Leipzig, Dept. of Radiology

• Wednesday, January 25th: 8:41 - 9:02, Room 3 - Technical Forum

  Case 46 – Chemosaturation of liver metastases

  Center:

  Leipzig, Dept. of Radiology

  Case 46 – LEI 15: male, 82 years (N-C)

  Operators:

  • Jochen Fuchs,
  • Michael Moche

  CLINICAL DATA
  Uveal melanoma 07/2013, enucleation of the right eye 08/2013,
  unresectable liver metastases 03/2016,
  chemosaturation 04/2016, 06/2016, 11/2016, 12/2016
  
  RISK FACTORS
  Type 2 diabetes mellitus, hypertension
  
  PROCEDURAL STEPS
  1. Evaluation procedure (some days) prior to treatment:
  - Anatomical mapping
  - Embolization (to avoid reflux or infusion into GI or visceral arteries)
  
  2. US-guided venous and arterial access to avoid multiple punctures
  Establishment of 10F jugular venous return sheath, 18F femoral venous sheath for the venous isolation catheter and 4F femoral arterial sheath
  
  3. Full Heparinization (about 30.000 IE) with ACT control (> 450 sec!)
  Arterial catheter placement for Infusion into hepatic artery
  Connection and start of extracorporeal circuit
  
  4. Isolation of the hepatic veins by inflation of the double balloon catheter
  Check for proper isolation with DSA (no leakage!) and fixation the catheter
  
  5. Closing the Bypass-line to bring the filters of the extracorporeal circuit online
  CAVE: Watch out for blood pressure drop
  
  6. Start of arterial infusion of Melphalan (3 mg/kg) with injector (25 ml/min)
  Check intermittently for arterial spasms (if any consider nitroglycerin)
  After Melphalan is fully injected, 30 min wash-out period is applied
  
  7. Deflation of the balloons and disconnection of the filters
  Removal of arterial and venous catheters
  Removal of the sheaths after coagulation status has been normalized
  

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• Wednesday, January 25th: 11:48 - 12:08, Room 3 - Technical Forum

  Case 49 – Coiling of lumbal arteries and inferior mesenteric artery befor EVAR

  Center:

  Leipzig, Dept. of Radiology

  Case 49 – LEI 16: male, 68 years

  Operators:

  • Michael Moche,
  • Jochen Fuchs

  CLINICAL DATA
  Incidental finding of an eccentric infrarenal AAA with 5.1 cm diameter
  4.5 mm IMA
  3 mm lumbal artery 3 (already embolised)
  4 mm lumbal artery 5 with common trunc
  Art. hypertension, hyperlipidemia, former smorker
  
  CT-SCAN
  AAA with max. 51 mm diameter, eccentric, potentially old containt rupture
  
  PROCEDURAL STEPS
  1. Right groin access
  - 4F sheath CFA
  - 4F sidewinder cath.
  
  2. Embolisation of IMA
  - 4F sidewinder cath.
  - 5 mm Amplatzer Vascular Plug4 (ST. JUDE/ABBOTT)
  
  3. Embolisation of lumbal arteries 5
  - VortX Diamond Coils (BOSTON SCIENTIFIC)
  - POD Anchor Coil (PENUMBRA)
  

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