MAA shunt study prior to y90 radioembolization technique and dictation

PROCEDURE:

1. Celiac axis angiogram
2. Gastroduodenal artery (GDA) angiogram
3. Common hepatic artery angiogram
4. Common hepatic artery 3-D CT Angiogram
5. Coil embolization of the GDA
6. Post embolization angiogram of the GDA
7. Right hepatic artery angiogram
8. subselective right hepatic artery angiogram
9. Left hepatic artery angiogram
10. Right common femoral artery angiogram
11. Arteriotomy closure with Starclose device

INDICATION: __ year old male/female with multifocal HCC presenting for a shunt study evaluation for possible Y90 Radio embolization of the hepatic tumors.

MEDICATIONS: Versed     mg IV, Fentanyl     mcg IV

OPERATORS:

CONTRAST:     ml of nonionic contrast

FLUOROSCOPY TIME:     minutes

ACCESS SITE: Right common femoral artery

TECHNIQUE: The risks, benefits, and alternatives to the procedure and sedation were explained to the patient    , and written informed consent obtained. The patient was placed in supine position on the angiography table and the right groin were prepped and draped in sterile fashion. The skin and subcutaneous tissue overlying the right common femoral artery were infiltrated with local. The right common femoral artery was punctured using a micropuncture needle. A 0.018″ wire was advanced through the needle into the artery. The needle was exchanged for a 5 French transitional catheter. The inner dilator and the 0.018″ wire were removed and a 0.035″ Bentson wire was advanced into the artery. The transitional catheter was exchanged for 5 French long vascular sheath, which was attached to a pressurized bag of heparinized saline. 

A SOS Omni flush was used to pass the guidewire over the illiac bifurcation.  The flush catheter was then removed and a 5 French Sim-I Glidecath was formed over the arch and was used to select the Celiac artery.  Digital subtraction angiography was performed.  

 A 2.4F Renegade STC catheter and 0.014″ Transend guidewire were advanced coaxially through the Glidecath and used to select the right hepatic.  the microcatheter was then removed and digital subtraction angiography was performed. A 2.7F Renegade High Flow catheter and 0.014″ Transend guidewire were advanced coaxially through the Glidecath and used to select the GDA.  Digital subtraction angiography was performed.

The GDA was then embolized with a 6 X 20 and 4 X 10 Azur coils   . Post-embolization GDA angiogram was performed.

The microcatheter was then repositioned into the proper hepatic artery. Once the catheter was adequately positioned distal to the origin of the gastroduodenal artery, approximately     mCi of technetium MAA were infused into the hepatic artery. The catheter was then flushed and removed.  

Right common femoral angiography was performed through the sheath.  The arteriotomy was closed with a Starclose device.  A sterile dressing was applied.  The patient tolerated the procedure well, and was brought to Nuclear Medicine for the shunt study. 

FINDINGS: 

1. No replaced or accessory right hepatic artery off the superior mesenteric artery. 
2. Celiac axis angiogram demonstrates conventional anatomy.  There is tumor blush arising from the    ___
3. GDA angiogram demonstrates conventional anatomy. 
4. Post embolization GDA angiogram demonstrates no collateral filling from the common hepatic artery.
5. 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 pre-Y90 evaluation with embolization of the gastroduodenal artery and injection of MAA into the hepatic artery as described above.