Using n-Butyl Cyanoacrylate and the Fixed-Catheter-Tip Technique in Percutaneous Implantation of a Port-Catheter System in Patients Undergoing Repeated Hepatic Arterial Chemotherapy
Takuji Yamagami1,
Shigeharu Iida,
Takeharu Kato,
Osamu Tanaka,
Tatsuya Hirota,
Toshiyuki Nakamura and
Tsunehiko Nishimura
1 All authors: Department of Radiology, Kyoto Prefectural University of
Medicine, 465 Kajii-chyo, Kawaramachi-Hirokoji, Kamigyo, Kyoto, 602-0841,
Japan.
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Fig. 1A. —62-year-old man with liver metastasis from colon cancer in
whom port-catheter system was placed using fixed-catheter-tip technique with
addition of n-butyl cyanoacrylate. Arteriogram shows 5-French
catheter inserted from left subclavian artery being advanced to common hepatic
artery. Microcoils (arrow) that were inserted in right gastric artery
before placement of indwelling catheter are visible.
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Fig. 1B. —62-year-old man with liver metastasis from colon cancer in
whom port-catheter system was placed using fixed-catheter-tip technique with
addition of n-butyl cyanoacrylate. Radiograph shows indwelling
catheter (short thick arrow) with side hole being advancing over
microguidewire already positioned with its tip in right gastroepiploic artery
(long arrow). Microcoil (short thin arrow) is used to
embolize branch of gastroduodenal artery arising near bifurcation.
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Fig. 1C. —62-year-old man with liver metastasis from colon cancer in
whom port-catheter system was placed using fixed-catheter-tip technique with
addition of n-butyl cyanoacrylate. Arteriogram obtained immediately
after advancement of side hole of indwelling catheter to planned position
confirms that side hole opens to common hepatic artery (arrow) and
that all intrahepatic arterial branches are visualized.
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Fig. 1D. —62-year-old man with liver metastasis from colon cancer in
whom port-catheter system was placed using fixed-catheter-tip technique with
addition of n-butyl cyanoacrylate. Radiograph shows that distal lumen
of indwelling catheter beyond side hole is occluded, with microcoil (thick
arrow) inserted through microcatheter advanced inside indwelling
catheter. Marker (thin arrow) on tip of microcatheter is also
visualized.
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Fig. 1E. —62-year-old man with liver metastasis from colon cancer in
whom port-catheter system was placed using fixed-catheter-tip technique with
addition of n-butyl cyanoacrylate. Radiograph shows microcatheter has
been inserted coaxially through side hole (thick arrow) of indwelling
catheter to gastroduodenal artery outside indwelling catheter over
micro-guidewire that already has been advanced to gastroduodenal artery
(thin arrow).
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Fig. 1F. —62-year-old man with liver metastasis from colon cancer in
whom port-catheter system was placed using fixed-catheter-tip technique with
addition of n-butyl cyanoacrylate. Radiograph shows that tip of
indwelling catheter is fixed to gastroduodenal artery with microcoils
(thick arrow) and mixture of n-butyl cyanoacrylate and
iodized oil (thin arrow).
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Fig. 1G. —62-year-old man with liver metastasis from colon cancer in
whom port-catheter system was placed using fixed-catheter-tip technique with
addition of n-butyl cyanoacrylate. Radiograph shows proximal end of
indwelling catheter connected to port implanted subcutaneously.
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Fig. 1H. —62-year-old man with liver metastasis from colon cancer in
whom port-catheter system was placed using fixed-catheter-tip technique with
addition of n-butyl cyanoacrylate. Arteriogram via port obtained
after placement of port-catheter system confirms that all hepatic arterial
branches are well visualized and that inside lumen of catheter tip is
occluded. Note that catheter tip is fixed in gastroduodenal artery.
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Fig. 2A. —67-year-old woman with hepatocellular carcinoma who developed
hepatic arterial occlusion. Arteriogram via port obtained 28 days after
implantation of port-catheter system shows obstruction of proper hepatic
artery. Microcoils (small arrows) and cast of n-butyl
cyanoacrylate and iodized oil mixture (thick arrow) to fix catheter
tip as well as microcoils to embolize right gastric artery (thin
arrows) can be seen.
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Fig. 2B. —67-year-old woman with hepatocellular carcinoma who developed
hepatic arterial occlusion. After 1 day of continuous transarterial infusion
of 120,000 U of urokinase via port, arteriogram via port shows recanalization
of hepatic artery.
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Fig. 3A. —65-year-old man with liver metastasis from colon cancer and
migration of catheter tip. Arteriogram via port obtained just after
implantation shows that port-catheter system is correctly positioned.
Microcoils were inserted into right hepatic artery that arose from superior
mesenteric artery to convert two hepatic arteries into one (thin
arrows). Distal lumen of indwelling catheter is occluded with microcoil
(thick arrow).
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Fig. 3B. —65-year-old man with liver metastasis from colon cancer and
migration of catheter tip. Arteriogram via port obtained 283 days after
implantation of port-catheter system shows catheter-tip dislocation and
movement of side hole to more proximal site, resulting in visualization of
left gastric artery (thick arrow) and splenic artery (thin
arrow).
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Fig. 4A. —69-year-old woman with liver metastasis from breast cancer
and recanalization of gastroduodenal artery. Arteriogram via port obtained 5
days after implantation of port-catheter system shows that gastroduodenal
artery is recanalized (thick arrow), although this artery was
embolized with microcoils and mixture of n-butyl cyanoacrylate and
iodized oil at time of catheter placement. Note microcoils embolizing right
gastric artery (thin arrow).
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Fig. 4B. —69-year-old woman with liver metastasis from breast cancer
and recanalization of gastroduodenal artery. Arteriogram shows recanalization
of gastroduodenal artery. Microcatheter was coaxially advanced through common
hepatic artery to gastroduodenal artery outside of indwelling catheter via
5-French catheter inserted from right femoral artery and positioned at celiac
artery.
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Fig. 4C. —69-year-old woman with liver metastasis from breast cancer
and recanalization of gastroduodenal artery. Arteriogram via port obtained
after procedure to correct recanalization of gastroduodenal artery shows
gastroduodenal artery (arrow) successfully reembolized outside of
indwelling catheter with n-butyl cyanoacrylate and iodized oil
mixture.
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Fig. 5A. —47-year-old woman with liver metastasis from breast cancer
and migration of n-butyl cyanoacrylate plug. Arteriogram via port
obtained just after implantation shows port-catheter system is correctly
positioned but cast (arrow) of mixture of n-butyl
cyanoacrylate and iodized oil has migrated into proper hepatic artery.
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Fig. 5B. —47-year-old woman with liver metastasis from breast cancer
and migration of n-butyl cyanoacrylate plug. Arteriogram via port
obtained 5 days after implantation of port-catheter system shows that cast
(arrow) of n-butyl cyanoacrylate and iodized oil mixture has
moved to right hepatic artery. Nevertheless, blood flow of right hepatic
artery was sufficient.
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Fig. 5C. —47-year-old woman with liver metastasis from breast cancer
and migration of n-butyl cyanoacrylate plug. CT scan obtained during
arteriography via port reveals that contrast material is being distributed to
entire liver but not to adjacent extrahepatic organs such as pancreas and
stomach wall. Sufficient distribution of contrast material to tumor lesion
(arrow) is also seen.
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Copyright © 2002 by the American Roentgen Ray Society.
