4 f straight catheter

The arterial system was accessed through the common right femoral artery. After arterial puncture, a 4-F sheath (Terumo) and a 4-F straight catheter (Terumo) were introduced. An aortography was performed to assess the number and origin of hepatic arteries, and for the detection of abnormal anatomic blood supply to the liver in patients receiving their first treatment, especially if the anatomic blood supply was not clear from cross-sectional imaging. A 4-F Cobra (C2) or Sidewinder (SIM1) configured catheter (Cordis) was then introduced into the coeliac trunk and coeliacography was performed. From 2014 on, patients received a pre- and post-interventional cone beam CT. For selective catheterisation of hepatic arteries, a 2.7-F coaxial microcatheter was used (Progreat, Terumo). Selective (18%), or when possible super selective (82%), chemoembolisation was then performed using DC Bead particles (100–300 μm, BTG/Boston Scientific) loaded with 25–100 mg epirubicin. Drug-eluting microspheres were injected slowly under fluoroscopic control until near stasis was reached. After a time interval of approximately 10 min, selective control angiography was performed [21 (link)]. Follow-up CTs/MRIs to check for treatment response were performed every 3 months. The DEB-TACE procedure was repeated for patients with residual or recurrent tumours when feasible and necessary.

In all patients, endovascular intervention was performed using the same robotic digital subtraction angiography system (Artis Zeego Q, VE 40 A, Siemens, Forchheim, Germany). Percutaneous arterial access was achieved through the common femoral artery (19 G needle) under local anesthesia with placement of a 4F sheath (Terumo, Leuven, Belgium). A 4F straight catheter (Terumo, Leuven, Belgium) was utilized for aortography, while a 4F Cobra (C2) or sidewinder (SIM1) catheter was used for entering the coeliac trunk. A 2.7F coaxial microcatheter (Progreat; Terumo, Leuven, Belgium) was used for selective and super-selective access of the hepatic arteries. In case of extrahepatic tumor supply (two patients with a right inferior phrenic artery and one patient with a lumbar artery supply), an embolization of these additional feeders using pushable microcoils was performed. In all cases, a superselective TACE with DEB (100-300 μm DC-Beads (BTG, Langweid/Augsburg, Germany) loaded with 50 mg Epirubicin was conducted.