Clinical Diagnosis
55 year-old male with hepatitis C induced cirrhosis complicated by hepatocellular carcinoma.

Anatomy
Replaced right hepatic artery from the SMA. Angiographically occult 2.1 cm hepatocellular cancer because of subtle contrast enhancement and the patient’s inability to hold the breath. The lesion location was confirmed with cone-beam CT and perfused by the superior division of right hepatic artery.

Treatment Plan
Lipiodol-based segmental chemoembolization with lipiodol/epirubicin/mitomycin C emulsion as a bridge to transplantation. Flow-directed infusion was expected to result in only modest deposition of the mixture because of the subtle tumor vascularity. Pressure-directed infusion with the Surefire device was chosen to enable a more compact delivery of chemoembolization mixture and greater deposition in the tumor.

Target Vessel Diameter
Segment VII-VIII hepatic artery, 4.5 mm lumen.

Infusion
20 cc lipiodol, epirubicin, mitomycin C, and non-ionic contrast emulsion into target segmental artery to achieve uniform deposition in the tumor. The delivery was confirmed with cone-beam CT.