Brief Article
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World J Gastroenterol. Oct 7, 2010; 16(37): 4704-4708
Published online Oct 7, 2010. doi: 10.3748/wjg.v16.i37.4704
Usefulness of Y-shaped sheaths in CT angiography for examination of liver tumors
Toru Ishikawa, Kazuo Higuchi, Tomoyuki Kubota, Kei-ichi Seki, Terasu Honma, Toshiaki Yoshida, Takeo Nemoto, Keiko Takeda, Tomoteru Kamimura
Toru Ishikawa, Kazuo Higuchi, Tomoyuki Kubota, Kei-ichi Seki, Terasu Honma, Toshiaki Yoshida, Tomoteru Kamimura, Department of Gastroenterology and Hepatology, Saiseikai Niigata Second Hospital, Niigata 950-1104, Japan
Takeo Nemoto, Keiko Takeda, Department of Radiology, Saiseikai Niigata Second Hospital, Niigata 950-1104, Japan
Author contributions: Ishikawa T wrote and edited the paper; the other authors participated in the preparation of the manuscript.
Correspondence to: Toru Ishikawa, MD, Department of Gastroenterology and Hepatology, Saiseikai Niigata Second Hospital, Teraji 280-7, Niigata 950-1104, Japan. toruishi@ngt.saiseikai.or.jp
Telephone: +81-25-2336161 Fax: +81-25-2338880
Received: April 30, 2010
Revised: June 13, 2010
Accepted: June 20, 2010
Published online: October 7, 2010
Abstract

AIM: To conduct a single-stage, combined computed tomography (CT) arterial portography (CTAP) and CT arteriography (CTA) imaging operation, we used Y-shaped sheaths with 2 valves, which allowed the insertion of 2 catheters simultaneously.

METHODS: Of 1254 patients who underwent abdominal angiography for transarterial embolization and/or intraarterial chemotherapy in our department from May 2002 to November 2009, 664 patients in whom Y-shaped sheaths with 2 valves were used underwent CT angiography using a combination of CTA and CTAP. The Seldinger method was used to insert a 10 cm Y-shaped short sheath with 2 valves into the femoral artery. Under radiographic guidance, a 3.2 French (Fr) catheter was placed in the celiac artery or proper hepatic artery, and a second 3.2 Fr catheter was then placed distal to the inferior pancreaticoduodenal artery of the superior mesenteric artery. CTAP was then performed followed by CTA 10 min later. Photographs were taken during the early and late phases of the procedure.

RESULTS: Insertion of 3.2 Fr catheters was not possible in 6 of 664 (0.9%) patients with strong curvature of the femoral artery and 4 of 664 (0.6%) patients with strong curvature of the abdominal aorta. In addition, performing CTAP and CTA as a single-stage combined intervention was not possible in 14 of 664 (2.1%) patients whose right hepatic artery originated from the superior mesenteric artery and in 8 of 664 (1.2%) patients whose left hepatic artery branched from the left gastric artery. There were no sheath-related complications such as those related to arterial dissection or hemostasis.

CONCLUSION: Although transfers to and from the CT room were necessary for anatomically variant patients, CT angiography using the Y-shaped sheath for combined CTAP and CTA was considered useful.

Keywords: Computed tomography angiography; Interventional radiology; Liver tumors