Precision TACE assisted by radial artery approach and CBCT three-dimensional vascular reconstruction in the treatment of primary liver cancer: report of 124 cases_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

LIU Jianming , CHEN Huimin , TU Liang , LIU Pingguo ,  XIONG Yu

Department of Hepatobiliary Surgery, Zhongshan Hospital Affiliated to Xiamen University, Fujian Provincial Key Laboratory of Chronic Liver Disease and Hepatocellular Carcinoma, Xiamen, Fujian 361004, P. R. China;

Corresponding author：

XIONG Yu, Email: 740140255@qq.com

Keywords：

primary liver cancer; trans-radial artery approach; precision transcatheter arterial chemoembolization; cone beam computed tomography; 3D vascular reconstruction

DOI：

10.7507/1007-9424.202203072

Video：

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Objective To investigate the safety and feasibility of transcatheter arterial chemoembolization (TACE) assisted by transradial approach and cone beam computed tomography (CBCT) three-dimensional vascular reconstruction in the treatment of primary liver cancer. Methods The clinical data of 124 patients with primary liver cancer who underwent precision TACE via radial artery in our hospital from May 2018 to December 2019 were retrospectively collected. Results Among the 124 patients, 118 patients were successfully punctured through the left radial artery and completed the TACE operation. The operation time was (109.57±31.32) min, and the median of postoperative hospitalization was 3 d. One patient changed to the right radial artery to complete TACE due to chronic renal failure and left brachial artery and vein puncture and catheterization before operation. The operation time was 119 minutes, and the patient was discharged after 5 days of hospitalization. After successful puncture of the left radial artery in one patient, the forearm artery was twisted into a loop and the guide wire catheter failed to pass, and the right femoral artery was used to complete TACE. The operation time was 123 minutes, and the patient was discharged after 4 days of improvement. The radial artery puncture was unsuccessful in four patients, and the right femoral artery approach was used to complete the operation; the operation time was (111.66±32.77) min, and the median of postoperative hospitalization was 3 d. One of the patients successfully completed up to 5 consecutive TACE via the radial artery. All patients underwent precision TACE with superselective cannulation assisted by CBCT three-dimensional vascular reconstruction. No vascular injury andocclusion, urinary retention, subcutaneous hemorrhage, and other complications occurred in all patients. Conclusions Trans-radial arterial precision TACE is safe and effective, which can be repeated many times and has few complications and high patient comfort. It can be used as one of the routine approaches of TACE.

Citation： LIU Jianming, CHEN Huimin, TU Liang, LIU Pingguo, XIONG Yu. Precision TACE assisted by radial artery approach and CBCT three-dimensional vascular reconstruction in the treatment of primary liver cancer: report of 124 cases. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2022, 29(5): 570-575. doi: 10.7507/1007-9424.202203072 Copy

1.	Sung H, Ferlay J, Siegel RL, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin, 2021, 71(3): 209-249.
2.	中华人民共和国国家卫生健康委员会医政医管局. 原发性肝癌诊疗指南 (2022年版). 中国实用外科杂志, 2022, 42(3): 241-273.
3.	张雯, 周永杰, 颜志平. 再论精细TACE. 介入放射学杂志, 2021, 30(10): 971-975.
4.	Johnson WH 3rd, Cromartie RS 3rd, Arrants JE, et al. Simplified method for candidate selection for radial artery harvesting. Ann Thorac Surg, 1998, 65(4): 1167. doi: 10.1016/S0003-4975(98)00103-9.
5.	Rao SV, Tremmel JA, Gilchrist IC, et al. Best practices for transradial angiography and intervention: a consensus statement from the society for cardiovascular angiography and intervention’ transradial working group. Catheter Cardiovasc Interv, 2014, 83(2): 228-236.
6.	Otaki M. Percutaneous transradial approach for coronary angiography. Cardiology, 1992, 81(6): 330-333.
7.	Kiemeneij F, Laarman GJ. Percutaneous transradial artery approach for coronary stent implantation. Cathet Cardiovasc Diagn, 1993, 30(2): 173-178.
8.	Shiozawa S, Tsuchiya A, Endo S, et al. Transradial approach for transcatheter arterial chemoembolization in patients with hepatocellular carcinoma: comparison with conventional transfemoral approach. J Clin Gastroenterol, 2003, 37(5): 412-417.
9.	Bruix J, Sherman M. Management of hepatocellular carcinoma. Hepatology, 2005, 42(5): 1208-1236.
10.	Becher T, Behnes M, Ünsal M, et al. Radiation exposure and contrast agent use related to radial versus femoral arterial access during percutaneous coronary intervention (PCI)-Results of the FERARI study. Cardiovasc Revasc Med, 2016, 17(8): 505-509.
11.	Bishay VL, Biederman DM, Ward TJ, et al. Transradial approach for hepatic radioembolization: initial results and technique. AJR Am J Roentgenol, 2016, 207(5): 1112-1121.
12.	Chen YY, Liu P, Wu YS, et al. Transradial vs transfemoral access in patients with hepatic malignancy and undergoing hepatic interventions: A systematic review and meta-analysis. Medicine (Baltimore), 2018, 97(52): e13926. doi: 10.1097/MD.0000000000013926.
13.	Fischman AM, Swinburne NC, Patel RS. A technical guide describing the use of transradial access technique for endovascular interventions. Tech Vasc Interv Radiol, 2015, 18(2): 58-65.
14.	Loewenstern J, Welch C, Lekperic S, et al. Patient radiation exposure in transradial versus transfemoral yttrium-90 radioembolization: a retrospective propensity score-matched analysis. J Vasc Interv Radiol, 2018, 29(7): 936-942.
15.	Ljungqvist O, Scott M, Fearon KC. Enhanced recovery after surgery: a review. JAMA Surg, 2017, 152(3): 292-298.
16.	Kehlet H. Multimodal approach to control postoperative pathophysiology and rehabilitation. Br J Anaesth, 1997, 78(5): 606-617.
17.	胡俊刚, 王晓东, 朱旭, 等. 锥体束CT三维肝动脉造影在TACE术中判断原发性肝癌肿瘤供血动脉的临床价值. 介入放射学杂志, 2015, 24(6): 481-487.
18.	He MK, Le Y, Li QJ, et al. Hepatic artery infusion chemotherapy using mFOLFOX versus transarterial chemoembolization for massive unresectable hepatocellular carcinoma: a prospective non-randomized study. Chin J Cancer, 2017, 36(1): 83. doi: 10.1186/s40880-017-0251-2.
19.	Liu B, Zhu X, Gao S, et al. Safety and efficacy of hepatic arterial infusion chemotherapy with raltitrexed and oxaliplatin post-transarterial chemoembolization for unresectable hepatocellular carcinoma. J Interv Med, 2019, 2(2): 91-96.
20.	Wang Z, Lin M, Lesage D, et al. Three-dimensional evaluation of lipiodol retention in HCC after chemoembolization: a quantitative comparison between CBCT and MDCT. Acad Radiol, 2014, 21(3): 393-399.
21.	Loffroy R, Lin M, Rao P, et al. Comparing the detectability of hepatocellular carcinoma by C-arm dual-phase cone-beam computed tomography during hepatic arteriography with conventional contrast-enhanced magnetic resonance imaging. Cardiovasc Intervent Radiol, 2012, 35(1): 97-104.
22.	Miyayama S, Yamashiro M, Hashimoto M, et al. Identification of small hepatocellular carcinoma and tumor-feeding branches with cone-beam CT guidance technology during transcatheter arterial chemoembolization. J Vasc Interv Radiol, 2013, 24(4): 501-508.

1. Sung H, Ferlay J, Siegel RL, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin, 2021, 71(3): 209-249.
2. 中华人民共和国国家卫生健康委员会医政医管局. 原发性肝癌诊疗指南 (2022年版). 中国实用外科杂志, 2022, 42(3): 241-273.
3. 张雯, 周永杰, 颜志平. 再论精细TACE. 介入放射学杂志, 2021, 30(10): 971-975.
4. Johnson WH 3rd, Cromartie RS 3rd, Arrants JE, et al. Simplified method for candidate selection for radial artery harvesting. Ann Thorac Surg, 1998, 65(4): 1167. doi: 10.1016/S0003-4975(98)00103-9.
5. Rao SV, Tremmel JA, Gilchrist IC, et al. Best practices for transradial angiography and intervention: a consensus statement from the society for cardiovascular angiography and intervention’ transradial working group. Catheter Cardiovasc Interv, 2014, 83(2): 228-236.
6. Otaki M. Percutaneous transradial approach for coronary angiography. Cardiology, 1992, 81(6): 330-333.
7. Kiemeneij F, Laarman GJ. Percutaneous transradial artery approach for coronary stent implantation. Cathet Cardiovasc Diagn, 1993, 30(2): 173-178.
8. Shiozawa S, Tsuchiya A, Endo S, et al. Transradial approach for transcatheter arterial chemoembolization in patients with hepatocellular carcinoma: comparison with conventional transfemoral approach. J Clin Gastroenterol, 2003, 37(5): 412-417.
9. Bruix J, Sherman M. Management of hepatocellular carcinoma. Hepatology, 2005, 42(5): 1208-1236.
10. Becher T, Behnes M, Ünsal M, et al. Radiation exposure and contrast agent use related to radial versus femoral arterial access during percutaneous coronary intervention (PCI)-Results of the FERARI study. Cardiovasc Revasc Med, 2016, 17(8): 505-509.
11. Bishay VL, Biederman DM, Ward TJ, et al. Transradial approach for hepatic radioembolization: initial results and technique. AJR Am J Roentgenol, 2016, 207(5): 1112-1121.
12. Chen YY, Liu P, Wu YS, et al. Transradial vs transfemoral access in patients with hepatic malignancy and undergoing hepatic interventions: A systematic review and meta-analysis. Medicine (Baltimore), 2018, 97(52): e13926. doi: 10.1097/MD.0000000000013926.
13. Fischman AM, Swinburne NC, Patel RS. A technical guide describing the use of transradial access technique for endovascular interventions. Tech Vasc Interv Radiol, 2015, 18(2): 58-65.
14. Loewenstern J, Welch C, Lekperic S, et al. Patient radiation exposure in transradial versus transfemoral yttrium-90 radioembolization: a retrospective propensity score-matched analysis. J Vasc Interv Radiol, 2018, 29(7): 936-942.
15. Ljungqvist O, Scott M, Fearon KC. Enhanced recovery after surgery: a review. JAMA Surg, 2017, 152(3): 292-298.
16. Kehlet H. Multimodal approach to control postoperative pathophysiology and rehabilitation. Br J Anaesth, 1997, 78(5): 606-617.
17. 胡俊刚, 王晓东, 朱旭, 等. 锥体束CT三维肝动脉造影在TACE术中判断原发性肝癌肿瘤供血动脉的临床价值. 介入放射学杂志, 2015, 24(6): 481-487.
18. He MK, Le Y, Li QJ, et al. Hepatic artery infusion chemotherapy using mFOLFOX versus transarterial chemoembolization for massive unresectable hepatocellular carcinoma: a prospective non-randomized study. Chin J Cancer, 2017, 36(1): 83. doi: 10.1186/s40880-017-0251-2.
19. Liu B, Zhu X, Gao S, et al. Safety and efficacy of hepatic arterial infusion chemotherapy with raltitrexed and oxaliplatin post-transarterial chemoembolization for unresectable hepatocellular carcinoma. J Interv Med, 2019, 2(2): 91-96.
20. Wang Z, Lin M, Lesage D, et al. Three-dimensional evaluation of lipiodol retention in HCC after chemoembolization: a quantitative comparison between CBCT and MDCT. Acad Radiol, 2014, 21(3): 393-399.
21. Loffroy R, Lin M, Rao P, et al. Comparing the detectability of hepatocellular carcinoma by C-arm dual-phase cone-beam computed tomography during hepatic arteriography with conventional contrast-enhanced magnetic resonance imaging. Cardiovasc Intervent Radiol, 2012, 35(1): 97-104.
22. Miyayama S, Yamashiro M, Hashimoto M, et al. Identification of small hepatocellular carcinoma and tumor-feeding branches with cone-beam CT guidance technology during transcatheter arterial chemoembolization. J Vasc Interv Radiol, 2013, 24(4): 501-508.

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CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Precision TACE assisted by radial artery approach and CBCT three-dimensional vascular reconstruction in the treatment of primary liver cancer: report of 124 cases

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