Abstract No. 378 EE: Direct Hepatic Artery Puncture for Transarterial Therapy in Liver Cancer

Abstract

To describe the novel technique of direct percutaneous hepatic arterial puncture under ultrasound guidance as an alternative method to obtain intrahepatic arterial access in order to successfully perform two Yttrium-90 (Y90) radioembolization procedures and one transarterial embolization (TAE) procedure. Three patients with unresectable liver cancers who presented for transarterial therapy all demonstrated challenging vascular anatomy on pretreatment planning secondary to previous catheter-induced vessel injury and inherently complicated anatomic variations. These limitations prevented conventional transfemoral catheterization for the angiographic evaluation of the target lesion, assessment of surrounding vasculature, and ultimate delivery of the therapeutic agent. Ultrasound guidance was provided for direct percutaneous hepatic arterial puncture in order to gain alternative intrahepatic arterial access. When angiographic challenges prevent standard hepatic vascular access, the resources available to the interventional radiologist may allow for improvised delivery of various embolic particles via direct percutaneous hepatic arterial puncture under ultrasound guidance. The most technically difficult aspect of the procedure is the actual direct transhepatic puncture of the desired hepatic artery. The target vessel will be predominantly dictated by the patient's anatomy. The actual delivery of the radioembolic particles (Y90) via the direct percutaneous hepatic arterial system is identical to conventional transarterial delivery, except performed in a retrograde manner. Since the tip of the catheter is directed centrally, the microspheres are deposited proximally which allows natural flow dynamics to carry the particles distally (antegrade) to the tumor bed. Spherical (150-300 microns) particles were infused in the bland embolization case. The vascular anatomy and the location of the target lesion in the right liver lobe allowed for antegrade catheterization of the supplying hepatic arterial branch. The delivery of the particles was identical to conventional bland embolization and was performed until flow stagnation was achieved.