LINC 2019 live case guide

Jena

• Wednesday, January 23rd: 8:49 - 9:14, Room 3 - Technical Forum

  Case 45 – Selective internal radiation therapy in hepatocellular carcinoma

  Center:

  Jena

  Case 45 – JEN 01: male, 63 years (D-J)

  Operators:

  • René Aschenbach,
  • S. Witting,
  • R. Drescher

  CLINICAL DATA
  HCC Stage IIIa (pT3 Nx M0) 6/18
  Atypical segmentectomy segment III 6/18
  cTACE performed in referring hospital
  Multifocal HCC in both liver lobes
  Primary outside MILAN
  Universal liver tumor board waived sequential SIRT, starting right
  Evaluation showed a 2.5% shunt to the lung and estimated dose of 2.5GBq for Therasphere (BTG)
  No extrahepatic deposition of radioactivity in test-dose
  
  RISK FACTORS
  Liver cirrhosis CHILD A, MELD 6
  Diabetis mellitus, arterial hypertonia
  
  PROCEDURAL STEPS
  1. Right groin retrograde access
  - 0.035‘‘ EMERALD guidewire 150 cm (CORDIS)
  - 5F 10 cm Radiofocus Introducer II sheath (TERUMO)
  2. Placement of diagnostic catheter in main hepatic artery
  - 0.035‘‘Radiofocus angled guidewire, 180 cm (TERUMO)
  - Diagnostic catheter SIM 1, 4F 0.035‘‘, 100 cm (CORDIS)
  3. Placement of microcatheter in right hepatic artery
  - Progreat 2.7F (TERUMO)
  - alternative wire: Cirrus 14‘ (COOK)
  4. Radioembolisation
  - SIRT with TheraSphereR yttrium-90 glass microspheres (BTG)
  5. Puncture site occlusion
  - Vascularclosure Device Exoseal (CORDIS)

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• Wednesday, January 23rd: 11:08 - 11:33, Room 3 - Technical Forum

  Case 46 – Transarterial chemoembolization with drug-eluting-beads (DEB-TACE) in hepatocellular carcinom

  Center:

  Jena

  Case 46 – JEN 02: female, 58 years (H-L)

  Operators:

  • René Aschenbach,
  • S. Witting

  CLINICAL DATA
  Differentiated hepatocellular carcinoma (G1)
  
  RISK FACTORS
  Liver cirrhosis CHILD A
  Chronische hepatitis
  
  PROCEDURAL STEPS
  1. Right groin retrograde access
  - 0.035‘‘ EMERALD guidewire 150 cm (CORDIS)
  - 5F 10 cm Radiofocus Introducer II sheath (TERUMO)
  2. Placement of diagnostic catheter in main hepatic artery
  - 0.035‘‘ Radiofocus angled guidewire, 180 cm (TERUMO)
  - Diagnostic catheter Cobra 4, 4F 0.035‘‘, 100 cm (CORDIS)
  3. Placement of microcatheter in right hepatic artery
  - Progreat 2.7F (TERUMO)
  - alternative wire: Cirrus 14‘ (COOK)
  4. Superselective placement of microcatheter in feeding artery
  5. Embolization
  - 40μm Embozene-Tandem (BOSTON SCIENTIFIC) loaded with 150 mg Doxorubicin till stasis
  6. If still perfusion after administration of the whole 3ml Embozene Tandem 40μm then additional embolization with blande microparticals Embozene 400μm till stasis is reached
  7. Control angiography
  8. Puncture site occlusion
  - Vascular closure device Exoseal (CORDIS) and pressure dressing

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• Wednesday, January 23rd: 15:08 - 15:29, Room 3 - Technical Forum

  Case 49 – Prostatic artery embolization for symptomatic benign prostatic hyperplasia

  Center:

  Jena

  Case 49 – JEN 03: male, 58 years (M-K)

  Operators:

  • Tobias Franiel,
  • F. Bürckenmeyer

  CLINICAL DATA
  Prostatic volume 80 ml
  Negative TRUST-guided systematic biopsy due to increased PSA 6.0
  IPSS: 19 (0-35), QoL: 3 (0-6), Qmax: 13.0 ml/s with voided volume of 160 ml
  IIEF-5: 15 (1-25)
  
  RISK FACTORS
  Arterial hypertension
  
  DUPLEX
  Post void residual urine of 100ml
  
  PRESENT STATE
  Lower urinary tract symptoms due to BPH (confirmed by urology department)
  No successful medication therapy for more than 6 month, refusing operative therapy
  
  PROCEDURAL STEPS
  1. Right groin access
  - ST. JUDE (ABBOTT)
  2. Placement of coaxial catheter in distal aorta
  - RIM 4F (CORDIS) or alternative (MERRIT Medical)
  - Alternative wire: Cirrus 14“ (COOK)
  3. Large-FOV-dyna CT for determination of anatomy and origins of the prostatic arteries
  4. Placement of microcatheter in the left prostatic artery for embolization
  - Progreat 2.7F (TERUMO), alternative: Progreat 2.0F alpha (TERUMO), alternative SwiftNinja (MERRIT Medical)
  - Embozene 250 μm (BOSTON SCIENTIFIC), alternative: 400 μm (BOSTON SCIENTIFIC)
  5. Placement of the microcatheter in the right prostatic artery for embolization
  - Progreat 2.7F (TERUMO), alternative: Progreat 2.0F alpha (TERUMO), alternative SwiftNinja (MERRIT Medical)
  - Embozene 250 μm (BOSTON SCIENTIFIC)
• Wednesday, January 23rd: 16:51 - 17:15, Room 3 - Technical Forum

  Case 51 – Aneurysma embolization (coiling) of the splenic artery

  Center:

  Jena

  Case 51 – JEN 04: female, 74 years (V-S)

  Operators:

  • F. Bürckenmeyer,
  • I. Diamantis

  CLINICAL DATA
  16 mm neurysm of the lienal artery with growth tendency
  
  RISK FACTORS
  Arterial hypertension, rheumatoid arthritis
  
  PROCEDURAL STEPS
  1. Right groin retrograde access
  - 0.035‘‘ EMERALD guidewire 150 cm (CORDIS)
  - 5F 10 cm Radiofocus Introducer II sheath (TERUMO)
  2. Placement of diagnostic catheter in main hepatic artery
  - 0.035‘‘ Radiofocus angled guidewire, 180 cm (TERUMO)
  - Diagnostic catheter Cobra 4, 4F 0.035‘‘, 100 cm (CORDIS)
  3. Placement of microcatheter in splenic artery
  - Progreat 2.7F (TERUMO)
  - alternative wire: Cirrus 14‘ (COOK)
  4. Embolization
  - PENUMBRA Coils system
  5. Control angiography
  6. Puncture site occlusion
  - Vascular Closure System Exoseal (CORDIS) and pressure dressing

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