Korean J Radiol.  2007 Jun;8(3):225-230. 10.3348/kjr.2007.8.3.225.

A New Technique for Superselective Catheterization of Arteries: Preshaping of a Micro-Guide Wire into a Shepherd's Hook Form

• Baek JH
• Chung JW
• Jae HJ
• Lee W
• Park JH

• KMID: 1779438
• DOI: http://doi.org/10.3348/kjr.2007.8.3.225

Abstract

OBJECTIVE
We wanted to introduce a new technique for superselective catheterization of arteries with preshaping of a micro-guide wire into a shepherd's hook form, and this is useful for superselection of small arteries branching at an acute angle from a large parent artery for the treatment of tumors and hemorrhages. MATERIALS AND METHODS: We developed a superselective catheterization technique by using preshaping of a micro-guide wire into a shepherd's hook form. We encountered six patients in our practice for whom we failed to catheterize the small tumor-feeding arteries that branched at an acute angle from wide parent arteries during chemoembolization of hepatocellular carcinoma; the parent arteries were the right inferior phrenic artery (n = 4) and the left gastric artery (n = 1) from the celiac axis with celiac stenosis due to compression by the median arcuate ligament and the proper hepatic artery from the gastroduodenal artery (n = 1) in a patient who had celiac axis occlusion with collateral circulation via the pancreaticoduodenal arcade from the superior mesenteric artery. In these consecutive six patients, we tested the usefulness of this new technique with employing preshaping of a micro-guide wire into a shepherd's hook form for superselective catheterization of targeted vessels. RESULTS: The target arteries were successfully catheterized and satisfactory transcatheter arterial chemoembolization was performed in all six patients. There were no significant complications such as arterial dissection. CONCLUSION: We developed a technique that is effective for superselection of vessels with preshaping of micro-guide wire into a shepherd's hook form, and we successfully applied it during chemoembolization of hepatocellular carcinoma. This technique can be useful for superselection of small arteries that branch from a large parent artery at acute angles for the treatment of tumors and hemorrhages.

Keyword

Angiography; Arteries, celiac; Arteries, stenosis or obstruction; Liver neoplasms, chemotherapeutic infusion

MeSH Terms

Adult
Aged
Arterial Occlusive Diseases/therapy
*Arteries
Carcinoma, Hepatocellular/*blood supply
Catheterization/*instrumentation/*methods
Chemoembolization, Therapeutic
Dilatation, Pathologic/therapy
Humans
Liver Neoplasms/*blood supply
Male
Middle Aged
Retrospective Studies
Stomach/blood supply

Figure

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  Fig. 1 Conceptual illustrations of selective catheterization with use of preshaping of a micro-guide wire into a sphepherd's hook form. A. The micro-guide wire advances through the stenotic segment of the greater vessel into the distal portion that shows post-stenotic dilatation. It then rotates to recover its preshaped form. B. After recovery of the preshaped shepherd's hook form, the micro-guide wire is pulled back. C. During its backward movement, the tip of the micro-guide wire catches the opening of the targeted vessel, such as right inferior phrenic artery. D. After the tip catches the opening of the targeted vessel, micro-guide wire advances into it. E. As the wire stays in the targeted vessel, the microcatheter advances coaxially. F. Finally, the micro-guide wire and microcatheter proceed together into the target vessel.

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  Fig. 2 Selection of the left gastric artery from the celiac artery with preshaping of a micro-guide wire into a shepherd's hook form. A. Two viable tumors are seen in segment 4 and segment 8 of the liver during the arterial phase of contrast-enhanced CT (open arrows). B. The angiographic image shows stenosis of the proximal celiac artery due to the external compression by the median arcuate ligament and the post-stenotic dilatation (open arrows). The left gastric artery arises at an acute angle at the proximal segment of the celiac artery (open arrowhead). C. The replaced left hepatic artery from the left gastric artery supplies the tumor in segment 4. D. The micro-guide wire recovers its preshaped form after passing the opening of the microcatheter in the dilated segment of celiac artery. E. The micro-guide wire is being retracted. F. The tip of the micro-guide wire passes through the orifice of the right inferior phrenic artery. G. The micro-guide wire is placed in the proximal portion of the right inferior phrenic artery and the microcatheter advances coaxially. H. A tumor in segment 4 is well demonstrated angiographically. I. Successful chemoembolization was done for the tumor in segment 4.

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