Go back
Title: WHERE THERE IS A WILL, THERE IS A WAY: NOVEL APPROACH FOR TRANS-ARTERIAL CHEMO-EMBOLISATION
e-poster Number: EPOS 9
Category: e Poster
Author Name: Dr. Harshit Bansal
Institute:
Co-Author Name:
Abstract :
INTRODUCTION:
Transcatheter arterial chemoembolization (TACE) is the current standard of care for patients with large or multinodular HCC and relatively preserved liver function and no evidence of vascular invasion or extrahepatic spread (Intermediate stage according to the BCLC staging system)
METHODS / CASE DETAILS:
We present the case of a 55-year-old gentleman who presented to the IR OPD with a large right lobe Hepatocellular Carcinoma (7 X 5.9 cm) on the background of Chronic Liver disease. He was a poor surgical candidate with high risk for general anaesthesia, however due to liver limited disease and good ECOG status, patient was considered for Trans-arterial Chemoembolization.
CECT Abdomen performed before the procedure showed severe stenosis of Coeliac artery origin due to a large calcific plaque.
Using 4F MPA catheter through radial access, angiographic run was taken at the level of T12 vertebral body which showed complete stenosis of Coeliac artery origin. Multiple attempts at cannulating the coeliac origin using 014 wire failed both from radial as well as femoral access (using SIM 1 catheter). SMA was cannulated and 3DCT was taken to provide a road map for cannulating the collaterals leading to GDA and Hepatic artery. Using 2.4F microcatheter, a small collateral channel was cannulated which led to the GDA. After negotiating through the tortuosity and reaching the GDA, the angle from GDA to common hepatic artery was very acute which led to unsuccessful cannulation of CHA even with use of Pre-shaped microcatheters.
Since no other arterial access was possible, trans-splenic arterial access was planned Under USG guidance and using micro-puncture set, intraparenchymal branch of Splenic artery was accessed and 4F vascular sheath was inserted. Cobra C1 catheter and 2.4F microcatheter was used to super-selectively cannulated tumour feeders and perform conventional TACE using 15ml Lipiodol and 75 mg Doxorubicin followed by embolization using PVA particles. Trans-splenic access tract was embolised using 50% NBCA-Lipiodol combination. No periprocedural/post-procedural complications were seen.
RESULTS:
Dynamic CEMRI was performed after 4 weeks which showed complete response with no sign of active disease. Serum AFP also showed massive decline from 3351 to 282.
In view of large initial size of tumour, systemic therapy in the form of low dose Lenvatinib was started to prevent any local or distant disease recurrence.
Patient has been on follow up for the last 9 months with no signs on recurrence or residual disease.
CONCLUSIONS:
In the presence of coeliac artery stenosis, access to hepatic artery is challenging and necessitates innovative approach and out of the box thinking.
Trans-splenic arterial access is a highly unexplored approach, if performed with precision and adequate precautions are taken it can be considered a viable and safe option in cases where other approaches have been unsuccessful.
