Brazilian Journal of Anesthesiology
Brazilian Journal of Anesthesiology
Original Investigation

Hemodynamic course during ablation and selective hepatic artery embolization for metastatic liver carcinoid: a retrospective observational study

Evolução hemodinâmica durante a ablação e embolização seletiva da artéria hepática para carcinoide hepático metastático: um estudo observacional retrospectivo

Nathan J. Vinzant, Mariana L. Laporta, Juraj Sprung, Thomas D. Atwell, Christopher J. Reisenauer, Tasha L. Welch, Phillip J. Schulte, Toby N. Weingarten

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Manipulation of carcinoid tumors during ablation or selective hepatic artery embolization (transarterial embolization, TAE) can release vasoactive mediators inducing hemodynamic instability. The main aim of our study was to review hemodynamics and complications related to minimally invasive treatments of liver carcinoids with TAE or ablation.

Electronic medical records of all patients with metastatic liver carcinoid undergoing ablation or TAE from 2003to 2019 were abstracted. Noted were severe hypotension (mean arterial pressure [MAP] ≤ 55 mmHg), severe hypertension (systolic blood pressure ≥ 180 mmHg), and perioperative complications. Associations of procedure type and pre-procedure octreotide use with intraprocedural hemodynamics were assessed using linear regression. A robust covariance approach using generalized estimating equation method was used to account for multiple observations.

A total of 161 patients underwent 98 ablations and 207 TAEs. Severe hypertension was observed in 24 (24.5%) vs.15 (7.3%), severe hypotension in 56 (57.1%) vs. 6 (2.9%), and cutaneous flushing observed in 2 (2.0%) vs. 48 (23.2%) ablations and TAEs, respectively. After adjusting for preprocedural MAP, ablation was associated with lower intraprocedural MAP compared to TAE (estimate -27 mmHg, 95%CI -30 to -24 mmHg, p <  0.001). Intraprocedural declines in MAP were not affected by preprocedural use of octreotide (p =  0.7 for TAE and p =  0.4 for ablation).

Ablation of liver carcinoids was associated with substantial hemodynamic instability, especially hypotension. In contrast, a higher number of TAE patients had cutaneous flushing. Preprocedural use of octreotide was not associated with attenuation of intraprocedural hypotension.


Ablation,  Carcinoid tumor,  Embolization,  Hypertension,  Hypotension,  Octreotide,  Serotonin



A manipulação de tumores carcinoides durante a ablação ou embolização seletiva da artéria hepática (embolização transarterial, ETA) pode liberar mediadores vasoativos induzindo instabilidade hemodinâmica. O principal objetivo do nosso estudo foi revisar a hemodinâmica e as complicações relacionadas aos tratamentos minimamente invasivos dos carcinoides hepáticos com ETA ou ablação.


Os prontuários médicos eletrônicos de todos os pacientes com carcinoide hepático metastático submetidos a ablação ou ETA de 2003 a 2019 foram coletados. Foram observadas hipotensão grave (pressão arterial média [PAM] ≤ 55 mmHg), hipertensão grave (pressão arterial sistólica ≥ 180 mmHg) e complicações perioperatórias. As associações do tipo de procedimento e do uso de octreotida pré-procedimento com a hemodinâmica intraprocedimento foram avaliadas por meio de regressão linear. Uma abordagem robusta de covariância usando o método de equação de estimativa generalizada foi usada para explicar múltiplas observações.


Um total de 161 pacientes foram submetidos a 98 ablações e 207 ETAs. Hipertensão grave foi observada em 24 (24,5%) vs. 15 (7,3%), hipotensão grave em 56 (57,1%) vs. ) ablações e ETAs, respectivamente. Após ajuste para PAM pré-procedimento, a ablação foi associada a menor PAM intraprocedimento em comparação com ETA (estimativa -27 mmHg, IC 95% -30 a -24 mmHg, p < 0,001). Os declínios intraprocedimentos na PAM não foram afetados pelo uso pré-procedimento de octreotida (p = 0,7 para ETA e p = 0,4 para ablação).


A ablação de carcinoides hepáticos foi associada a instabilidade hemodinâmica substancial, especialmente hipotensão. Em contrapartida, um maior número de pacientes com ETA apresentou rubor cutâneo. O uso pré-procedimento de octreotida não foi associado à atenuação da hipotensão intraprocedimento.


Ablação; Tumor carcinoide; Embolização; Hipertensão; Hipotensão; Octreotida; Serotonina


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