Korean J Radiol.  2010 Dec;11(6):648-655. 10.3348/kjr.2010.11.6.648.

A Simplified Technique of Percutaneous Hepatic Artery Port-Catheter Insertion for the Treatment of Advanced Hepatocellular Carcinoma with Portal Vein Invasion

• Choi SY
• Kim AH
• Kim KA
• Won JY
• Lee DY
• Lee KH

• KMID: 1119228
• DOI: http://doi.org/10.3348/kjr.2010.11.6.648

Abstract

OBJECTIVE
We assessed the outcomes of a simplified technique for the percutaneous placement of a hepatic artery port-catheter system for chemotherapy infusion in advanced hepatocellular carcinoma with portal vein invasion.
MATERIALS AND METHODS
From February 2003 to February 2008, percutaneous hepatic artery port-catheter insertion was performed in 122 patients who had hepatocellular carcinoma with portal vein invasion. The arterial access route was the common femoral artery. The tip of the catheter was wedged into the right gastroepiploic artery without an additional fixation device. A side hole was positioned at the distal common hepatic artery to allow the delivery of chemotherapeutic agents into the hepatic arteries. Coil embolization was performed only to redistribute to the hepatic arteries or to prevent the inadvertent delivery of chemotherapeutic agents into extrahepatic arteries. The port chamber was created at either the supra-inguinal or infra-inguinal region.
RESULTS
Technical success was achieved in all patients. Proper positioning of the side hole was checked before each scheduled chemotherapy session by port angiography. Catheter-related complications occurred in 19 patients (16%). Revision was achieved in 15 of 18 patients (83%).
CONCLUSION
This simplified method demonstrates excellent technical feasibility, an acceptable range of complications, and is hence recommended for the management of advanced hepatocellular carcinoma with portal vein thrombosis.

Keyword

Liver cancer; Hepatic arterial catheterization; Percutaneous catheter placement

MeSH Terms

Angiography
Antineoplastic Agents/*administration & dosage
Carcinoma, Hepatocellular/*drug therapy/pathology
*Catheters, Indwelling/adverse effects
Embolization, Therapeutic
Female
Femoral Artery/surgery
Fluoroscopy
*Hepatic Artery
Humans
Infusions, Intra-Arterial
Liver Neoplasms/*drug therapy/pathology
Male
Middle Aged
Portal Vein/*pathology
*Radiography, Interventional
Treatment Outcome

Figure

• 

  Fig. 1 Illustration of our simplified fixed-catheter-tip method with no additional fixation material.

• 

  Fig. 2 Hepatocellular carcinoma treatment using implantable port-catheter system with our simplified fixed-catheter-tip method. 72-year-old man with advanced hepatocellular carcinoma and left portal vein invasion. Transarterial chemoembolization was performed 1-week before procedure. A. Superior mesenteric artery angiography was performed using 5-Fr catheter with nonvisualization of left portal vein (arrows) because of tumor invasion. B. Celiac angiography revealed extensive tumor staining (black arrows) involving left hepatic lobe. Previously treated region of hepatocellular carcinoma involving left lateral segment was not stained (white arrows). C. 5-Fr indwelling catheter with side hole was inserted in right common femoral artery. Tip of catheter was wedged into proximal portion of right gastroepiploic artery. No additional distal tip-fixation material, such as coil or n-butyl cyanoacrylate, was used. Location of side hole was confirmed by test injection of contrast media, and proper hepatic artery (arrow) was opacified. D. 6-month follow-up angiography revealed that location of indwelling catheter was not changed, and hepatic artery (arrow) was patent.

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