Hepatic Arterial Chemoembolization Protocol

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.