded to be scored up. Immediately after the Z-stent placement into the stenotic lesions, the venous pressure distal to the stenosis decreased from 36.0 +/- 3.4 cmH2O to 12.0 +/- 12.0 cmH2O (p < 0.001), the diameter of stenotic lumen increased from 3.3 +/- 3.4 mm to 14.0 +/- 3.4 mm (p < 0.01). According to the remarkable symptomatic improvements the averaged score decreased from 6.7 to 1.3 (p < 0.01). The pressure, the diameter and the symptom scores were highly correlated each other (magnitude of gamma not equal to 0.9). Among two cases with the right atrial pressure increase by 2 cmH2O after the placement one suffered transient cardiac in compensation due to overload by reperfusion. Conclusively, the Z-stent therapy was very effective on the SVC syndrome in reducing abnormally elevated venous pressure due to the stenosis, and relieving the symptoms, while the pressure monitor was necessary.

We examined 35 untreated patients with unresectable hepatocellular carcinoma who exhibited positivity for both plasma PIVKA-II and serum AFP, and studied the weekly course of these markers from the pre-TAE or -HAI period to the third week of treatment. We correlated changes in these markers with the tumor necrosis rate and the time course on X-ray CT images. One week after TAE, the tumor necrosis rate and the time course of PIVKA-II showed a significant correlation (r = 0.7), while the correlation was between the time course of AFP and the tumor necrosis rate was insignificant (r = 0.2). At two and three weeks after TAE, both the time course of AFP and PIVKA-II showed significant correlations with the tumor necrosis rate. In 16 patients with tumor necrosis rates of not less than 90%, the mean of the actual half-life (AHL) of PIVKA-II was 3.2 days, the shortest was 1.83 days, and 75% of all AHLs clustered from two days to four days, while the mean and shortest AHLs of AFP were six days and 2.98 days, respectively, exhibiting a broader distribution. On the other hand, in three out of the nine cases of hepatocellular carcinoma complicated with portal tumor thrombi, PIVKA-II increased after HAI in spite of a reduction in tumor size. It was suggested that the PIVKA-II level requires careful interpretation in cases of portal vein obstruction after intensive hepatic arterial infusion of anticancer agents.

We developed a method of intraportal placement of a covered stent against portal tumor thrombi. Half around a z-stent was covered with a Dacron mesh sheet. In one case with portal tumor thrombi protruding into the main portal branch, the stent was placed percutaneously-transhepatically, through a coaxial introducer. Immediately after the placement, portal vein was dilated and, which was still patent after six months. No complication has been observed.

One hundred three patients with bladder cancer underwent balloon-occluded arterial infusion. In 66 patients whose therapeutic effects could be evaluated by endoscope, CT and angiography, the anti-tumor effective rate (CR + PR) was 78.8%. In 15 patients who were not treated by trans-urethral resection or total cystectomy but BOAI, one-year cumulative survival rate was 46.7% and the two-year rate 13.3%. The longest survival period after BOAI was 7 years and 8 months. 133Xe activity of bladder tumor area in BOAI was 6.60 times higher than in simple arterial infusion. BOAI was thought to be a promising conservative treatment in advanced bladder cancer.

Thirty-two patients with iliac and femoropopliteal artery occlusions were treated with direct intrathrombotic injection of ultrahigh-dose urokinase (10,000 IU/min). Occlusions ranged from 3 to 25 cm (average 13.3 cm) in length and the total urokinase dose from 120,000 to 1,410,000 IU (average 688,000 IU). The procedure was usually followed by balloon angioplasty to dilate the underlying stenoses. The initial recanalization rate was 96.9%, the two week patency rate 81.3%, and the cumulative one-year patency rate 66.3%. Complications associated with this procedure included three episodes of minimal bleeding, two distal embolisms, one local hematoma, and one low-grade fever. All were well controlled by palliative treatment. Results indicate that this procedure can provide rapid recanalization at a higher success rate and with fewer complications than previously reported.

The following studies were performed to develop a new technique of hyperthermia by vascular catheterization for the treatment of malignant neoplasm. A balloon catheter was inserted into the artery of a cancer-affected organ and inflation of the balloon temporarily occluded the artery, after which an anticancer drug solution warmed to 45 degrees C was infused. The purpose of this technique was to enable the solution to arrive at the affected area undiluted by blood. It would then remain in the organ and act on the lesion. When OK-432 was intravenously administered to induce pyrexia of 40 degrees C, followed by the above-mentioned arterial infusion, it was expected that the effects of hyperthermia and chemotherapy would be synergistic. In cases of liver cancer and urinary bladder cancer subjected to the arterial infusion of warmed anticancer drugs, however, the temperature in the hepatic vein increased by only 0.5 degree C while that in urethra near the tumor increased by only 1 degree C. In the future, further improvement needs to be made to obtain effective local heating with this technique.

A number of reports of regional intraarterial infusion chemotherapy for malignant tumors have been published. Balloon occluded arterial infusion was newly developed by us. Balloon catheter is used for temporal occlusion of the hepatic artery during intraarterial infusion of anticancer drugs. Interruption of the arterial blood flow keeps the drugs at high concentration for a long time in the distal artery to the occluded portion. This procedure has been performed in 87 cases of hepatomas and metastatic liver cancers with the sufficiently good results.