All interventions were performed in the same robotic angiography suite (Artis Zeego Q, Siemens Healthcare, Forchheim, Germany). The arterial system was accessed by puncture of the right common femoral artery, after introduction of a 4 F sheath (Terumo, Leuven, Belgium) over a 0.035 in. guidewire (Terumo, Leuven, Belgium). In cases of unclear origin of the hepatic arteries a straight diagnostic catheter was introduced and aortography was performed. The celiac trunk was accessed with a cobra (C2) or sidewinder (SIM1) configurated catheter (Cordis, Fremont, California, U.S.) and celiacography was performed. After selective catheterization of the common hepatic artery, overview angiography was performed for assessment of the number and extent of tumor blushes and tumor feeding vessels. A 2.7 F microcatheter (Progreat, Terumo) was introduced for super selective catheterization of the tumor feeders. Epirubicin loaded microparticles (100–300 μm, DC-Beads, BTG, Langweid/Augsburg, Germany) were cautiously applied under fluoroscopy control until near stasis was reached, according to the guidelines of DEB-TACE [4 (link)]. Finally, completion angiography from the common hepatic artery was performed.
4f sheath
Manufactured by Terumo
Sourced in Belgium, Japan
The 4F sheath is a medical device used in various procedures. It provides vascular access by creating a small opening in the patient's blood vessel. The sheath facilitates the introduction of other medical instruments during the procedure.
Automatically generated - may contain errors
7 protocols using 4f sheath
1
Robotic Angiography for DEB-TACE Procedure
2
Hepatic Arterial Chemoembolization Protocol
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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.
3
Endovascular Treatment of Venous Occlusions
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After application of local anesthesia, percutaneous puncture access in the femoral vein was performed, and a catheter was inserted for venography. After identification of the occlusion lesion, a 4 F sheath (Terumo) was inserted for access. Venography was performed by injecting contrast media on both sides of the lesion to identify the length and position of the occluded segment, and to determine the diameter of normal vein close to the lesion. A conventional technique, sharp recanalization, or a flossing wire technique7 (link)
was performed to cross the occlusive lesion. Indications for the placement of a stent were recoiled lesion after PTA or sharp recanalization in this study. The covered stent used was a Viabahn® (W. L. Gore & Associates Inc., CA, USA), and the bare stents used were a ProtégéTM GPSTM (ev3 Inc., MN, USA) and Absolute Pro (Abbott Vascular, CA, USA). The use of a particular stent was based on the lesion characteristics. Post-stent dilation with a corresponding larger balloon was considered if necessary. After stent placement, venography was performed to identify patency.
was performed to cross the occlusive lesion. Indications for the placement of a stent were recoiled lesion after PTA or sharp recanalization in this study. The covered stent used was a Viabahn® (W. L. Gore & Associates Inc., CA, USA), and the bare stents used were a ProtégéTM GPSTM (ev3 Inc., MN, USA) and Absolute Pro (Abbott Vascular, CA, USA). The use of a particular stent was based on the lesion characteristics. Post-stent dilation with a corresponding larger balloon was considered if necessary. After stent placement, venography was performed to identify patency.
4
Iliofemoral Venography Procedure Guideline
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The patient was in supine position in the interventional suite equipped with an angiographic fluoroscopy system (GE Innova 4100-Q, GE Healthcare, Fairfield, CA, USA). The groin area was routinely sterilized and dressed. Under local anesthesia, a skin incision was made above the femoral vein on the affected side. The Seldinger technique, sometimes ultrasound-guided, was used to achieve femoral vein access via the introduction of a 4F sheath (Terumo Corporation, Tokyo, Japan). Under X-ray guidance, a 4F pigtail catheter was introduced and positioned at the external iliac vein. The contrast agent lopamidol (diluted with normal saline to a concentration of 185 mg/150 mL) was injected using a high-pressure auto-injector at a pressure of 600 pounds per square inch, injection speed of 7 mL/s, and injection volume of 15 mL. The exposure field extended from the third lumbar vertebra cephalically to the common femoral vein caudally. Anteroposterior (AP) and lateral projection venography images were obtained while the patient held their breath.
5
Robotic Angiography and TACE with DEB
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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.
6
Hepatic Artery Embolization Strategies
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Hepatic arteries in the CSM-ATO and TAE-CSM groups were embolized with CSM, while the hepatic arteries in the cTACE-ATO and TAE-lipiodol groups were embolized with lipiodol. All rabbits were anesthetized using the aforementioned method in tumor implantation, then the right femoral artery was exposed, and a 4-F sheath (Terumo, Tokyo, Japan) was placed into the artery; after that, a 4-F catheter (Terumo) was inserted into the common hepatic artery to identify the hepatic artery anatomy. A 2.7-F coaxial microcatheter (Terumo) was then catheterized to the left hepatic artery, and the following treatments were conducted respectively according to the method previously described in grouping and treatment. After the treatment, the sheath and the catheter were removed from the artery and the wound was sewn up.
7
Bronchial Artery Embolization Procedure
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The arterial system was accessed through the right common femoral artery. A 4F sheath (Terumo, Leuven, Belgium) was placed. In the case of an unclear origin of the bronchial arteries, an aortography was performed using 4F pigtail configured catheters. For access to bronchial arteries, C2, SIM1, SOS, or H1 configured catheters were used. Selective angiography and intubation were performed using a 2,7F microcatheter (Progreat, Terumo, Leuven, Belgium). Embolic agents were coils (n = 68), histoacryl (n = 19), PVA agents (n = 1), vascular plugs (n = 1), or combinations of different agents (n = 11), according to the preference of the interventional radiologist, as well as the site of bleeding and vessel size. Successful embolization was defined as complete devascularization of the treated peripheral bronchial artery system.
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