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Innovation in catheter design for intra-arterial liver cancer treatments results in favorable particle-fluid dynamics.

van den Hoven AF, Lam MG, Jernigan S, van den Bosch MA, Buckner GD - J. Exp. Clin. Cancer Res. (2015)

Bottom Line: Here, we present first evidence of catheter design effect on particle-fluid dynamics and downstream branch targeting during microsphere administrations.Quantitative analyses confirmed a significantly more homogeneous distribution with the ARC; the mean DHD was 40.85 % (IQR 22.76 %) for the SMC and 15.54 % (IQR 6.46 %) for the ARC (p = 0.047).Catheter type has a significant impact on microsphere administrations in an in-vitro hepatic arterial model.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Room E.01.132, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands. a.f.vandenhoven@umcutrecht.nl.

ABSTRACT

Background: Liver tumors are increasingly treated with radioembolization. Here, we present first evidence of catheter design effect on particle-fluid dynamics and downstream branch targeting during microsphere administrations.

Materials and methods: A total of 7 experiments were performed in a bench-top model of the hepatic arterial vasculature with recreated hemodynamics. Fluorescent microspheres and clinically used holmium microspheres were administered with a standard microcatheter (SMC) and an anti-reflux catheter (ARC) positioned at the same level along the longitudinal vessel axis. Catheter-related particle flow dynamics were analyzed by reviewing video recordings of UV-light illuminated fluorescent microsphere administrations. Downstream branch distribution was analyzed by quantification of collected microspheres in separate filters for two first-order branches. Mean deviation from a perfectly homogenous distribution (DHD) was used to compare the distribution homogeneity between catheter types.

Results: The SMC administrations demonstrated a random off-centered catheter position (in 71 % of experiments), and a laminar particle flow pattern with an inhomogeneous downstream branch distribution, dependent on catheter position and injection force. The ARC administrations demonstrated a fixed centro-luminal catheter position, and a turbulent particle flow pattern with a more consistent and homogenous downstream branch distribution. Quantitative analyses confirmed a significantly more homogeneous distribution with the ARC; the mean DHD was 40.85 % (IQR 22.76 %) for the SMC and 15.54 % (IQR 6.46 %) for the ARC (p = 0.047).

Conclusion: Catheter type has a significant impact on microsphere administrations in an in-vitro hepatic arterial model. A within-patient randomized controlled trial has been initiated to investigate clinical catheter-related effects during radioembolization treatment.

No MeSH data available.


Related in: MedlinePlus

Catheter positions during fluorescent microsphere administrations. Photographs of the catheter positions in the geometry of the recreated hepatic arterial model, corresponding to the fluorescent microsphere administrations in Fig. 4. a Note the SMC tip deviation towards the right side. b Fixed centro-luminal position of the ARC. Abbreviations: LHA = left hepatic artery; RHA = right hepatic artery; PHA = proper hepatic artery. NB: the model is oriented up-side down
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Fig3: Catheter positions during fluorescent microsphere administrations. Photographs of the catheter positions in the geometry of the recreated hepatic arterial model, corresponding to the fluorescent microsphere administrations in Fig. 4. a Note the SMC tip deviation towards the right side. b Fixed centro-luminal position of the ARC. Abbreviations: LHA = left hepatic artery; RHA = right hepatic artery; PHA = proper hepatic artery. NB: the model is oriented up-side down

Mentions: After achieving a constant flow velocity of 10 ml/min, the catheter was introduced into the model through a port proximal to the hepatic arterial model. The tip of the SMC (Progreat 2.7 Fr., Terumo Europe, Leuven, Belgium) and the ARC (Surefire Infusion System mT, Surefire Medical Inc., Westminster, Co, USA) were positioned at a target location on the longitudinal axis of the vessel. Different target locations were chosen to test both catheter types in various geometrical configurations. For the first experiment, this location was at 2 mm distance to the LHA/RHA bifurcation, for the second and third experiment a 5 mm distance was chosen (representative for a whole liver treatment with a proper hepatic artery injection). For the experiments with holmium microspheres in the second model (experiments 4–7), the catheters were positioned in the surgical tubing inserted in the RHA before the branching of the S4A (representative for a lobar treatment with a right hepatic artery injection). The position of the SMC in the cross-sectional vessel plane was a result of random placement, affected by the entire vessel geometry (Fig. 3a). Deviation of the SMC tip position was noted. The tip of the ARC was deployed just before the injection.Fig. 3


Innovation in catheter design for intra-arterial liver cancer treatments results in favorable particle-fluid dynamics.

van den Hoven AF, Lam MG, Jernigan S, van den Bosch MA, Buckner GD - J. Exp. Clin. Cancer Res. (2015)

Catheter positions during fluorescent microsphere administrations. Photographs of the catheter positions in the geometry of the recreated hepatic arterial model, corresponding to the fluorescent microsphere administrations in Fig. 4. a Note the SMC tip deviation towards the right side. b Fixed centro-luminal position of the ARC. Abbreviations: LHA = left hepatic artery; RHA = right hepatic artery; PHA = proper hepatic artery. NB: the model is oriented up-side down
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4522078&req=5

Fig3: Catheter positions during fluorescent microsphere administrations. Photographs of the catheter positions in the geometry of the recreated hepatic arterial model, corresponding to the fluorescent microsphere administrations in Fig. 4. a Note the SMC tip deviation towards the right side. b Fixed centro-luminal position of the ARC. Abbreviations: LHA = left hepatic artery; RHA = right hepatic artery; PHA = proper hepatic artery. NB: the model is oriented up-side down
Mentions: After achieving a constant flow velocity of 10 ml/min, the catheter was introduced into the model through a port proximal to the hepatic arterial model. The tip of the SMC (Progreat 2.7 Fr., Terumo Europe, Leuven, Belgium) and the ARC (Surefire Infusion System mT, Surefire Medical Inc., Westminster, Co, USA) were positioned at a target location on the longitudinal axis of the vessel. Different target locations were chosen to test both catheter types in various geometrical configurations. For the first experiment, this location was at 2 mm distance to the LHA/RHA bifurcation, for the second and third experiment a 5 mm distance was chosen (representative for a whole liver treatment with a proper hepatic artery injection). For the experiments with holmium microspheres in the second model (experiments 4–7), the catheters were positioned in the surgical tubing inserted in the RHA before the branching of the S4A (representative for a lobar treatment with a right hepatic artery injection). The position of the SMC in the cross-sectional vessel plane was a result of random placement, affected by the entire vessel geometry (Fig. 3a). Deviation of the SMC tip position was noted. The tip of the ARC was deployed just before the injection.Fig. 3

Bottom Line: Here, we present first evidence of catheter design effect on particle-fluid dynamics and downstream branch targeting during microsphere administrations.Quantitative analyses confirmed a significantly more homogeneous distribution with the ARC; the mean DHD was 40.85 % (IQR 22.76 %) for the SMC and 15.54 % (IQR 6.46 %) for the ARC (p = 0.047).Catheter type has a significant impact on microsphere administrations in an in-vitro hepatic arterial model.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Room E.01.132, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands. a.f.vandenhoven@umcutrecht.nl.

ABSTRACT

Background: Liver tumors are increasingly treated with radioembolization. Here, we present first evidence of catheter design effect on particle-fluid dynamics and downstream branch targeting during microsphere administrations.

Materials and methods: A total of 7 experiments were performed in a bench-top model of the hepatic arterial vasculature with recreated hemodynamics. Fluorescent microspheres and clinically used holmium microspheres were administered with a standard microcatheter (SMC) and an anti-reflux catheter (ARC) positioned at the same level along the longitudinal vessel axis. Catheter-related particle flow dynamics were analyzed by reviewing video recordings of UV-light illuminated fluorescent microsphere administrations. Downstream branch distribution was analyzed by quantification of collected microspheres in separate filters for two first-order branches. Mean deviation from a perfectly homogenous distribution (DHD) was used to compare the distribution homogeneity between catheter types.

Results: The SMC administrations demonstrated a random off-centered catheter position (in 71 % of experiments), and a laminar particle flow pattern with an inhomogeneous downstream branch distribution, dependent on catheter position and injection force. The ARC administrations demonstrated a fixed centro-luminal catheter position, and a turbulent particle flow pattern with a more consistent and homogenous downstream branch distribution. Quantitative analyses confirmed a significantly more homogeneous distribution with the ARC; the mean DHD was 40.85 % (IQR 22.76 %) for the SMC and 15.54 % (IQR 6.46 %) for the ARC (p = 0.047).

Conclusion: Catheter type has a significant impact on microsphere administrations in an in-vitro hepatic arterial model. A within-patient randomized controlled trial has been initiated to investigate clinical catheter-related effects during radioembolization treatment.

No MeSH data available.


Related in: MedlinePlus