LINC 2018 live case guide

Frankfurt/Main

• Wednesday, January 31st: 8:08 - 8:33, Room 3 - Technical Forum

  Case 43 – Microwave ablation-HCC

  Center:

  Frankfurt/Main

  Case 43 – FRA 01: female, 76 years (K-M)

  Operators:

  • K. Eichler,
  • Bita Panahi

  CLINICAL DATA
  - HCC-lesion in liver segment 3 in alcoholic liver cirrhosis
  - BCLC B
  - 12/2014 atypical liver resection Seg 7 (G2,pT3a, R0)
  - 09/2016 microwave ablation seg 6
  - 10/2016 microwave ablation seg 8
  
  PRESENT STATE
  - MELD score:6
  - CHILD-PUGH: A
  - No ascites
  
  PROCEDURAL STEPS
  1. Pre-ablation imaging like CT (contrast enhanced)
  2. Local anesthesia, analgosedation
  3. One antenna is placed directly into the lesion
  - EMPRINT CA15L2, Short percutaneous Antenna with thermosphere technology (COVIDIEN)
  - Generator: EMPRINT (COVIDIEN)
  

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• Wednesday, January 31st: 11:49 - 12:14, Room 3 - Technical Forum

  Case 46 – Conventional transarterial chemoembolization (cTACE) of hepatocellular carcinoma (HCC)

  Center:

  Frankfurt/Main

  Case 46 – FRA 02: female, 54 years (T-C)

  Operators:

  • T. Gruber-Rouh,
  • B. Bodelle

  CLINICAL DATA
  - 54 year old patient with HCC lesions in liver segments 8, 8/5 and 6
  - 12/2017: TACE
  
  RISK FACTORS
  liver cirrhosis, hepatitis B, BCLC-Stage-B, Type 2 diabetes mellitus, hypertension
  
  PROCEDURAL STEPS
  1. Right retrograde access
  - 5F sheath Introducer 2® (TERUMO)
  2. Catheterization and DSA of celiac trunk plus indirect porotgraphy
  - 5 F Side-Winder catheter (TERUMO)
  - 0.035'' angled guidewire (TERUMO)
  3. Selective catheterization of segmental and subsegmental branches of the hepatic artery in depending on location, size, and arterial feeding vessel of the target tumor
  - 2.8F coaxial microcatheter system Progreat (TERUMO)
  4. Chemoembolization with mitomycin C and lipiodol
  5. Puncture site closure with a percutaneous closure device
  - 6F Angio-Seal™ VIP (ST. JUDE Medical)
  

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• Wednesday, January 31st: 15:53 - 16:14, Room 3 - Technical Forum

  Case 50 – Transjugular intrahepatic portosystemic shunt (TIPSS)

  Center:

  Frankfurt/Main

  Case 50 – FRA 03: female, 59 years (B-H)

  Operators:

  • A. Thalhammer,
  • M. Nour Eldin,
  • S. Fischer

  CLINICAL DATA
  Alcoholic liver cirrhosis with portal hypertension, including refractory ascites and variceal bleeding
  
  RISK FACTORS
  Type 2 diabetes mellitus, hypertension
  
  PROCEDURAL STEPS
  1. Insertion of 10F sheath into the right jugular vein
  - 10F x 17-3%4'' sheath super Arrow-Flex® Psi Set, 45 cm, and tisue dilatator (Arrow International)
  - 0.035'' angled guide wire (TERUMO)
  2. Access to the a hepatic vein (right or middle) by inserting a 5F multi-purpose catheter
  - 5F MP A1 (CORDIS)
  - 0.035'' angled guide wire (TERUMO)
  3. Puncture of the portal vein under ultrasound or fluoroscopic control using a Tips puncture set
  - Tips puncture set with a spezial nitinol guide wire; needle size: ø 1.8 mm x 580 mm, 60° curved (OPTI MED)
  - 0.035'' straight guide wire (stiff type) (TERUMO)
  4. Placement of stiff guide wire and a catheter into the portal venous system to produce a direct portogram and to measure the direct portal pressure
  - 4F Berenstein catheter (ANGIO DYNAMICS)
  - Haemofix-Monitorin Kit Art/Ven BSS
  5. Dilatation of the parenchymateous tract using an angioplasty balloon
  - 0.035'' Supra Core 35 (ABBOTT VASCULAR)
  - 6F Armada 35 PTA catheter (ABBOTT VASCULAR)
  - Inflation device (MERIT MEDICAL)
  6. Placement of the 10F sheath into the portal mainstem
  - 10 F Check Flo Performer® introducer (COOK)
  7. Implantation the portovenous PTFE covered stent under fluoroscopic control
  - VIATORR 10 mm x 8 cm/2 cm; 10F (GORE)
  8. Dilatation of stent using an angioplasty balloon
  - 0.035'' Supra Core 35 (ABBOTT VASCULAR)
  - 6F Armada 35 PTA catheter (ABBOTT VASCULAR)
  - Inflation device (MERIT MEDICAL)
  9. Direct portography and measure the pressure gradients between the portal vein and the inferior vena cava
  - 5F- MP A1 (CORDIS)
  - F Check Flo Performer® introducer (COOK)
  10. Placement of a central venous catheter in the superior vena cava or right atrium
  - Mahurkar acute dual lumen catheter, 11.5F x 19.5 cm (COVIDIEN)
  
  

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