Clinical Diagnosis
Metastatic Breast Cancer

Anatomy
Right-sided disease in a patient with severe vessel tortuosity.

Imaging
Celiac access was obtained using a 4 Fr. Simmons 1 catheter. The 4.8 Fr. Guide Sheath was advanced over an 0.035” glidewire and positioned in the Right Hepatic Artery. Right hepatic arteriogram was performed using the 4.8 Fr. end hole guiding sheath by power injector (12ml at 3ml/sec.). Significant reflux into the left hepatic, the right gastric and the gastroduodenal artery was noted.

Next the Surefire Infusion System was deployed to the same infusion site over an 0.016” Fathom guidewire, and the expandable tip of the Surefire system was deployed. Repeat right hepatic arteriogram was then acquired (12ml at 3ml/sec.) at the same site.

A cone-beam CT (8 seconds rotation with a delay after start of contrast injection of 6 seconds) with 50% diluted contrast (42ml at 3ml/sec.) through the Surefire Infusion System confirmed that no non-target vessels were displayed and no reflux was detected.

Observations
When contrast was injected at a rate 12ml at 3ml/sec. using a 4.8 Fr. end hole catheter, reflux was readily noted on the angiograms (Figure 2A). With the Surefire Infusion System, no reflux was observed, and enhanced tumor blush was noted in arterial phase imaging (Figure 2B).