5 f catheter

TACE was performed by two radiologists with >10 years of interventional therapy experience.8 (link),13 (link) Following the introduction of 5 F catheter (Cook Medical, Bloomington, IN, USA) through the femoral artery, superior mesenteric artery angiography and hepatic arteriography were performed to determine portal patency and intrahepatic tumor blood supply. Then, the 2.7 F microcatheter was placed in the tumor-feeding arteries and confirmed by angiography. Chemoembolization was performed using 50 mg pirarubicin with 5–20 mL of lipiodol (Guerbet Laboratories, Roissy, France). Gelatin sponge particles (350–560 µm) or embolism microspheres (300–500 µm) were added to supplement embolism. When the contrast column cleared within two to five heartbeats, it was considered the endpoint of the embolization.

Sedation was achieved by continuous infusion of propofol (4–6 mg/kg, Jiangsu Enhua Pharmaceutical Co., Ltd., Xuzhou, China). Local anesthesia with 2% lidocaine (5–10 mL) was applied to the puncture site. The steps for the procedure were as follows: (I) the FV access was successfully established by a 9F sheath (90 cm in length for the SVC and PA; 45 cm for the IVC; Cook Medical, Indiana, USA) under the guidance of digital subtraction angiography (DSA; Artis-zeego, Siemens Healthineers, Munich, Germany). (II) A 0.035-inch soft guide wire (Terumo Medical, Tokyo, Japan) and a 5F catheter (100 cm in length; Cook Medical) were introduced through the sheath and reopened the obstructive blood vessels. (III) The initial soft guide wire was replaced with strengthened guide wire to adjust the sheath direction. (IV) The 9F sheath was advanced to the proximal end of the vascular obstructive site, and the location was confirmed by vascular angiography. (V) Forceps biopsy (clamp diameter =6 mm, length =120 mm; Nanjing Micro-tech) was introduced through the 9F sheath to the obstructed area, pushed forward 5–10 mm, and then tightened and pulled out of the sheath. The specimens were evaluated by expert pathologists. The IVFB was performed 3–6 times to obtain satisfactory specimens.

The Seldinger puncture technique was used to puncture the femoral artery, and the 5F catheter (Cook Medical, Bloomington, IN) was delivered to common hepatic or superior mesenteric artery under digital subtraction angiography. Angiography was performed to determine the variations of blood vessels, the presence of arteries in tumor blood supply, and the dyeing conditions. When the superselected catheterization reached the blood supply vessel of tumors, 30 mg epirubicin (Pfizer, New York, NY) was added to 5 to 20 mL of super liquid iodized oil for chemoembolization. If the remaining tumor feeding arteries were still abundant, embospheres with different diameters (Merit Medical Inc, South Jordan, UT) were selected for supplementary embolism. Routine hepatic treatment was performed after surgery.

All patients in both groups received TACE once at least. TACE was conducted by specialists with 10 years` experiences. Under the guidance of digital subtraction angiography (DSA), a 5-F catheter (Cook, Bloomington, Indiana, USA) was placed into the hepatic artery and a 2.7-F microcatheter (Progreat, Terumo, Tokyo, Japan) was inserted selectively into tumor feeding arteries. About 2–20 mL lipiodol and 20–60 mg epirubicin were prepared to make emulsion. Then, the emulsion was administrated into the tumor feeding arteries through the microcatheter. Gelatin sponge particles (350–710 μm, Alicon, Hangzhou, China) were used to embolize completely the tumor feeding arteries. Finally, hepatic artery angiography was performed to validate the complete embolism of the feeding arteries. If the residual lesions were confirmed by enhanced CT, the repeated TACE would be recommended.