Radial Artery Approach for Transcatheter Arterial Chemoembolization in Patients with Hepatocellular Carcinoma

PURPOSE: To evaluate the feasibility and usefulness of the transradial approach for intra-arterial chemoembolization therapy in patients with hepatocellular carcinomas. MATERIALS AND METHODS: Twenty-nine patients with hepatocellular carcinoma who underwent intra-arterial chemoembolization via the radial artery approach were involved in this study. All underwent Allen's test to check ulnar arterial patency. In all cases, we used the radial approach hepatic artery (RHA) catheter designed by ourselves, evaluating the selection ability of the hepatic artery using an RHA cathter, the number of punctures, the procedure time, and compression time at the puncture site as well as complications occurring during and after the procedure. RESULTS: Except for three in which puncture failure, brachial artery variation or hepatic artery variation occurred, all procedures were successful. The mean number of punctures was 3.5, and the average duration of the whole procedure was one and half hours. This gradually decreased as the number of procedures increased. The average duration at a compression of puncture site was 12 minutes. There were no major complications. Minor complications included minimal intimal dissection of the radial artery (3.8%), reversible vasospasm of the radial artery (7.7%), hematoma at a puncture site (7.7%) and transient neurologic deficit (3.8%). CONCLUSION: The transradial approach using an RHA catheter for intra-arterial chemoembolization therapy in patients with hepatocellular carcinomas was technically feasible, with acceptable levels of safety. It may be a good alternative to absolute bed rest with a sand bag after the femoral approach.

Effect of Percutaneous Thrombin Injection under Ultrasonography Guidance for Occlusion of Common Femoral Artery Pseudoaneurysm after Failed Ultrasonography-guided Compression: A Case Report

The occurrence of pseudoaneurysm of the femoral artery after catheterization is uncommon. Ultrasonography-guided compression is currently the first choice of treatment, with a success rate of more than 90%. Recently, however, with the increasing use of larger percutaneous instruments and periprocedural anticoagulation, the incidence of pseudoaneurysm unresponsive to ultrasonography-guided compression is increasing. The authors encountered a case of pseudoaneurysm of the common femoral artery which did not respond to the repeated use of this technique, though treatemnt involving was successful. We believe that in ultrasonography-guided percutaneous thrombin injection was successful. We believe that in cases involving occlusion of a a pseudoaneurysm in which ultrasonography-guided mpression has failed, this is a simple, safe, and time-saving procedure.

Brachial Artery Approach for Outpatient Arteriography

PURPOSE: To evaluate the diagnostic usefulness of brachial approach arteriography for outpatients, withparticular regard to safety and image quality. MATERIALS AND METHODS: The angiographic findings and follow-upmedical records of 131 brachial approach arteriographies in 121 outpatients were retrospectively analysed. 5 Fpigtail catheters were used in 125 cases, and 5-F OCU-A catheters were used in three cases of renal arteriography,and three of upper extremity arteriography without catheter. RESULTS: Except for three cases of brachial arterypuncture failure, all procedures were performed successfully. One hundred and fifteen of 119 lower extremityarteriographies were visualized down to the level of the tibioperoneal artery. The non-visualized cases were threein which there was multiple obstruction at the distal common iliac artery and one with insufficient contrastamount due to renal failure. In four cases there were complications : two involved arterial thrombosis, one was anintramuscular hematoma, and one an A-V fistula. CONCLUSION: For outpatients, brachial approach arteriography canreplace the femoral approach. Its image quality is excellent, there are time-cost benefits, and the rate ofcomplications is relatively low.

Ultrasound-guided Compression Repair of pseudoaneurysms and

PURPOSE: For the treatment of arterial lesions occurring after catheterization, ultrasound-guided compressionrepair (UGCR) has recently been introduced. Using this technique, we repeatedly attempted treatment of theselesions and assessed their characteristics, as seen on US. MATERIALS AND METHODS: We prospectively studied 21patients who had suffered arterial injury (16 pseudoaneurysms and five arteriovenous fistulae) during arterialcatheterization. Occlusion of one pseudoaneurysm (PA) occurred spontaneously. UGCR was attempted in 20 casesinvolving arterial injury, including two which had occurred five months earlier. In six lesions, multiple attemptswere necessary. RESULTS: UGCR was successful in 18 (90%) of 20 arterial injuries, and all 15 PAs weresuccessfully treated;eight were completely closed at the first attempt, five were seen on follow-up US to havebeen closed after the first attempt, and two were completely closed at the second attempt. Three of fiveateriovenous fistulae (AVF) were successfully closed, one was completely closed at the first attempt, and two atthe second attempt. Mean compression time was 37(range:3-75)min in AVFs. Mean diameter of the cavity of PAs was3.8(range:1.5-10)cm;mean width of the track was 2.6(range:1-5)mm in PAs and 3.8(range:1.6-8)mm in AVFs. CONCLUSION: USGC can be successful after multiple attempts, even in patients with large cavity lesions and in chronic cases.AVFs with wide necks need a longer compression time and the results of the procedure are poorer.

Radiological Findings and Interventions for Iatrogenic Vascular Injuries

PURPOSE: To evaluate the radiological findings and effectiveness of radiological interventions in patientswith iatrogenic vascular injuries. MATERIALS AND METHODS: We analyzed 50 patients with iatrogenic vascularinjuries treated with radiological intervention. The causes of injuries were surgery(n=20), cardiovascularintervention(n=15), non-cardiovascular radiological intervention(n=14), and endoscopic intervention(n=1). Theinjury had resulted in hemorrhage in 35 cases. The iliac and/or femoral, hepatic, and renal vessels were commonlyinjured. Angiography, ultrasonography with Doppler examination, CT, and CT angiography were performed to diagnosevascular injuries and guide the radiological intervention. The mean follow-up period was 23 months and in 16 caseswas more than one year. RESULTS: The major radiological findings were extravasation, pseudoaneurysm,arteriovenous shunt, or vascular obstruction. To control these lesions, radiological interventions such asembolization(n=36), local urokinase administration, stent insertion, foreign body removal, ultrasonography-guidedcompression, or stent-graft insertion were performed. The clinical problems were immediately controlled by thesingle trials of radiological interventions and did not recur in 40 cases (80%). CONCLUSION: Radiologicalexaminations and interventions are useful in cases with iatrogenic vascular injuries.

Local Vascular Complications of the Puncture Site in Angiography

PURPOSE: To evaluate the types, follow-up studies, and management of local vascular complications of the puncture site in transfemoral angiography. MATERIALS AND METHODS: Fourteen patients who suffered local vascular complications during angiography of postangiographically were evaluated. We reviewed their clinical findings, radiological follow-up studies(Doppler-USG, angiography), treatment and final outcomes. RESULTS: The complications were three cases of perforation which needed emergency treatment, three cases of thrombosis which occurred several hours after angiography, two cases of arteriovenous fistula and two cases of arteriovenous fistula combined with pseudoaneurysm which appeared a few days after angiography, and four cases of pseudoaneurysm that showed variable detection time, from a few days to several months. The causes of complication were faulty puncture sites, carelessness and vascular fragility due to underlying vascular diseases such as diabetes mellitus and atherosclerosis. The complications were evaluated by angiography or doppler-USG and eight cases were treated successfully by interventional methods(manual compression, USG-guided compression, coil embolization,thrombolysis). Five cases needed surgical intervention. It was decided not to treat one case, but only to observe it. CONCLUSION: Local vascular injuries are serious complications occurring during angiography or postangiographically. They may, however, be properly controlled by various interventional techniques. It is important to be aware of their occurrence, findings and method of management.