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Prediction of common hepatic artery catheter insertion based on celiac trunk morphology
Atsushi Saiga1, Hajime Yokota2, Akira Akutsu1
1Department of Radiology, Chiba University Hospital, Chiba, Japan.
Insights
Celiac trunk morphology impacts common hepatic artery catheter insertion success. Celiac angiography offers high predictability, while CT can identify median arcuate ligament syndrome, a risk factor for insertion failure.
Area of Science:
- Interventional Radiology
- Vascular Anatomy
- Medical Imaging
Background:
- Successful transcatheter procedures rely on accurate vessel access.
- Celiac trunk morphology can influence guidewire catheter navigation into the common hepatic artery (CHA).
- Predicting insertion success is crucial for optimizing treatment delivery.
Purpose of the Study:
- To evaluate the predictive capability of celiac trunk morphology for 4-5 French (Fr) catheter insertion into the CHA using a guidewire.
- To compare the efficacy of celiac angiography and preprocedural computed tomography (CT) in predicting insertion success.
- To assess the utility of the balloon anchor technique (BAT) in cases of failed insertion.
Main Methods:
- Retrospective analysis of 64 patients undergoing transcatheter procedures.
- Classification of celiac trunk morphology (upward, horizontal, downward) via celiac angiography.
- Measurement of the aortic-celiac trunk angle using preprocedural contrast-enhanced CT.
- Evaluation of 4-5 Fr catheter and 0.035-inch guidewire insertion success into the CHA.
- Assessment of median arcuate ligament syndrome (MALS) and application of BAT for difficult cases.
Main Results:
- Catheter insertion into the CHA was successful in 87.50% of patients (56/64).
- The downward celiac trunk type showed a significantly lower success rate (53.85%) compared to the upward type (100%).
- Celiac angiography demonstrated higher predictive accuracy (AUC=0.91) than preprocedural CT (AUC=0.72) for CHA insertion.
- All three MALS cases experienced unsuccessful CHA insertion, but all eight unsuccessful cases were successfully navigated using BAT.
Conclusions:
- Celiac angiography and preprocedural CT are valuable tools for predicting CHA catheter insertion success.
- Celiac angiography provides superior predictability compared to CT.
- CT can identify MALS, a significant risk factor for failed CHA catheterization, and BAT is effective for overcoming insertion challenges.
Purpose:
This study aimed to predict the ability to insert a 4-5 French (Fr) catheter insertion with a guidewire into the common hepatic artery (CHA) based on celiac trunk morphology.
Methods:
This retrospective study included 64 patients who underwent balloon-occluded transcatheter arterial chemoembolization (n = 56), transcatheter arterial chemotherapy (n = 2), or were fitted with an implantable port system (n = 6) between June 2019 and December 2019 in our institution. The morphology of the celiac trunk was classified into three types (upward, horizontal, and downward) based on celiac angiography. The aortic-celiac trunk angle was measured on sagittal images of preprocedural contrast-enhanced computed tomography (CT). We reviewed whether a 4-5-Fr shepherd's hook catheter could advance beyond the CHA using a 0.035-inch guidewire (Radifocus® Guidewire M; Terumo). Three patients were diagnosed with median arcuate ligament syndrome (MALS) based on the characteristic hook shape of the celiac artery on sagittal images of contrast-enhanced CT. The predictive ability of celiac angiography and preprocedural CT for CHA insertion success was evaluated. In unsuccessful cases, the balloon anchor technique (BAT) was attempted as follows: (1) a 2.7/2.8-Fr microballoon catheter (Attendant Delta; Terumo) was placed beyond the proper hepatic artery, and (2) the balloon was inflated as an anchor for parent catheter advancement.
Results:
Upward, horizontal, and downward celiac trunk types were noted in 42, 9, and 13 patients, respectively. The median CT angle was 122.83° (first quartile-third quartile, 102.88°-136.55°). Insertion in the CHA using the guidewire was successful in 56 of 64 patients (87.50%), and the success rate in the downward type was significantly lower than that in the upward type [42/42 (100%) vs. 7/13 (53.85%), P < 0.001]. The CT angle was significantly larger downward in the unsuccessful group than in the successful group (121.03° vs. 140.70°, P = 0.043). Celiac angiography had a significantly higher area under the curve (AUC) than preprocedural CT (AUC = 0.91 vs. AUC = 0.72, P = 0.040). All three cases of MALS showed unsuccessful CHA insertion. In all eight patients with unsuccessful insertion, the catheter could be advanced using the BAT [8/8 (100%)].
Conclusion:
Celiac angiography and preprocedural CT could predict CHA catheter insertion using a guidewire, and celiac angiography had high predictability. CT could detect MALS, a risk factor for unsuccessful CHA insertion.
