A 5-Fr arterial catheter (Radiofocus; Terumo) was punctured into the femoral artery using the Seldinger technique under the guidance of digital subtraction angiography (Allura Xper FD20, Philips). A 5-Fr hepatic catheter (Radiofocus; Terumo) was then inserted into the hepatic artery through the abdominal aorta. The feeding arteries were incrementally injected with an emulsion composed of a chemotherapeutic agent (anthracycline or platinum, 10–50 mg/m2) combined with 5–20 ML of iodized oil (Lipiodol; Guerbet), followed by 350–560 µm gelatin sponge particles (Gelfoam; Alicon). The endpoint of TACE treatment was achieved when tumor staining diminished and Lipiodol filling appeared in the minute peritumoral portal vein branches. The dosages of chemotherapy agents and iodized oil were determined by the tumor's characteristics and the patient's liver function. Additional TACE procedures were performed as needed upon the detection of intrahepatic recurrence or metastasis. Treatment was discontinued in cases of TACE refractoriness [17] (link), severe complications, or withdrawal of consent.
Radiofocus
Manufactured by Terumo
Sourced in Japan
Radiofocus is a laboratory equipment product manufactured by Terumo. It is designed for use in medical and research settings. The core function of Radiofocus is to provide a precise and controlled environment for various applications.
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10 protocols using radiofocus
1
Transarterial Chemoembolization for Liver Cancer
2
Femoral Artery Access for Interventional Procedures
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After local anesthesia, the right common femoral artery was accessed with an 18-gauge needle (Angiocath; BD) under ultrasonography guidance, and a 10-cm, 5-Fr vascular sheath (Radiofocus; Terumo) was introduced over a 0.035-inch guidewire. Using a 0.035-inch guidewire (Radiofocus; Terumo) and a Roberts uterine (Jungsung Medical), Yashiro (Terumo), or Cobra catheter (Jungsung Medical), the left IIA was catheterized. The right IIA was catheterized using a Waltman loop or by direct selection. Hemostasis was achieved by closing the devices (Perclose, Abbott, or Mynx control, Cordis).
3
Gonadal Vein Embolization for Pelvic Venous Disorders
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Indications for GVE with coils were the presence of PeVD symptoms (CPP, dyspareunia, discomfort or heaviness in the hypogastric area), reflux (>1 s) in GV, PV, UV single-trunk conductive type of GV, the GV diameter < 10 mm, according to transvaginal and transabdominal DUS, and the absence of nutcracker or May-Thurner syndromes, according to DUS, renal venography or multiplanar pelvic venography.
GVE was performed under local anaesthesia with 5.0–10.0 mL of 0.5% lidocaine solution with a patient under intravenous sedation. For the left GV embolization, the transfemoral approach (119 patients) was used, while for the right or both GV embolization, the transjugular approach (31 patients) was used. The vein puncture was performed under ultrasound guidance. The 5F multipurpose angiographic catheters (Radiofocus, Terumo Europe, Leuven; Belgium), standard ‘moving core’ J 0.035” guidewire, and an angled hydrophilic guidewire (Radiofocus; Terumo Corp., Japan) were used. For the GV occlusion, the pushable 0.035” standard stainless-steel coils (Gianturco; William Cook, Bjæverskov, Denmark) and 0.035” coils made of Inconel with interwoven long collagen fibrils (MReye; Cook Medical Inc., Bloomington, IN, USA) were used. The diameter of coils was 8–12 mm, and the length was 10–20 cm. In this study, GVE was not combined with sclerotherapy of GVs.
GVE was performed under local anaesthesia with 5.0–10.0 mL of 0.5% lidocaine solution with a patient under intravenous sedation. For the left GV embolization, the transfemoral approach (119 patients) was used, while for the right or both GV embolization, the transjugular approach (31 patients) was used. The vein puncture was performed under ultrasound guidance. The 5F multipurpose angiographic catheters (Radiofocus, Terumo Europe, Leuven; Belgium), standard ‘moving core’ J 0.035” guidewire, and an angled hydrophilic guidewire (Radiofocus; Terumo Corp., Japan) were used. For the GV occlusion, the pushable 0.035” standard stainless-steel coils (Gianturco; William Cook, Bjæverskov, Denmark) and 0.035” coils made of Inconel with interwoven long collagen fibrils (MReye; Cook Medical Inc., Bloomington, IN, USA) were used. The diameter of coils was 8–12 mm, and the length was 10–20 cm. In this study, GVE was not combined with sclerotherapy of GVs.
4
Transradial Approach for Prostatic Artery Embolization
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Local anesthesia (2% lidocaine) was delivered to the subcutaneous tissues around the left radial artery. This artery was then accessed with a microintroducer kit (Galt) equipped with a 21-G needle under ultrasonography guidance. A 7-cm, 5-French vascular sheath (Radiofocus, Terumo) was placed over the 0.025-inch guidewire. An antispasmatic cocktail (2 mg verapamil, 0.2 mg nitroglycerin, and 2000 IU heparin) was diluted to 20 mL and slowly reinjected [4 (link)]. An additional cocktail was injected every 1 hour through the sheath. Using standard angiography devices including a 125-cm, 5-Fr diagnostic catheter (Davis; Jungsung Medical) and a 180-cm, 0.035-inch guidewire (Radiofocus; Terumo), both internal iliac arteries (IIAs) were accessed under fluoroscopic and 3D real-time navigation guidance. The 3D-guiding system provided a real-time overlay of the 3D roadmap, which could save fluoroscopic time and contrast medium (Fig. 3A ). The prostatic arteries were catheterized using a 150-cm microcatheter (1.7–1.9 Fr; Progreat Lambda, Terumo; Carnelian, Tokai Medical; and Pursue, Merit) and a 165-cm, 0.016-inch guidewire (Meister; Asahi Intecc). Hemostasis was achieved using a compression device (TR band; Terumo). Any conversion from TRA to TFA owing to catheterization difficulty or catheter length was recorded.
5
Intraarterial BM-MSC Delivery in Rete
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After 14 days in culture, 70e80% confluent BM-MSCs were added to the gel as described earlier. The animal was anaesthetised, a left femoral artery cut-down was performed, a short 6F introducer (Glidesheath, Terumo Inc, Japan) was inserted through a retrograde femoral puncture. Under fluoroscopy, a long 0.035 00 guidewire (Radiofocus, Terumo Inc, Japan) was inserted into the left common carotid artery using a 5F vertebral angiography catheter. The short introducer was replaced by a 90 cm long 6F introducer (Destination, Terumo) that reached the left common carotid artery. Baseline angiography through the introducer was performed, allowing the use of road map to catheterise the ascending pharyngeal artery and reach the rete with a 0.014 00 guidewire (Spartacore, Abbott Vascular, Santa Clara, CA, USA) and a 100 cm 5F vertebral catheter (Cook Inc., Bloomington, IN, USA). The hydrogel containing PKH26 labelled BM-MSCs was then injected through the vertebral catheter using a 2 mL syringe. The catheter was then withdrawn and a control angiogram performed through the introducer. The femoral artery was sutured after material removal.
6
Radial Artery Hemostasis Protocol
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The procedure for TRA-TACE is described in a previous study.3 (link) After insertion of a sheath (5-Fr radial access kit, Radiofocus, Terumo) in the left radial artery, patients were given a cocktail consisting of 5 mg of verapamil, 200 μg of nitroglycerine, and 3000 U of heparin diluted in 20 mL of their blood via the vascular sheath.3 (link) The method to achieve hemostasis in the radial artery was based on the patent hemostasis strategy, which requires the maintenance of antegrade blood flow through the radial artery during hemostatic compression.13 (link) The patent hemostasis strategy is briefly described as follows: (1) after removing the guiding catheter, pull out the sheath approximately 2–3 cm; (2) place the center of the radial compression device (Finale, Merit) 2–3 mm proximal to the skin entry site and tighten; (3) remove the sheath completely; (4) decompress the device until minimal bleeding is observed; (5) recompress the device at a level just enough to maintain patent hemostasis; (6) confirm the patency of the radial artery by the reverse Barbeau’s test; and (7) after at least 30 min, remove the device according to the strategy described below.
7
Hepatic Artery Infusion and Embolization
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With the patient under local anesthesia, right femoral access was obtained, and angiography of the superior mesenteric and common hepatic arteries was performed using a 5-Fr Rösch hepatic catheter (Radiofocus; Terumo, Tokyo, Japan). A 3-Fr microcatheter (MicroFerret; Cook, Indiana, USA) was coaxially placed into the proper, lobar, segmental, or subsegmental hepatic artery, and 500 to 1000 mg 5-fluorouracil was infused through the microcatheter for 10 to 15 min. Subsequently, 20 to 40 mg doxorubicin mixed at a 1:1 ratio in an emulsion of iodized oil (Lipiodol; Guerbet, France) was infused, which was followed by embolization with gelatin sponge pledgets (Gelfoam; Upjohn, Missouri, USA) until stasis or near stasis of arterial flow was achieved. Hemostasis at the access site was achieved by manual compression.
8
Transradial Cardiac Catheterization Outcomes
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This is a prospective and observational study where 489 patients were included from April 2011 to July 2015. They underwent elective transradial cardiac catheterization with sameday discharge, after the compression bandage was withdrawn and hemostasis was achieved. All cases were performed across a hydrophilic 5 French sheath (Radiofocus, Terumo, Tokyo, Japan). Patients needing hospitalization due to clinical criteria, comorbidities or other reasons were excluded. A total of 140 (28.6%) patients under acenocumarol therapy and with an INR value in the proper range (group A) were compared with 349 (71.4%) patients (group B) who received the standard anticoagulant therapy with an intraarterial bolus of 5000 UI of unfractionated heparin until the access was achieved. No additional anticoagulant drug was administered to patients from group A. Furthermore, 2.5 mg of verapamil was administered intra-arterially to all patients for prevention of radial spasm.
9
CT-Guided Brachytherapy for Liver Metastases
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The detailed methodology of CT-guided brachytherapy has been described elsewhere [10 (link)]. In brief, placement of the brachytherapy applicators was performed under guidance of a Fluoroscopy-CT (Toshiba, Japan) (for metastasis with a diameter > 20 mm) or an open MRI at 1.0 T (Panorama HFO, Philips Healthcare, Best, The Netherlands) for smaller liver lesions (Fig. 1A -D ). Thirty lesions were treated under CT guidance, twenty-two metastases under open MRI guidance. After adequate patient positioning, puncture of the lesion was performed employing an 18-gauge needle. An angiography sheath of 6 F diameter (Radiofocus, Terumo™, Tokyo, Japan) was inserted over a stiff angiography guide wire (Amplatz, Boston Scientific, Boston, USA). Finally, 16-gauge brachytherapy catheters (Nucletron, Elekta AB, Stockholm, Sweden) were placed in the sheaths. For treatment planning purposes, a contrast-enhanced CT in breathhold technique was acquired after placement of the catheters. The HDR afterloading system (Nucletron, Elekta AB, Stockholm, Sweden) used a 192Iridium source of 10 Ci. The source diameter was < 1 mm. In mean 2 applicators were inserted (range 1-5).
10
Radial Artery Access for Percutaneous Coronary Intervention
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After routine preparation and sterile draping, the skin of the distal flexor aspect of the forearm was infiltrated with 1–2 ml of preservative free 1% lidocaine, 2–3 fingerbreaths above the styloid process. Radial pulse was palpated at that site and radial artery access was obtained using a 20-gauge teflon sheathed needle after which a 0.021′′ guide wire was placed through the teflon cannula into the radial artery lumen, once continuous blood flow was visualized. A 6 french hydrophilic introducer sheath (Radiofocus, Terumo Medical) with outer diameter of 2.65 mm was placed over the guide wire into the radial artery. We did not have any patients in our dataset who had their sheath size upsized during the procedure. 5 mg of Diltiazem and 200 mcg of nitroglycerin were administered via the introducer sheath in an intraarterial fashion. A 0.035′′ J-tipped guidewire was placed in the ascending aorta and a 6 french guide catheter was advanced over the wire.
All patients received aspirin 81 mg orally, and a thienopyridine agent before the procedure. The PCI procedure was completed successfully in 1251 patients. 1 patient developed coronary artery perforation, neccessitating emergent coronary artery bypass graft surgery, and was excluded from the analysis, in view of receiving an ipsilateral radial arterial line catheter for hemodynamic monitoring.
All patients received aspirin 81 mg orally, and a thienopyridine agent before the procedure. The PCI procedure was completed successfully in 1251 patients. 1 patient developed coronary artery perforation, neccessitating emergent coronary artery bypass graft surgery, and was excluded from the analysis, in view of receiving an ipsilateral radial arterial line catheter for hemodynamic monitoring.
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