Celsite

The catheter/port system (Celsite, B. Braun, Chasseneuil, France) was implanted by fixed catheter tip method as described previously.7 (link) Hepatic arterial angiography prior to port-catheter implantation was performed to assess arterial supply to extrahepatic adjacent organs. The gastroduodenal artery, right gastric artery and left gastric artery were embolized with metallic coils (Tornade, Cook, Bloomington, IL, USA) to prevent the gastrointestinal mucosa injury caused by chemotherapy drugs. In addition, before each hepatic arterial infusion, angiography was performed by injecting contrast agent via the port system to ensure that the port-catheter was not blocked and displaced.

The procedure was implemented under local anesthesia, accessing either through the right femoral or the left subclavian artery. Utilizing the Seldinger technique, a catheter was introduced into the arterial lumen over a 0.035-inch guidewire (Terumo, Tokyo, Japan). Angiography was performed on celiac, superior mesenteric, and extrahepatic arteries that fed the tumor, if present, to assess the anatomy of the hepatic blood supply and tumor arteries. Before HAIC port implantation, collateral branches from extrahepatic arteries were occluded to enhance treatment efficacy. Microcoils (Tornado, Cook, USA) were used to embolize the right gastric artery to prevent chemotherapeutic agents from refluxing into the stomach. A 5 Fr port and catheter (Celsite, B. Braun Medical, Pennsylvania, USA) were placed in the common hepatic artery before the distal end of the catheter was fixed to the gastroduodenal artery using Microcoils. After each cycle of HAIC therapy, 3,000–5,000 U of heparin were injected into the port to prevent catheter occlusion (17 (link)).