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British Journal of Radiology (2007) 80, e33-e37
© 2007 British Institute of Radiology
doi: 10.1259/bjr/36527189
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Percutaneous transluminal angioplasty using a pull-through technique for hepatic arterial occlusion at the time of port-catheter implantation

R Yoshimatsu, MD T Yamagami, MD, PhD T Katou, MD, PhD T Hirota, MD T Matsumoto, MD and T Nishimura, MD, PhD

Department of Radiology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-chyo, Kawaramachi-Hirokoji, Kamigyo, Kyoto, 602-8566, Japan


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  		Figure 1. Images taken from a 59-year-old man with multiple hepatocellular carcinomas. (a) Common hepatic arteriogram obtained from a 5-French catheter inserted from the left femoral artery after embolisation of the replaced right (large arrowhead) and left (small arrowhead) hepatic arteries shows the successful conversion of the three hepatic arteries into one. Note that the right gastric artery was embolised using micro-coils (arrow). (b) A subintimal dissection occurred (arrow) in the common hepatic artery when a 5-French catheter was advanced from a branch of the left subclavian artery to the common hepatic artery. (c) Coeliac arteriogram obtained from a 5-French catheter inserted from the left femoral artery just after the subintimal dissection had occurred shows the complete obstruction of the common hepatic artery (arrowhead). (d) Superior mesenteric arteriogram obtained from a 5-French catheter inserted from the left femoral artery shows the development of hepatopetal collateral flow through the pancreaticoduodenal arteries (arrow). (e) A radiograph shows a snare catheter (arrow) capturing the distal tip of the micro-guide wire that had been inserted through the pancreaticoduodenal artery via the femoral artery and passed the obstructed segment of the common hepatic artery. (f) A radiograph shows the performance of percutaneous transluminal angioplasty for the obstructed segment in the common hepatic artery using an angioplasty balloon catheter (arrowhead) advanced from the left femoral artery over the micro-guide wire, which had been passed from the femoral artery and pulled out of the left subclavian artery with tension maintained at both ends. (g) Arteriogram via the port catheter after catheter placement confirmed the patency of the hepatic artery and good hepatic perfusion. The tip of the indwelling catheter was positioned in the gastroduodenal artery and a side hole was opened into the common hepatic artery.

 




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