Treatment of Hepatic Tumors with Inaccessible Vasculature Using an Adjustable Length Dual Occlusion Balloon Catheter System

Transarterial embolotherapy with the use of maximally selective techniques is associated with decreased toxicity and improved survival in patients with hepatic malignancies ( 1 Miyayama S. Matsui O. Yamashiro M. et al. Ultraselective transcatheter arterial chemoembolization with a 2-F tip microcatheter for small hepatocellular carcinomas: relationship between local tumor recurrence and visualization of the portal vein with iodized oil. J Vasc Interv Radiol. 2007; 18: 365-376 Abstract Full Text Full Text PDF PubMed Scopus (196) Google Scholar ). This strategy maximizes therapeutic delivery to the tumor while preserving hepatic function, which is important considering the repetitive catheter-directed treatment algorithms often used and the incidence of baseline liver dysfunction in this population. Occasionally, tumor-feeding vessels cannot be selected, preventing a superselective approach. This can occur with hypovascular or infiltrative tumors that have tiny feeding vessels or because of difficult vessel navigability, such as when a vascular origin is stenotic or sharply angulated. Occlusion balloon catheters offer a solution, allowing an operator to alter flow dynamics to target therapeutic agent delivery without vessel selection. Here, a technique to deliver targeted transarterial embolotherapy to technically inaccessible tumor vessels with the use of a dual-occlusion balloon catheter is presented along with an illustrative case.