Small bowel-origin carcinoid tumor is indolent but may metastasize relentlessly to various sites, including the liver. Over the past 9 years, we have treated a 69-year-old woman who has undergone 5 percutaneous liver ablations, 5 hepatic intra-arterial chemoembolizations, an ovarian cryoablation, and a trans-ventral hernia mesenteric cryoablation. These interventions are all related to her inoperable carcinoid malignancy. After the patient presented with swelling of the abdomen and both lower extremities, computed tomography (CT) angiography was performed, revealing a circumferential hepatic metastatic mass encasing the intrahepatic inferior vena cava (IVC) and extensive third spacing of fluids specific to the IVC distribution below the diaphragm. A venogram of the intrahepatic IVC revealed extrinsic compression causing 95% narrowing of the vessel. A balloon was advanced to the level of the lesion and inflated, increasing the caliber of the vessel. Subsequently, 2 covered aortic stent graft cuffs were deployed in an overlapping fashion within the lumen of the IVC, traversing the area of narrowing. Next, an open-cell aortic dissection stent was placed across both overlapping aortic stents from the renal veins to the hepatic veins. Following this, three 17-gauge cryoablation probes were inserted into the segment 1 intrahepatic lesions encasing the newly stented IVC via an anterior percutaneous approach. Two 10-min freeze cycles were performed with intraoperative CT imaging, demonstrating circumferential coverage of the lesions. Posttreatment venogram revealed patent stent grafts within the intrahepatic IVC, and restoration of vessel patency. No immediate postoperative complications were noted. The patient’s abdominal and lower extremity swelling resolved completely within 1 week after procedure. Two-month follow-up CT demonstrated markedly decreased size of the metastatic lesions and no adverse effects. Six- and 9-month PET-CT scans demonstrated maintained patency of the IVC stent. This palliative procedure allowed the patient to maintain good performance status and alleviated her symptoms of IVC syndrome. The radial force generated by the multiple aortic stents will ostensibly maintain the patency of the intrahepatic IVC. Cryoablation of the encasing metastatic lesion was performed with markedly decreased size of the tumor on the 2-month follow-up.
Gastrointest Tumors

中文翻译：

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下腔静脉综合征是转移性类癌的表现

肠源性小类癌为惰性，但可能无休止地转移到包括肝脏在内的各个部位。在过去的9年中，我们治疗了一位69岁的女性，该女性经历了5次经皮肝切除术，5次肝动脉内化学栓塞术，卵巢冷冻消融术以及经腹腹疝气肠系膜冷冻消融术。这些干预措施均与她无法手术的类癌恶性肿瘤有关。在患者出现腹部和下肢肿胀后，进行了计算机断层扫描（CT）血管造影，发现周围肝转移性肿块包裹了肝内下腔静脉（IVC）和下面IVC分布所特有的第三种广泛的液体间隔膜片。肝内IVC的静脉图显示外在压迫导致血管狭窄95％。气球前进至病变水平并膨胀，从而增加了血管的口径。随后，将两个有盖的主动脉覆膜支架袖带以重叠的方式部署在IVC内腔中，穿过变窄的区域。接下来，从肾静脉到肝静脉跨两个重叠的主动脉支架放置开孔主动脉夹层支架。之后，将三个17号冷冻消融探针通过前经皮入路插入第1段肝内病变中，以包裹新近置入支架的IVC。术中CT成像进行了两个10分钟的冷冻周期，显示了病灶的周向覆盖范围。治疗后的静脉造影显示肝内IVC内有专利的支架移植物，并且血管通畅性得以恢复。没有发现立即的术后并发症。术后1周内患者的腹部和下肢肿胀完全消失。为期两个月的随访CT显示转移灶的大小明显减少，并且没有不良反应。六个月和九个月的PET-CT扫描显示IVC支架保持通畅。姑息治疗使患者保持良好的表现状态并减轻了IVC综合征的症状。表面上，由多个主动脉支架产生的径向力将保持肝内IVC的通畅。在2个月的随访中，冷冻消融了转移灶，肿瘤的大小明显减少。为期两个月的随访CT显示转移灶的大小明显减少，并且没有不良反应。六个月和九个月的PET-CT扫描显示IVC支架保持通畅。姑息治疗使患者保持良好的表现状态并减轻了IVC综合征的症状。表面上，由多个主动脉支架产生的径向力将保持肝内IVC的通畅。在2个月的随访中，冷冻消融了转移灶，肿瘤的大小明显减少。为期两个月的随访CT显示转移灶的大小明显减少，并且没有不良反应。六个月和九个月的PET-CT扫描显示IVC支架保持通畅。姑息治疗使患者保持良好的表现状态并减轻了IVC综合征的症状。表面上，由多个主动脉支架产生的径向力将保持肝内IVC的通畅。在2个月的随访中，冷冻消融了转移灶，肿瘤的大小明显减少。表面上，由多个主动脉支架产生的径向力将保持肝内IVC的通畅。在2个月的随访中，冷冻消融了转移灶，肿瘤的大小明显减少。表面上，由多个主动脉支架产生的径向力将保持肝内IVC的通畅。在2个月的随访中，冷冻消融了转移灶，肿瘤的大小明显减少。
胃肠道肿瘤