Percutaneous Femoral Catheter Placement for Long-Term Chemotherapy Infusions: Preliminary Technical Results
Tsuyoshi Tajima1,
Kengo Yoshimitsu1,
Toshirou Kuroiwa2,
Tatsuyuki Ishibashi2,
Hiroyuki Irie1,
Hitoshi Aibe1,
Kenji Shinozaki1,
Akihiro Nishie1,
Hidetake Yabuuchi2 and
Hiroshi Honda1
1 Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu
University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan.
2 Department of Radiology, National Kyushu Cancer Center, Fukuoka 811-1395,
Japan.
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Fig. 1A. —Configuration of indwelling catheters used for gastroepiploic
method. Illustrations focus on catheter tip of W-spiral catheter of
5-fluorouracil nontapered type (A) and schematic drawing of global
image of W-spiral catheter (B). Tip of catheter is preshaped, and
shape-memory metals are concealed within tip.
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Fig. 1B. —Configuration of indwelling catheters used for gastroepiploic
method. Illustrations focus on catheter tip of W-spiral catheter of
5-fluorouracil nontapered type (A) and schematic drawing of global
image of W-spiral catheter (B). Tip of catheter is preshaped, and
shape-memory metals are concealed within tip.
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Fig. 2A. —Difference in behavior of injected water solution between two
configurations of catheter tip. Photograph shows hook-shaped catheter.
Injected water flows out from both side-hole and end-hole
(arrows).
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Fig. 2B. —Difference in behavior of injected water solution between two
configurations of catheter tip. Photograph shows W-spiral catheter. Water
flows out only from side-hole (arrow), which enables virtually
selective infusion through it.
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Fig. 2C. —Difference in behavior of injected water solution between two
configurations of catheter tip. Schematic drawing shows fluid dynamics of
W-spiral catheter. Most of injected fluid runs off from side-hole, whereas
little of injected fluid flows out from end-hole (arrow), probably
because of resistance resulting from spiral-shaped flexion of catheter.
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Fig. 3A. —67-year-old man with liver metastases from sigmoid colon cancer.
Celiac arteriogram obtained before catheter placement shows no anatomical
variations in hepatic arteries and fine visualization of right gastroepiploic
artery.
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Fig. 3B. —67-year-old man with liver metastases from sigmoid colon cancer.
After placement of 5-French W-spiral catheter, arteriogram obtained via
implanted catheter cannot show small ill-defined hypovascular liver metastases
(arrows). Note cessation of flow in gastroduodenal and right
gastroepiploic arteries.
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Fig. 3C. —67-year-old man with liver metastases from sigmoid colon cancer.
Dynamic 99mTc-macroaggregated albumin scintigram obtained via port
3 days after B shows that homogeneous intrahepatic arterial perfusion
was obtained.
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Fig. 4A. —62-year-old woman with hepatocellular carcinoma. Angiogram obtained
just after catheter placement through 5-French W-spiral catheter with
injection rate of 0.7 mL/sec shows maintenance of blood flow through right
gastroepiploic artery distal to catheter tip (arrows). Tips of two
forceps indicate predetermined positions of side-hole and end-hole. Note that
accessory left gastric artery is not opacified because of selective
embolization.
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Fig. 4B. —62-year-old woman with hepatocellular carcinoma. Angiogram obtained
via implantable port 21 min after A with injection rate of 0.5 mL/sec
shows fine flow distribution through liver. Blood flow through right
gastroepiploic artery distal to catheter tip spontaneously has ceased. Arrow
indicates tip of W-spiral catheter. Note that right gastric artery is not
opacified because of additional embolization.
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Fig. 4C. —62-year-old woman with hepatocellular carcinoma. CT arteriogram
obtained via indwelling catheter shows 5-cm ill-defined hypervascular tumor in
segment IV. Hepatic arterial infusion chemotherapy (HAIC) was initiated 1 week
after catheter placement. No chemotherapeutic complications occurred after
four courses of HAIC.
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Fig. 4D. —62-year-old woman with hepatocellular carcinoma. Hepatic arterial
phase image of dynamic CT obtained 4 months after initiation of HAIC shows
complete diminishment of tumor except for nodular accumulation of iodized oil
(Lipiodol, Andre Guerbet) (arrow) due to previous transarterial
chemoembolization.
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Copyright © 2005 by the American Roentgen Ray Society.
