TACE for HCC patient Today’s case -1–
69 year old patient with HCC, the patient have had RFA once and SABR to S8 marginal recurrence (‘21.9.23.- ‘21.10.5.).
On follow up Liver CT, a nodular lesion is identifed which shows APHE and delayed washout.
![TACE, Today's case -1-](https://q-radiology.com/wp-content/uploads/2023/07/image-14.png)
The patient refered to angio room for TACE
I punctured the patient’s right femoral artery on US guide using micropuncture set
![](https://q-radiology.com/wp-content/uploads/2023/07/image-15.png)
After puncturing the right femoral artery, I inserted a 5Fr sheath. Subsequently, I inserted a 5Fr RH catheter to select the celiac artery.
However, the RH catheter shaping failed due to the patient’s excessive height. I attempted to select the contralateral iliac artery or renal artery to shape the RH catheter, but these attempts also failed. (Our angio room typically uses RH catheters from a Korean company, which often present these kinds of problems.)
Consequently, I requested a longer RH catheter from Cook, as their RH catheters are approximately 5cm longer.
Despite these challenges, I eventually succeeded in shaping the RH catheter using the right renal artery.
![Today's case 1](https://q-radiology.com/wp-content/uploads/2023/07/image-16.png)
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![Today's case -1-](https://q-radiology.com/wp-content/uploads/2023/07/image-18.png)
Utilizing these guidance techniques, I attempted to select the feeding artery with a microcatheter (Radiostar microcatheter, 1.9Fr, 110cm) and a microguidewire (ASAHI Meister, 0.016″, 135cm).
After selecting a small vessel, I checked whether it was the correct vessel using contrast media. However, I did not withdraw blood before injecting the contrast media. Consequently, the following issue occurred…
![Today's case -1-](https://q-radiology.com/wp-content/uploads/2023/07/image-19.png)
![Today's case -1-](https://q-radiology.com/wp-content/uploads/2023/07/image-20.png)
![Today's case -1-](https://q-radiology.com/wp-content/uploads/2023/07/image-21.png)
![Today's case -1-](https://q-radiology.com/wp-content/uploads/2023/07/image-22.png)
![](https://q-radiology.com/wp-content/uploads/2023/07/image-23.png)
This case provided me with valuable experience, emphasizing the importance of being cautious with the vulnerability of small vessels when using a microcatheter and guidewire.
End of Today’s Case -1-