Super-selective catheterization for “one-way valve occlusion” of the common hepatic artery during transcatheter arterial chemoembolization：discussion on the catheterization skill / 介入放射学杂志

ABSTRACT

Objective To discuss the technical skill of super-selective catheterization for “one-way valve occlusion” of the common hepatic artery during transcatheter arterial chemoembolization (TACE). Methods A total of 128 patients with “one-way valve occlusion”of the common hepatic artery were enrolled in this study, who were admitted to authors’ department to receive TACE during the period from 2000 to 2011. The lesions included hepatocellular carcinoma (n = 110), cholangiocellular carcinoma (n = 3) and hepatic metastasis (n=15). “One-way valve occlusion”of the common hepatic artery occurred in 90 patients (70.3%, 90/128) after 2-5 times of TACE had been carried out, and in the other 38 patients (29.7%, 39/128) the “one- way valve occlusion” of the common hepatic artery was recognized at the initial TACE procedure. Super-selective hepatic catheterization was performed via the superior mesenteric artery (SMA) approach or celiac artery (CA) approach using coaxial micro-catheter catheterization technique. The success rate and fluoroscopy time of super-selective catheterization were recorded, and the results were compared between the two approaches. Results A total of 337 times of hepatic super-selection catheterization were performed in 128 patients, with a mean of 2.6 times for each case. The success rate was 100%. Of the 337 procedures, the catheterization was via CA approach in 148 (43.9%, 148/337) and via SMA approach in 189 (56.1%, 189/337). The mean fluoroscopy time in CA approach group was 3.2 minutes(ranged 1-6 minutes), and in SMA group was 15.3 minutes(ranged 5-40 minutes). The difference between the two groups was statistically significant (P < 0.05). Conclusion Super- selective hepatic catheterization for “one-way valve occlusion” of the common hepatic artery can be achieved through SMA approach or CA approach by using coaxial micro-catheter catheterization. Compared with SMA approach, the technique of hepatic catheterization through CA approach is much simpler and the fluoroscopy time is significantly shorter.