Clinical application of a new indwelling catheter with a side-hole and spirally arranged shape-memory alloy for hepatic arterial infusion chemotherapy

Towards catheter steering using magnetic tractor beam coupling

Catheters are used in various clinical applications, and the ability to direct the catheter to the desired location is critical for clinical outcomes. Steerable catheters assist clinicians to access targeted areas, notably the vascular bundles and major vessels, while causing no damage to the surrounding tissue. A novel catheter actuation technology for catheter steering is presented in this study. The technique is simple and relies on three magnetic couples interacting with one another to generate steering motions. A proof-of-concept catheter prototype demonstrated the capacity to remotely steer a catheter over 100 mm of distance and ±45° of angular positioning, showing the potential manoeuvrability for clinical applications. It is feasible to steer a catheter using this three-magnet pair approach with the great potential to be used for catheterisation procedures. The presented mechanism's kinematics and a near-form solution for catheter steering regardless of design factors will be studied in the future.

Complications in hepatic arterial infusion chemotherapy: retrospective comparison of catheter tip placement in the right/left hepatic artery vs. the gastroduodenal artery

PURPOSE

To compare the complication rates associated with hepatic arterial infusion chemotherapy (HAIC) for unresectable hepatocellular carcinoma (HCC) using two different catheter tip locations, the right/left hepatic artery (group 1) and the gastroduodenal artery (group 2).

METHODS

Between April 2001 and March 2015, 88 patients (group 1, n = 36; group 2, n = 52) with unresectable HCC, underwent HAIC via a transfemorally placed infusion catheter. The incidence of complications related to catheter placement (including hepatic arterial occlusion, catheter dislocation, non-target embolization and port-catheter system infection) as well as catheter patency and patient survival were evaluated.

RESULTS

The technical success rate was 100%. The overall complication rate was 17% (15/88 patients). The specific complications were as follows: hepatic artery occlusion, n = 1 (group 2, n = 1), gastroduodenal ulcer, n = 6 (group 1, n = 2; group 2, n = 4); catheter dislocation, n = 1 (group 2, n = 1); port-catheter system infection, n = 3 (group 2, n = 3); and bleeding at the puncture site, n = 4 (group 1, n = 1; group 2, n = 3).

CONCLUSIONS

The complication rates in groups 1 and 2 did not differ to a statistically significant extent.

Intermittent transcatheter therapy through a new indwelling catheter system for patients with hepatocellular carcinoma

PURPOSE

This paper describes the technical details of the new indwelling catheter system, which we refer to as System-i, and provides an overview of our experience with this system at our institution.

MATERIALS AND METHODS

The system is implanted via the left brachial artery. The feeding artery of the tumor is catheterized at each treatment, and the system can be used for multiple treatments via more than one feeding artery. Between January 2004 and January 2013, System-i was used to administer 398 treatments in 30 patients with hepatocellular carcinoma (HCC). The technical aspects and outcomes of treatment procedures were evaluated.

RESULTS

Implantation was successful in all cases. System-i was used for a median number of 11 treatments per patient over a median period of 5.7 months, and 71.6 % of all treatments were administered on an outpatient basis.

CONCLUSION

System-i provides an effective and safe method for selective catheterization of feeding arteries for administration of transcatheter arterial chemoembolization or infusion in patients with HCC. Treatment regimens can be individualized without limiting the number of treatments or treatment locations, and patients can be treated on an outpatient basis.

The features of extrahepatic collateral arteries related to hepatic artery occlusion and benefits in the transarterial management of liver tumors

Purpose. To investigate the extrahepatic collateral arteries related to hepatic artery occlusion (HAO) and to determine its benefits in the transarterial management of liver tumors. Methods and Findings. Eleven patients (7 hepatocellular carcinomas, 3 liver metastases, and 1 with hemangioma) with HAO confirmed with digital subtraction angiography (DSA) were admitted to our hospital. Of the 11 patients, 7 were men and 4 were women, with an average age of 41.5 ± 15.5 years (range: 29 to 70 years). DSA was performed to evaluate the collateral routes to the liver. In the 11 patients with HAO, DSA showed complete occlusion of the common hepatic artery in 9 patients and the proper hepatic artery (PHA) in 2 patients. Extrahepatic collateral arteries supplying the liver were readily evident. The collateral arteries originated from the superior mesenteric artery (SMA) in 8 patients, from the gastroduodenal artery in 2 patients, and from the left gastric artery (LGA) in 1 patient. Transcatheter treatment was successfully performed via the collateral artery in all patients except the one who had hemangioma. Conclusions. DSA is an effective method for detecting collateral circulation related to HAO and may provide information to guide transcatheter management decisions.