Cobra c2

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.

The interventions were performed in a dedicated angiography suite. After applying local anesthesia, unilateral percutaneous femoral artery access was gained. In selected cases, the pre-installed epidural or general anesthesia was maintained throughout the embolizations. 4 F catheters (Cobra C2, Cordis Corp., Miami Lakes, FL, USA) were advanced into both uterine arteries or at least into the anterior divisions of the respective internal iliac arteries. In some cases, at the discretion of the interventional radiologist, coaxial microcatheters (Progreat®, 2.7 F, Terumo Corp., Leuven, Belgium, China) were utilized to engage the uterine arteries. Depending on the chosen catheter, embolizations were performed either with gelfoam pledgets or gelfoam slurry, which are considered temporary embolic agents, until flow stasis in the uterine arteries was achieved (Fig. 1).

The interventions were performed in a dedicated angiography suite. After applying local anesthesia, unilateral percutaneous femoral artery access was gained. In selected cases, the pre-installed epidural or general anesthesia was maintained throughout the embolizations. 4 F catheters (Cobra C2, Cordis Corp., Miami Lakes, FL, USA) were advanced into both uterine arteries or at least into the anterior divisions of the respective internal iliac arteries. In some cases, at the discretion of the interventional radiologist, coaxial microcatheters (Progreat®, 2.7 F, Terumo Corp., Leuven, Belgium, China) were utilized to engage the uterine arteries. Depending on the chosen catheter, embolizations were performed either with gelfoam pledgets or gelfoam slurry, which are considered temporary embolic agents, until flow stasis in the uterine arteries was achieved (Fig. 1).