Microcatheter

Bevacizumab [Avastin, Roche Pharma (Switzerland) Ltd.] was administered at 7.5 mg/kg every 3 weeks until tumor progression or the occurrence of intolerant adverse events (AEs). Sintilimab, a PD-1 inhibitor (Innovent Biologics Suzhou Co. Ltd., China), was administered at 200 mg every 3 weeks, starting on the same day of bevacizumab administration.
HAIC was performed within 3 days after sintilimab and bevacizumab were administrated. After femoral artery puncture and catheterization, arteriography of the coeliac artery (CA) and superior mesenteric artery (SMA) was performed to detect the tumor blood supply. Then, a microcatheter (Terumo Corp., Tokyo, Japan) was inserted into the proper hepatic artery. We did not embolize gastroduodenal artery (GDA) and right gastric artery (RGA) which are routinely performed at other centers (10 (link),12 (link),14 (link)) to make the chemotherapeutics cover the hilar region of the liver. A modified FOLFOX-6 regimen (oxaliplatin at 85 mg/m² from hour 0 to 2 on day 1; leucovorin at 400 mg/m² from hour 2 to 3 on day 1; 5-fluorouracil at 400 mg/m² bolus at hour 3 on day 1; 5-fluorouracil at 2,400 mg/m² over 46 hours on days 1–2) was then administrated.

We accessed the right common femoral artery in every patient and a 5-Fr introducing angiographic sheath (Terumo Corporation, Tokyo, Japan) was placed. A 5-Fr Cobra catheter (Cook, Bloomington, IN, USA) was used to perform nonselective angiograms of the internal iliac arteries in order to achieve a general understanding of the vascular anatomy associated with the uterine AVM; the right internal iliac artery was selected after creating a Waltman loop with the Cobra catheter. In lateralized UVMs, i.e. UVMs located predominantly off the midline and toward one side, the dominant uterine artery ipsilateral to the lesion was initially super-selected using a microcatheter ranging from 2.0 to 2.4 Fr (Terumo Corporation, Tokyo, Japan). Particulate embolic materials such as gelatin sponge pledgets (Gelfoam; Pharmacia & Upjohn Co., Kalamazoo, MI, USA) or polyvinyl alcohol particles (Contour; Boston Scientific, Cork, Ireland) were commonly used, yet micro-coils were occasionally chosen. Aor-tograms were obtained after bilateral UAE in all patients in order to identify any extra-uterine blood supply.

To evaluate the CT tracking property of Au-Hyp-NP via intra-arterial injection, three rabbits bearing VX2 orthotopic liver tumors were employed.^{53 (link)} After iodinated contrast-enhanced CT confirmation of tumor size over 1 cm (Fig. S6†), rabbits were prepared to conduct selective intra-arterial injection. After induction of general anesthesia with 2.5% inhalational isoflurane, the femoral artery was exposed and a 5 F vascular sheath was inserted. Then a microcatheter (Terumo Medical Corporation, Japan) was used to selectively catheterize the proper hepatic artery under fluoroscopy. Angiography was performed to identify the characteristic tumor staining using 1 mL iohexol contrast injection (Fig. S6†). Next, the catheter was left in position and the animals were transferred to the CT scanning system. Au-Hyp-NPs were injected via the catheter at a gold dose of 1.5 mg kg⁻¹, then repeated CT scanning was performed to obtain the tumor images at the following time points: before injection, 5 min, 30 min, and 60 min after injection. All images were transmitted into a picture archiving and communication system (PACS) to conduct further analysis.