Value of Micronester coils in port-catheter implantation for continuous hepatic arterial infusion chemotherapy with fixed catheter tip method

Abstract

To retrospectively evaluate the use of Micronester coils in port-catheter implantation with the fixed catheter tip method in comparison with other previously used coils. The cohort of this study was 143 consecutive patients with unresectable advanced liver cancer for whom a port-catheter system was percutaneously implanted. In the most recent 32 patients, Micronester coils were used for catheter tip fixation. Details of embolic agents for fixation, persistent blood flow beyond the distal end of the indwelling catheter, and complications were compared between cases without and with Micronester coils. In all, percutaneous port-catheter placement was successful. Mean number of coils used for fixation was 4.2 without Micronester coils vs. 2.5 with Micronester coils. N-butyl cyanoacrylate (NBCA)-Lipiodol was additionally used for catheter tip fixation in 85.6% of 111 procedures without Micronester coils and in 50% of 32 using Micronester coils. The gastroduodenal artery beyond the distal end was not detected at the final examination after any procedure. Catheter dislocation occurred in five and hepatic arterial obstruction or severe stenosis in eight. The number of coils used and necessity of NBCA-Lipiodol could be decreased with usage of Micronester coils without decreasing fixation ability compared to other coils.

Hepatic arterial infusion chemotherapy with a coaxial reservoir system using a non-braided spiral tip microcatheter

“…d The port was placed in the right region of the hypogastric area (white curved arrow). The catheter was placed in the subcutaneous tunnel (thin white arrows), making a loop from just under the inguinal ligament in the cranial direction at the superior border to center of the femoral head (thin black arrow) tip method with a coil or n-butyl cyanoacrylate-lipiodol mixture is associated with a rate of 5-6.8% [11,14,[16][17][18]. The present study found higher rates of hepatic arterial occlusion than observed for the conventional reservoir.…”

“…Catheter occlusion was reported in 0-11.4% of cases [5,7,8,11,[13][14][15][16][17][18][21][22][23]. One study reported a high rate of occlusion using a 5-F catheter [23]; therefore, catheter size and occlusion rate do not appear to be related.…”

A Simplified Technique of Percutaneous Hepatic Artery Port-Catheter Insertion for the Treatment of Advanced Hepatocellular Carcinoma with Portal Vein Invasion

“…We used a non-tapered indwelling catheter, such as a 5-Fr or 5.8-Fr polyurethane catheter, where a tip-fixation effect may be expected, and no coil insertion or n-butyl cyanoacrylate embolization was performed for additional catheter-tip fixation. In our study, catheter dislocation occurred more frequently than in previous reports using the classic fixed-catheter-tip method (18, 19, 21-25). However, among 18 of the 19 cases with complications that required correction of the implantable port-catheter system, correction was possible in the majority of cases with the distal catheter tip at the gastroepiploic or gastroduodenal artery.…”

“…A review of large published studies describing percutaneous port-catheter system placement for hepatic arterial infusion chemotherapy using the fixed-catheter-tip method, revealed that the rate of indwelling catheter dislocation was 2-8% (16, 18, 19, 21-25), and the rate of hepatic artery obstruction was 3-20% (19, 21-25). However, several important problems exist with this method such as the difficulty in catheter removal (19), the long procedure duration for catheter-tip fixation using microcoils alone or with n-butyl cyanoacrylate, and the migration of the coil or cast of n-butyl cyanoacrylate.…”