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Value of Transcatheter Arterial Embolization with Coils and n-Butyl Cyanoacrylate for Long-term Hepatic Arterial Infusion Chemotherapy¹

¹ From the Department of Radiology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-chyo, Kawaramachi-Hirokoji, Kamigyo, Kyoto 602-8566, Japan. Received November 26, 2002; revision requested February 3, 2003; final revision received August 5; accepted August 22. Address correspondence to T.Y. (e-mail: yamagami@koto.kpu-m.ac.jp).

View larger version (35K): [in a new window]   Figure 1.  Schematic of desired catheter position and occluded vessels for infusion with fixed catheter tip method involving the gastroduodenal artery (F). Catheter tip (straight white arrow) is located in the gastroduodenal artery. Side hole (large black arrow) through which anticancer drugs are infused via the port catheter and distributed to intrahepatic arterial branches is opened toward the common hepatic artery (D). Inside lumen of the catheter tip is occluded with the microcoil (curved arrow). Catheter tip is tightly fixed in the gastroduodenal artery with microcoils (small thick arrows) and NBCA-iodized oil (arrowhead) placed on the outside of the catheter. Right gastric artery (G) and branches of the pancreaticoduodenal arcade are embolized with microcoils (small thin arrows). A = celiac artery, B = left gastric artery, C = splenic artery, E = proper hepatic artery, H = dorsal pancreatic artery.

View larger version (141K): [in a new window]   Figure 2a.  Images in a 67-year-old man with liver metastasis from the colon. (a) Arteriogram obtained just after implantation shows correct positioning of port catheter system. Catheter tip is fixed to gastroduodenal artery with six microcoils (long arrow) and NBCA-iodized oil (arrowhead). Right gastric artery is embolized with four microcoils (short arrow). (b) Arteriogram obtained 61 days after implantation shows movement of side hole to celiac arterial site. Blood flow into left gastric artery (arrow) and splenic artery (arrowhead) is shown. Right hepatic artery is not visualized. (c) Superior mesenteric arteriogram shows dilated retroportal artery (arrow) that developed after catheter placement. (d) Celiac arteriogram obtained after TAE of retroportal artery with four microcoils (arrows) and NBCA-iodized oil, which were inserted from the microcatheter advanced in retrograde through the proper hepatic artery via a 5-F catheter located in the celiac artery into the retroportal artery, shows all hepatic arteries converted into a single route via the celiac artery. Note enlarged right inferior phrenic artery (arrowhead). (e) Arteriogram obtained after indwelling catheter was replaced by a second one. Tip is fixed in the splenic artery with four microcoils and NBCA-iodized oil with the side-hole opening in the celiac artery. Good patency of all hepatic arterial branches is shown. Note that left gastric artery (arrowhead) and right inferior phrenic artery (arrow) are both embolized with three microcoils. (f) Transverse CT images obtained during arteriography after implantation of second catheter system shows good distribution of contrast agent over entire liver.

View larger version (159K): [in a new window]   Figure 2b.  Images in a 67-year-old man with liver metastasis from the colon. (a) Arteriogram obtained just after implantation shows correct positioning of port catheter system. Catheter tip is fixed to gastroduodenal artery with six microcoils (long arrow) and NBCA-iodized oil (arrowhead). Right gastric artery is embolized with four microcoils (short arrow). (b) Arteriogram obtained 61 days after implantation shows movement of side hole to celiac arterial site. Blood flow into left gastric artery (arrow) and splenic artery (arrowhead) is shown. Right hepatic artery is not visualized. (c) Superior mesenteric arteriogram shows dilated retroportal artery (arrow) that developed after catheter placement. (d) Celiac arteriogram obtained after TAE of retroportal artery with four microcoils (arrows) and NBCA-iodized oil, which were inserted from the microcatheter advanced in retrograde through the proper hepatic artery via a 5-F catheter located in the celiac artery into the retroportal artery, shows all hepatic arteries converted into a single route via the celiac artery. Note enlarged right inferior phrenic artery (arrowhead). (e) Arteriogram obtained after indwelling catheter was replaced by a second one. Tip is fixed in the splenic artery with four microcoils and NBCA-iodized oil with the side-hole opening in the celiac artery. Good patency of all hepatic arterial branches is shown. Note that left gastric artery (arrowhead) and right inferior phrenic artery (arrow) are both embolized with three microcoils. (f) Transverse CT images obtained during arteriography after implantation of second catheter system shows good distribution of contrast agent over entire liver.

View larger version (167K): [in a new window]   Figure 2c.  Images in a 67-year-old man with liver metastasis from the colon. (a) Arteriogram obtained just after implantation shows correct positioning of port catheter system. Catheter tip is fixed to gastroduodenal artery with six microcoils (long arrow) and NBCA-iodized oil (arrowhead). Right gastric artery is embolized with four microcoils (short arrow). (b) Arteriogram obtained 61 days after implantation shows movement of side hole to celiac arterial site. Blood flow into left gastric artery (arrow) and splenic artery (arrowhead) is shown. Right hepatic artery is not visualized. (c) Superior mesenteric arteriogram shows dilated retroportal artery (arrow) that developed after catheter placement. (d) Celiac arteriogram obtained after TAE of retroportal artery with four microcoils (arrows) and NBCA-iodized oil, which were inserted from the microcatheter advanced in retrograde through the proper hepatic artery via a 5-F catheter located in the celiac artery into the retroportal artery, shows all hepatic arteries converted into a single route via the celiac artery. Note enlarged right inferior phrenic artery (arrowhead). (e) Arteriogram obtained after indwelling catheter was replaced by a second one. Tip is fixed in the splenic artery with four microcoils and NBCA-iodized oil with the side-hole opening in the celiac artery. Good patency of all hepatic arterial branches is shown. Note that left gastric artery (arrowhead) and right inferior phrenic artery (arrow) are both embolized with three microcoils. (f) Transverse CT images obtained during arteriography after implantation of second catheter system shows good distribution of contrast agent over entire liver.

View larger version (163K): [in a new window]   Figure 2d.  Images in a 67-year-old man with liver metastasis from the colon. (a) Arteriogram obtained just after implantation shows correct positioning of port catheter system. Catheter tip is fixed to gastroduodenal artery with six microcoils (long arrow) and NBCA-iodized oil (arrowhead). Right gastric artery is embolized with four microcoils (short arrow). (b) Arteriogram obtained 61 days after implantation shows movement of side hole to celiac arterial site. Blood flow into left gastric artery (arrow) and splenic artery (arrowhead) is shown. Right hepatic artery is not visualized. (c) Superior mesenteric arteriogram shows dilated retroportal artery (arrow) that developed after catheter placement. (d) Celiac arteriogram obtained after TAE of retroportal artery with four microcoils (arrows) and NBCA-iodized oil, which were inserted from the microcatheter advanced in retrograde through the proper hepatic artery via a 5-F catheter located in the celiac artery into the retroportal artery, shows all hepatic arteries converted into a single route via the celiac artery. Note enlarged right inferior phrenic artery (arrowhead). (e) Arteriogram obtained after indwelling catheter was replaced by a second one. Tip is fixed in the splenic artery with four microcoils and NBCA-iodized oil with the side-hole opening in the celiac artery. Good patency of all hepatic arterial branches is shown. Note that left gastric artery (arrowhead) and right inferior phrenic artery (arrow) are both embolized with three microcoils. (f) Transverse CT images obtained during arteriography after implantation of second catheter system shows good distribution of contrast agent over entire liver.

View larger version (125K): [in a new window]   Figure 2e.  Images in a 67-year-old man with liver metastasis from the colon. (a) Arteriogram obtained just after implantation shows correct positioning of port catheter system. Catheter tip is fixed to gastroduodenal artery with six microcoils (long arrow) and NBCA-iodized oil (arrowhead). Right gastric artery is embolized with four microcoils (short arrow). (b) Arteriogram obtained 61 days after implantation shows movement of side hole to celiac arterial site. Blood flow into left gastric artery (arrow) and splenic artery (arrowhead) is shown. Right hepatic artery is not visualized. (c) Superior mesenteric arteriogram shows dilated retroportal artery (arrow) that developed after catheter placement. (d) Celiac arteriogram obtained after TAE of retroportal artery with four microcoils (arrows) and NBCA-iodized oil, which were inserted from the microcatheter advanced in retrograde through the proper hepatic artery via a 5-F catheter located in the celiac artery into the retroportal artery, shows all hepatic arteries converted into a single route via the celiac artery. Note enlarged right inferior phrenic artery (arrowhead). (e) Arteriogram obtained after indwelling catheter was replaced by a second one. Tip is fixed in the splenic artery with four microcoils and NBCA-iodized oil with the side-hole opening in the celiac artery. Good patency of all hepatic arterial branches is shown. Note that left gastric artery (arrowhead) and right inferior phrenic artery (arrow) are both embolized with three microcoils. (f) Transverse CT images obtained during arteriography after implantation of second catheter system shows good distribution of contrast agent over entire liver.

View larger version (158K): [in a new window]   Figure 2f.  Images in a 67-year-old man with liver metastasis from the colon. (a) Arteriogram obtained just after implantation shows correct positioning of port catheter system. Catheter tip is fixed to gastroduodenal artery with six microcoils (long arrow) and NBCA-iodized oil (arrowhead). Right gastric artery is embolized with four microcoils (short arrow). (b) Arteriogram obtained 61 days after implantation shows movement of side hole to celiac arterial site. Blood flow into left gastric artery (arrow) and splenic artery (arrowhead) is shown. Right hepatic artery is not visualized. (c) Superior mesenteric arteriogram shows dilated retroportal artery (arrow) that developed after catheter placement. (d) Celiac arteriogram obtained after TAE of retroportal artery with four microcoils (arrows) and NBCA-iodized oil, which were inserted from the microcatheter advanced in retrograde through the proper hepatic artery via a 5-F catheter located in the celiac artery into the retroportal artery, shows all hepatic arteries converted into a single route via the celiac artery. Note enlarged right inferior phrenic artery (arrowhead). (e) Arteriogram obtained after indwelling catheter was replaced by a second one. Tip is fixed in the splenic artery with four microcoils and NBCA-iodized oil with the side-hole opening in the celiac artery. Good patency of all hepatic arterial branches is shown. Note that left gastric artery (arrowhead) and right inferior phrenic artery (arrow) are both embolized with three microcoils. (f) Transverse CT images obtained during arteriography after implantation of second catheter system shows good distribution of contrast agent over entire liver.

View larger version (132K): [in a new window]   Figure 3a.  Arteriograms in a 58-year-old man with hepatocellular carcinoma complicated by duodenal mucosal lesion. (a) Image obtained just after implantation shows correct positioning of port catheter system. Note that right gastric artery is embolized with two microcoils (arrow). (b) Image obtained 56 days after implantation shows newly visualized branch of the pancreaticoduodenal arcade (arrow). Note that left hepatic artery is obstructed. (c) Image obtained with microcatheter advanced into newly visualized branch of the pancreaticoduodenal arcade via a 5-F catheter positioned in the celiac artery shows inflow into duodenum and pancreas. (d) Image obtained after six-microcoil embolization of the branch of the pancreaticoduodenal arcade shows no blood flow into this branch (arrow). Note that multiple tumor stains are seen in both right and left hepatic lobes and that tumor in left lobe is supplied with blood from right hepatic artery through intrahepatic collateral vessels.

View larger version (142K): [in a new window]   Figure 3b.  Arteriograms in a 58-year-old man with hepatocellular carcinoma complicated by duodenal mucosal lesion. (a) Image obtained just after implantation shows correct positioning of port catheter system. Note that right gastric artery is embolized with two microcoils (arrow). (b) Image obtained 56 days after implantation shows newly visualized branch of the pancreaticoduodenal arcade (arrow). Note that left hepatic artery is obstructed. (c) Image obtained with microcatheter advanced into newly visualized branch of the pancreaticoduodenal arcade via a 5-F catheter positioned in the celiac artery shows inflow into duodenum and pancreas. (d) Image obtained after six-microcoil embolization of the branch of the pancreaticoduodenal arcade shows no blood flow into this branch (arrow). Note that multiple tumor stains are seen in both right and left hepatic lobes and that tumor in left lobe is supplied with blood from right hepatic artery through intrahepatic collateral vessels.

View larger version (125K): [in a new window]   Figure 3c.  Arteriograms in a 58-year-old man with hepatocellular carcinoma complicated by duodenal mucosal lesion. (a) Image obtained just after implantation shows correct positioning of port catheter system. Note that right gastric artery is embolized with two microcoils (arrow). (b) Image obtained 56 days after implantation shows newly visualized branch of the pancreaticoduodenal arcade (arrow). Note that left hepatic artery is obstructed. (c) Image obtained with microcatheter advanced into newly visualized branch of the pancreaticoduodenal arcade via a 5-F catheter positioned in the celiac artery shows inflow into duodenum and pancreas. (d) Image obtained after six-microcoil embolization of the branch of the pancreaticoduodenal arcade shows no blood flow into this branch (arrow). Note that multiple tumor stains are seen in both right and left hepatic lobes and that tumor in left lobe is supplied with blood from right hepatic artery through intrahepatic collateral vessels.

View larger version (160K): [in a new window]   Figure 3d.  Arteriograms in a 58-year-old man with hepatocellular carcinoma complicated by duodenal mucosal lesion. (a) Image obtained just after implantation shows correct positioning of port catheter system. Note that right gastric artery is embolized with two microcoils (arrow). (b) Image obtained 56 days after implantation shows newly visualized branch of the pancreaticoduodenal arcade (arrow). Note that left hepatic artery is obstructed. (c) Image obtained with microcatheter advanced into newly visualized branch of the pancreaticoduodenal arcade via a 5-F catheter positioned in the celiac artery shows inflow into duodenum and pancreas. (d) Image obtained after six-microcoil embolization of the branch of the pancreaticoduodenal arcade shows no blood flow into this branch (arrow). Note that multiple tumor stains are seen in both right and left hepatic lobes and that tumor in left lobe is supplied with blood from right hepatic artery through intrahepatic collateral vessels.

View larger version (151K): [in a new window]   Figure 4a.  Images in a 67-year-old man with liver metastasis from the colon. (a) Transverse CT image obtained during arteriography with infusion of contrast agents via the port catheter performed 236 days after implantation shows poor distribution into posterior segment of the liver (arrows). (b) Arteriogram shows correct positioning of port catheter system. Note radiopaque NBCA-iodized oil casts of right inferior phrenic artery (arrows). (c) Transverse CT image obtained during arteriography with infusion of contrast agents via the port catheter performed after embolization of right inferior phrenic artery shows good distribution over entire liver, including posterior segment in which tumors exist.

View larger version (141K): [in a new window]   Figure 4b.  Images in a 67-year-old man with liver metastasis from the colon. (a) Transverse CT image obtained during arteriography with infusion of contrast agents via the port catheter performed 236 days after implantation shows poor distribution into posterior segment of the liver (arrows). (b) Arteriogram shows correct positioning of port catheter system. Note radiopaque NBCA-iodized oil casts of right inferior phrenic artery (arrows). (c) Transverse CT image obtained during arteriography with infusion of contrast agents via the port catheter performed after embolization of right inferior phrenic artery shows good distribution over entire liver, including posterior segment in which tumors exist.

View larger version (150K): [in a new window]   Figure 4c.  Images in a 67-year-old man with liver metastasis from the colon. (a) Transverse CT image obtained during arteriography with infusion of contrast agents via the port catheter performed 236 days after implantation shows poor distribution into posterior segment of the liver (arrows). (b) Arteriogram shows correct positioning of port catheter system. Note radiopaque NBCA-iodized oil casts of right inferior phrenic artery (arrows). (c) Transverse CT image obtained during arteriography with infusion of contrast agents via the port catheter performed after embolization of right inferior phrenic artery shows good distribution over entire liver, including posterior segment in which tumors exist.

View larger version (141K): [in a new window]   Figure 5a.  Arteriograms in 48-year-old woman with liver metastasis from the breast. (a) Replaced right hepatic artery (arrow) arises from superior mesenteric artery. (b) Common hepatic artery arises from celiac artery. Note that falciform artery (arrow) arises from middle hepatic artery. (c) Replaced left hepatic artery arises from left gastric artery, which directly arises from the aorta. (d) Image obtained 2 days after catheter placement following successful conversion of three hepatic arteries into one by means of embolization of replaced right (large arrowhead) and left hepatic arteries (small arrowhead). Right hepatic artery is poorly visualized. Note that right gastric artery (small thick arrow) and falciform artery (curved arrow) are embolized with a microcoil and that right inferior phrenic artery is embolized with NBCA-iodized oil (long thin arrow) (ratio 1:4). (e) Superior mesenteric arteriogram shows recanalization of replaced right hepatic artery, which was embolized with two microcoils. (f) Arteriogram obtained after additional embolization of recanalized replaced right hepatic artery with three microcoils (arrow) and NBCA-iodized oil (arrowhead) (administration rate, 1:1.5) shows good distribution into all intrahepatic arterial branches.

View larger version (158K): [in a new window]   Figure 5b.  Arteriograms in 48-year-old woman with liver metastasis from the breast. (a) Replaced right hepatic artery (arrow) arises from superior mesenteric artery. (b) Common hepatic artery arises from celiac artery. Note that falciform artery (arrow) arises from middle hepatic artery. (c) Replaced left hepatic artery arises from left gastric artery, which directly arises from the aorta. (d) Image obtained 2 days after catheter placement following successful conversion of three hepatic arteries into one by means of embolization of replaced right (large arrowhead) and left hepatic arteries (small arrowhead). Right hepatic artery is poorly visualized. Note that right gastric artery (small thick arrow) and falciform artery (curved arrow) are embolized with a microcoil and that right inferior phrenic artery is embolized with NBCA-iodized oil (long thin arrow) (ratio 1:4). (e) Superior mesenteric arteriogram shows recanalization of replaced right hepatic artery, which was embolized with two microcoils. (f) Arteriogram obtained after additional embolization of recanalized replaced right hepatic artery with three microcoils (arrow) and NBCA-iodized oil (arrowhead) (administration rate, 1:1.5) shows good distribution into all intrahepatic arterial branches.

View larger version (141K): [in a new window]   Figure 5c.  Arteriograms in 48-year-old woman with liver metastasis from the breast. (a) Replaced right hepatic artery (arrow) arises from superior mesenteric artery. (b) Common hepatic artery arises from celiac artery. Note that falciform artery (arrow) arises from middle hepatic artery. (c) Replaced left hepatic artery arises from left gastric artery, which directly arises from the aorta. (d) Image obtained 2 days after catheter placement following successful conversion of three hepatic arteries into one by means of embolization of replaced right (large arrowhead) and left hepatic arteries (small arrowhead). Right hepatic artery is poorly visualized. Note that right gastric artery (small thick arrow) and falciform artery (curved arrow) are embolized with a microcoil and that right inferior phrenic artery is embolized with NBCA-iodized oil (long thin arrow) (ratio 1:4). (e) Superior mesenteric arteriogram shows recanalization of replaced right hepatic artery, which was embolized with two microcoils. (f) Arteriogram obtained after additional embolization of recanalized replaced right hepatic artery with three microcoils (arrow) and NBCA-iodized oil (arrowhead) (administration rate, 1:1.5) shows good distribution into all intrahepatic arterial branches.

View larger version (119K): [in a new window]   Figure 5d.  Arteriograms in 48-year-old woman with liver metastasis from the breast. (a) Replaced right hepatic artery (arrow) arises from superior mesenteric artery. (b) Common hepatic artery arises from celiac artery. Note that falciform artery (arrow) arises from middle hepatic artery. (c) Replaced left hepatic artery arises from left gastric artery, which directly arises from the aorta. (d) Image obtained 2 days after catheter placement following successful conversion of three hepatic arteries into one by means of embolization of replaced right (large arrowhead) and left hepatic arteries (small arrowhead). Right hepatic artery is poorly visualized. Note that right gastric artery (small thick arrow) and falciform artery (curved arrow) are embolized with a microcoil and that right inferior phrenic artery is embolized with NBCA-iodized oil (long thin arrow) (ratio 1:4). (e) Superior mesenteric arteriogram shows recanalization of replaced right hepatic artery, which was embolized with two microcoils. (f) Arteriogram obtained after additional embolization of recanalized replaced right hepatic artery with three microcoils (arrow) and NBCA-iodized oil (arrowhead) (administration rate, 1:1.5) shows good distribution into all intrahepatic arterial branches.

View larger version (144K): [in a new window]   Figure 5e.  Arteriograms in 48-year-old woman with liver metastasis from the breast. (a) Replaced right hepatic artery (arrow) arises from superior mesenteric artery. (b) Common hepatic artery arises from celiac artery. Note that falciform artery (arrow) arises from middle hepatic artery. (c) Replaced left hepatic artery arises from left gastric artery, which directly arises from the aorta. (d) Image obtained 2 days after catheter placement following successful conversion of three hepatic arteries into one by means of embolization of replaced right (large arrowhead) and left hepatic arteries (small arrowhead). Right hepatic artery is poorly visualized. Note that right gastric artery (small thick arrow) and falciform artery (curved arrow) are embolized with a microcoil and that right inferior phrenic artery is embolized with NBCA-iodized oil (long thin arrow) (ratio 1:4). (e) Superior mesenteric arteriogram shows recanalization of replaced right hepatic artery, which was embolized with two microcoils. (f) Arteriogram obtained after additional embolization of recanalized replaced right hepatic artery with three microcoils (arrow) and NBCA-iodized oil (arrowhead) (administration rate, 1:1.5) shows good distribution into all intrahepatic arterial branches.

View larger version (129K): [in a new window]   Figure 5f.  Arteriograms in 48-year-old woman with liver metastasis from the breast. (a) Replaced right hepatic artery (arrow) arises from superior mesenteric artery. (b) Common hepatic artery arises from celiac artery. Note that falciform artery (arrow) arises from middle hepatic artery. (c) Replaced left hepatic artery arises from left gastric artery, which directly arises from the aorta. (d) Image obtained 2 days after catheter placement following successful conversion of three hepatic arteries into one by means of embolization of replaced right (large arrowhead) and left hepatic arteries (small arrowhead). Right hepatic artery is poorly visualized. Note that right gastric artery (small thick arrow) and falciform artery (curved arrow) are embolized with a microcoil and that right inferior phrenic artery is embolized with NBCA-iodized oil (long thin arrow) (ratio 1:4). (e) Superior mesenteric arteriogram shows recanalization of replaced right hepatic artery, which was embolized with two microcoils. (f) Arteriogram obtained after additional embolization of recanalized replaced right hepatic artery with three microcoils (arrow) and NBCA-iodized oil (arrowhead) (administration rate, 1:1.5) shows good distribution into all intrahepatic arterial branches.