Abstract
IntroductionConversion of multiple hepatic arteries into a single vascular supply is a very important technique for repeat hepatic arterial infusion chemotherapy using an implanted port catheter system. Catheterization of a replaced left hepatic artery arising from a left gastric artery using a percutaneous catheter technique is sometimes difficult, despite the recent development of advanced interventional techniques.Case presentationWe present a case of a 70-year-old Japanese man with multiple hepatocellular carcinomas in whom the replaced left hepatic artery arising from the left gastric artery needed to be embolized. After several failed procedures, the replaced left hepatic artery was successfully catheterized and embolized with a microcatheter and microcoils via the right gastric artery through the anastomosis.ConclusionA replaced left hepatic artery arising from a left gastric artery can be catheterized via a right gastric artery by using the appropriate microcatheter and microguidewires, and multiple hepatic arteries can be converted into a single supply.
Highlights
Conversion of multiple hepatic arteries into a single vascular supply is a very important technique for repeat hepatic arterial infusion chemotherapy using an implanted port catheter system
A replaced left hepatic artery arising from a left gastric artery can be catheterized via a right gastric artery by using the appropriate microcatheter and microguidewires, and multiple hepatic arteries can be converted into a single supply
We report an unusual case of a patient in whom the replaced left hepatic artery (LHA) was catheterized and embolized with a microcatheter through the anastomosis from the right gastric artery (RGA) to the left gastric artery (LGA)
Summary
Conversion of multiple hepatic arteries into a single vascular supply is a very important technique for repeat hepatic arterial infusion chemotherapy using an implanted port catheter system [1,2,3,4]. In cases in which a replaced left hepatic artery (LHA) arising from a left gastric artery (LGA) is present, the replaced LHA should be embolized at the proximal portion to convert multiple vascular supplies into a single supply. We report an unusual case of a patient in whom the replaced LHA was catheterized and embolized with a microcatheter through the anastomosis from the right gastric artery (RGA) to the LGA. We attempted the following methods to catheterize the LGA: (1) turning the catheter tip to the up-swinging celiac trunk by pulling the 5-French shepherd’s hook catheter (Terumo Clinical Supply, Tokyo, Japan) and trying to select the. We attempted to select the replaced LHA via the RGA and succeeded in visualizing and selecting it by using a 2-French microcatheter (Prograde-a; Terumo Clinical Supply) and 0.014-inch to 0.016-inch microguidewires (Transend, Boston Scientific, and GT wire, Terumo Clinical Supply) (Figure 4). On the day after the procedure, hepatic arterial infusion chemotherapy was started and the patient was transferred to the previous hospital
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