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Embolization of the Right Gastric Artery Before Hepatic Arterial Infusion Chemotherapy to Prevent Gastric Mucosal Lesions: Approach Through the Hepatic Artery Versus the Left Gastric Artery

Takuji Yamagami1, Toshiyuki Nakamura, Shigeharu Iida, Takeharu Kato and Tsunehiko Nishimura

1 All authors: Department of Radiology, Kyoto Prefectural University of Medicine, 465 Kajii-chyo, Kawaramachi-Hirokoji, Kamigyo, Kyoto, 602-8566, Japan.



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  		Fig. 1. —Schematic diagram of desired catheter position and occluded vessels for infusion according to Arai et al. [16]. Tip of catheter is located in gastroduodenal artery, and side hole (open arrow), through which anticancer drugs (short thin arrows) infused through port would be distributed to intrahepatic artery branches, is open toward common hepatic artery. Lumen of catheter tip is occluded with microcoil (arrowhead). Catheter tip is tightly fixed in gastroduodenal artery with microcoils (large arrow) and mixture of n-butyl cyanoacrylate and Lipiodol ([iodized oil] Laboratoire Guerbet, Roissy, France) (short solid arrow) placed on outside catheter. Right gastric artery and posterosuperior pancreaticoduodenal artery are embolized with microcoils (curved arrows). F = right gastric artery, C = left gastric artery, A = celiac artery, B = splenic artery, D = common hepatic artery, G = posterosuperior pancreaticoduodenal artery, E = gastroduodenal artery.

 


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  		Fig. 2A. —49-year-old woman with liver metastasis from breast cancer. Celiac arteriogram obtained before implantation of port-catheter system shows multiple foci of ring enhancement corresponding to liver malignancies. Note that right gastric artery (arrow) can be seen.

 


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  		Fig. 2B. —49-year-old woman with liver metastasis from breast cancer. Arteriogram obtained via microcatheter (thick arrow) coaxially advanced from 5-French catheter placed in left gastric artery (short thin arrow) shows communication between left and right gastric arteries (long thin arrow).

 


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  		Fig. 2C. —49-year-old woman with liver metastasis from breast cancer. Arteriogram obtained after microcatheter was advanced into right gastric artery shows right gastric artery arising from left hepatic artery (arrow).

 


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  		Fig. 2D. —49-year-old woman with liver metastasis from breast cancer. Common hepatic arteriogram obtained after embolization of right gastric artery through microcatheter via left gastric artery confirms completely embolized right gastric artery.

 


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  		Fig. 2E. —49-year-old woman with liver metastasis from breast cancer. Arteriogram obtained through port just after implantation of port-catheter system and 5 days after embolization of right gastric artery shows that indwelling port-catheter system is correctly implanted percutaneously. All hepatic artery branches are shown. Distal tip of catheter is fixed to gastroduodenal artery with five microcoils (long thin arrows) and n-butyl cyanoacrylate—Lipiodol ([iodized oil] Laboratoire Guerbet, Roissy, France) mixture. Distal lumen of indwelling catheter is occluded with microcoil (thick arrow). Note that right gastric artery (small thin arrow) is embolized with two microcoils.

 

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