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CVIR Endovascular
Fig. 1 | CVIR Endovascular

Fig. 1

From: The double-balloon technique: a safe and effective adjunctive technique in patients undergoing arterial therapy for hepatic malignancies with vascular supply not amenable to selective administration

Fig. 1

a-d Treatment of a OPTN5B caudate lesion. a Surveillance MRI in this patient with cirrhosis demonstrated an arterially enhancing lesion measuring 2.3 cm centered in segment 1(black arrow heads) with b early washout and pseudocapsule formation deeming it OPTN5b and was referred for Y-90 radioembolization. His Pre-SIRT and SIRT studies demonstrated the caudate lobe artery arising from the proximal left hepatic artery with single tumor blush but with substantial adjacent supply to segments II/III and IV. Given desire to reduce risk of hepatic parenchymal embolization due to comorbidities of cirrhosis and portal hypertension, the double balloon technique was used. A 2.1 French Sniper catheter was positioned beyond the caudate artery. c A second 2.1 French angled Sniper catheter was placed and positioned at the proximal left hepatic artery proximal to the caudate artery (black arrow). d Both balloons were inflated with dilute contrast per manufacturer protocol (green and black arrows). Digital subtraction angiography from the proximal catheter demonstrated selective flow of contrast into caudate artery with avid enhancement of target lesion (black arrow heads), and minimal, sluggish flow beyond the second/distal Sniper balloon, so Y-90 Theraspheres were administered

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