Jena

• Tuesday, June 7th: 8:28 - 8:48, Main Arena 2

  Radio-Segment-Ectomy S VII in HCC

  Center:

  Jena

  Case 16 – Jena 01: Male, 70 years (S-M)

  Operators:

  • Philipp Seifert

  CLINICAL DATA
  – NTLC Child B, prior resection intrahepatic bile duct adenoma S VIII,
  prior stereotactic radiation therapy of HCC S VIII (60Gy), new HCC segment VII, TACE failure, ITB waived radiosegmentectomy
  
  RISK FACTORS
  – Prior TACE non responder, surgery due to cirrhosis contraindicated,
  prior evaluation showed perfect tumor-to-liver ration in uptake, no relevant extrahepatic deposition or lung shunt, no extrahepatic disease, bridging to transplant
  
  PROCEDURAL STEPS
  1. Arterial puncture right groin
  
  2. Insertion 5F-sheath. (5F Radiofucus Introducer, TERUMO)
  
  3. Cannulation of the hepatic common artery origin from the mesenteric artery as a anatomical variant, (4F SIM 1 Super Torque, CORDIS)
  
  4. Cannulation of the right hepatic artery using microcatheter (Progreat 2.7F, TERUMO)
  
  5. Advance microcatheter to segment artry VII with dominant tumor supply
  
  6. Application of the calculated therapeutic dose of 0.5GBq Theraspheres (>350Gy tumor dose), Therasphere (BOSTON SCIENTIFIC)
  
  7. Removal of all catheters
  
  8. Vascular closure device right groin (Exoseal 5 F/CORDIS)

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• Tuesday, June 7th: 17:20 - 17:40, Main Arena 2

  Trans-jugulary-intrahepatic portosystemic stent shunt (TIPSS) in refractory ascites and Child C cirrhosis

  Center:

  Jena

  Case 21 – Jena 02: Female, 52 years (S-A)

  Operators:

  • Florian Bürckenmeyer

  CLINICAL DATA
  – Child C cirrhosis with ascites, otherwise refractory to therapy
  
  RISK FACTORS
  – CT confirmed cirrhosis and patency of the right hepatic vein, rule out of HCC in estimated puncture tract, no PVT, no large cysts
  
  PROCEDURAL STEPS
  1. Ultra-sound guided puncture of right jugulary vein
  
  2. Insertion of Flexor Check Flo II Introducer Set 10F (COOK)
  
  3. Cannulation of right hepatic vein using Turcon NB Advance Catheter (COOK) TIPS-Configuration and road-runner guide wire 0.018" (COOK)
  
  4. Advancing introducer-sheath into right hepatic vein using Amplatzer super stiff wire (BOSTON SCIENTIFIC)
  
  5. Ultrasound-guided puncture of intrahepatic right portal vein using Transjugulary liver access and biopsy Needle Set (COOK)
  
  6. Advancing diagnostic catheter into portal vein using PIG-Vessel sizing catheter-20B UHF (MERIT MEDICAL) to define lenght of TIPSS-Stentgraft
  
  7. Measurement of pressure in inferior caval vein, right hepatic vein and portal vein
  
  8. Dilatation of liver-tract using Passeo 35-XEO 8mm (BIOTRONIK) and advancement of the transjugulary sheath into the portal vein
  
  9. Implantation of Viatorr 8-10 mm controlled expandable stentgraft (GORE) and repeating of pressure measurement, target pressure of <10mm Hg for HVPG