PROCEDURE: 

  1. Superior mesenteric artery angiogram
  2. Celiac axis arteriogram
  3. Hepatic artery angiogram
  4. Chemoembolization of the subselective  ___ hepatic artery
  5. Post-embolization angiogram of the subselective     hepatic artery
  6. Limited right common femoral artery angiogram and deployment of a StarClose closure device

 

DATE OF PROCEDURE:    

INDICATION:    -year-old     with a history of hepatocellular carcinoma who is referred for local regional therapy with drug eluting beads.

MEDICATIONS: Versed and Fentanyl were titrated to effect for moderate sedation.  Premedications given per protocol.

OPERATOR: John Doe, MD (Attending)/Jane Doe, MD (Fellow)    

CONTRAST:    

FLUOROSCOPY TIME:     minutes

ACCESS SITE: Right common femoral artery

 

PROCEDURE:

The risks, benefits, and alternatives to the procedure and sedation were explained to the patient, and written informed consent obtained.

With the patient in the supine position, the right groin was prepped and draped in standard sterile fashion. The skin and subcutaneous tissue overlying the right common femoral artery were infiltrated with 2% lidocaine for local anesthetic. The common femoral artery was accessed with a micropuncture needle. A 0.018″ Nitinol wire was advanced through the needle into the artery. The needle was exchanged for 5 French transitional catheter. The wire and inner dilator were removed and 0.035″ Bentson wire was advanced into the artery. The transitional catheter was exchanged for a 5 French vascular sheath, and the sheath was attached to a heparinized, pressurized bag of saline.  

A 5 French Sim-I Glidecath was advanced over the Bentson wire and used to select the superior mesenteric artery. Digital subtraction angiography was performed.  Next, the Glidecath was used to select the celiac axis. Digital subtraction angiography was performed. A 2.4 French Renegade STC catheter was advanced over a 0.014″ Transend guidewire coaxially through the Glidecath into the right hepatic artery and a corresponding arteriogram was obtained. The catheter was further subselectively advanced into the anterior branches of the right hepatic lobe and a corresponding arteriogram was obtained. Subsequently, this vessel was embolized using 100-300 micron LC Beads coated with Doxorubicin. The catheter was then removed and disposed of appropriately. 

A right common femoral angiogram was obtained through the sheath.  The sheath was removed and the arteriotomy was closed with a StarClose device. A sterile dressing was applied. The patient tolerated the procedure well and left the angiography suite in stable condition without any immediate postprocedural complications. 

 

FINDINGS:

  1. Superior mesenteric arteriogram does not demonstrate an accessory right hepatic artery.
  2. Celiac axis arteriogram demonstrates conventional anatomy.  There is tumor blush arising from    
  3. Post embolization images demonstrate near stasis of flow to the targeted lesions.
  4. Limited right common femoral angiogram demonstrates adequate puncture site above the bifurcation and below the deep internal epigastric artery, adequate for closure device.

 

IMPRESSION: Successful chemoembolization of a ________hepatocellular carcinoma as described.