Transradial Access Chemoembolization for Hepatocellular Carcinoma Patients

Summary

Transarterial chemoembolization (TACE) is the standard therapy for patients in the intermediate stage of hepatocellular carcinoma and is typically performed through femoral artery access. Compared with transfemoral access, transradial access (TRA) can decrease the rate of bleeding complications and improve patient tolerance. A method is presented here to perform transarterial chemoembolization via radial artery access.

Abstract

Transarterial chemoembolization (TACE) is the most common modality for treatment of hepatocellular carcinoma (HCC) at the intermediate stage. TACE is typically performed via transfemoral access (TFA). However, transradial access (TRA) is preferred in coronary artery interventions due to decreased complications and mortality. Whether the advantages of TRA can be applied to TACE required investigation.

Patients receiving TRA TACE at a single center were retrospectively enrolled for study. Procedural details, technical success, radial artery occlusion (RAO) rate, and access site-related bleeding complications were evaluated. From October 2017 to October 2018, 112 patients underwent 160 TRA TACE procedures. The overall technical success rate was 95.0% (152/160). The rate of crossover from TRA to TFA was 1.9%. No access site-related bleeding complications were found in any cases. Asymptomatic RA occlusion occurred in three patients (2.7%). Compared with TFA, TRA can increase safety and patient satisfaction while decreasing access site-related bleeding complications. Moreover, TRA interventions can benefit patients with advanced age, obesity, or a high risk of bleeding complications.

Introduction

Hepatocellular carcinoma (HCC) is a very common malignancy, with the sixth highest incidence rate worldwide. It is also the second leading cause of cancer mortality around the world¹. Because only 5%–20% of patients can receive curative therapy, transarterial chemoembolization (TACE) is the most popular palliative treatment for patients with unresectable HCC². TACE has been recognized as the most commonly used and effective treatment approach for HCC patients at the intermediate stage³. Transfemoral access (TFA) chemoembolization is the most common approach for TACE⁴.....

Protocol

This single-center retrospective study was approved by the local Institutional Review Board of Zhongshan Hospital, Fudan University.

1. Obtaining informed consent

1. Before the TRA interventions, have interventional radiologists (IRs) explain the benefits and potential complications of TRA to the patients.

2. Patient evaluation

1. After obtaining informed consent, evaluate the RA for the feasibility of puncture and cannulation.
2. Perform a comprehensive review of the patient's medical history. Confirm if patients had severe vascular tortuosity, severe peripher....

Results

From October 2017 to October 2018, 112 patients underwent 160 TRA TACE procedures, and the overall technical success rate was 95.0% (152/160). Eight cases were met with technical failure. Of these, five cases were caused by left RA puncture failure and subsequently underwent successful TACE with right RA access. The other three cases were caused by cannulation failure, and underwent subsequent successful intervention by crossover to right FA access. The crossover rate of RA access to FA access was only 1.9%. No access si.......

Discussion

TRA interventional therapy has grown significantly worldwide in recent years, especially in diagnostic and Interventional cardiology procedures¹². Moreover, there has been increasing attention to peripheral vascular disease intervention. Without compromising procedural success rates, TRA to cardiac intervention can effectively reduce the rates of bleeding and vascular complications compared with TFA^13,14. Compared with TFA, TRA is superior.......

Materials

List of materials used in this article

Name	Company	Catalog Number	Comments
Reagents
Embosphere	Merit	20173776165
Gelfoam	Alicon	20143771056
Heparin	Hepatunn	H51021209
Injection syringe	KDL	20163150518
Iodinated oil	Yantai Luyin Pharmaceutical Co.Ltd	H37022398
Lidocaine	Shandong Hualu Pharmaceutical Co.Ltd	H37022147
Lobaplatin	Hainan Changan International Pharmaceutical Co.Ltd	H20050308
Nitroglycerin	Brijing Yimin Pharmaceutical Co.Ltd	H11020289
Normal saline	Anhui Shuanghe Pharmaceutical Co.Ltd	H34023609
Pharmorubicin	Pfizer	H20000496
Ultravist 370	Bayer	H20171333
Material
Hydrophilic Guide Wire	Merit	LWSTDA38180
Injection syringe	KDL	20163150518
Maestro Microcatheter	Merit	28MC24150SN
MPA1 (I) catheter	Cordis	451-406P0
Sheath Introducer	Merit	PSI-4F-11-035
Steerable Guidewire	Merit	TNR2411
TR Band	Terumo	XX*RF06
Equipment
DSA	Toshiba	INFX-9000V
Ultrasonic machine	SonoScape	20172231180