55 year-old male with hepatitis C induced cirrhosis complicated by hepatocellular carcinoma.
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.
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.
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.
Liver MRI before treatment demonstrated enhancement of a 2.1 cm HCC during the arterial phase of contrast distribution.
Selective replaced right hepatic arteriogram. Angiographically occult tumor required confirmation with cone-beam CT.
Radiograph of the liver during pressure-directed segmental infusion of chemoembolization mixture with the Surefire.
Follow up MRI three months after chemoembolization showed lack of tumor enhancement, indicating uniform necrosis.