What Is an Arterial Cannula?

Hepatic arterial intubation is a laparotomy, which is intubated from the right gastroretinal artery through the gastroduodenal artery to the proper hepatic artery or the right and left hepatic artery. It is used to continuously inject anticancer drugs. Patients with liver cancer after surgical resection or palliative resection. The Seldinger method can also be used to intubate the hepatic artery through the inguinal artery and leave the tube for a short time. Intubation and infusion can continue to inject anticancer drugs, and treat patients with liver cancer who cannot be surgically or palliatively resected. Intubation and infusion treatment can make drugs directly affect tumor tissues, increase local drug concentration, reduce systemic reactions, and achieve the purpose of treating tumors and prolonging life. Severe ascites, jaundice, or cachexia in advanced liver cancer are contraindications for intubation. ^[1]

Hepatic artery intubation

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Hepatic arterial intubation is a laparotomy, which is intubated from the right gastroretinal artery through the gastroduodenal artery to the proper hepatic artery or the right and left hepatic artery. It is used to continuously inject anticancer drugs. Patients with liver cancer after surgical resection or palliative resection. The Seldinger method can also be used to intubate the hepatic artery through the inguinal artery and leave the tube for a short time. Intubation and infusion can continue to inject anticancer drugs, and treat patients with liver cancer who cannot be surgically or palliatively resected. Intubation and infusion treatment can make drugs directly affect tumor tissues, increase local drug concentration, reduce systemic reactions, and achieve the purpose of treating tumors and prolonging life. Severe ascites, jaundice, or cachexia in advanced liver cancer are contraindications for intubation. ^[1]

Figure 1 Hepatic artery intubation (finger-guided intubation)

1. Large liver tumors cannot be resected in one stage. If the tumor occupies the entire liver area, less than 50% of those with liver cirrhosis and less than 75% of those without cirrhosis can be treated with arterial infusion chemotherapy to reduce the tumor with the possibility of two-stage resection.

2. No jaundice and ascites.

Hepatoprotective and procoagulant therapy.

Continuous epidural anesthesia.

Right in the right upper quadrant or through the right rectus incision, expand the gastric antrum after laparotomy, find the right gastroretinal artery on the side of the greater curvature of the gastric antrum, separate about 1 cm of arteries, and put two No. 4 silk threads into the distal end. Ligature, the end of the line is not cut, the assistant tightens the proximal arterial thread without ligation. The surgeon cuts the anterior wall of the artery with small scissors between the two lines. The left hand lifts the cut anterior wall of the artery with ophthalmic pointed forceps and holds it in the right hand. Tweezers clamp a plastic tube with an outer diameter of 3 to 4 mm and insert it into the arterial incision. While feeding the plastic tube inward, relax the proximal silk thread. After inserting 5 to 6 cm, use your left hand to show your finger and middle finger to extend from the small omentum hole into the hepatoduodenal ligament In the rear, place the thumb in front of the hepatoduodenal ligament, touch the plastic tube, and assist in guiding the plastic tube into the hepatic artery [Figure 1]. The ligament of the proximal right artery of the gastric omentum was ligated. Depending on the tumor site, the catheter is inserted into the proper hepatic artery, right hepatic artery, or left hepatic artery. To confirm the position of the catheter, you can inject 2ml beautiful blue. If the right half of the liver is stained immediately, it is confirmed that the catheter is in the right hepatic artery and vice versa. The catheter was fixed repeatedly on the omentum and peritoneum multiple times to lead the abdominal wall and fixed to the skin of the abdominal wall with silk threads.

Can also be intubated from the right gastric artery and gastroduodenal artery to the hepatic artery.

1. When inserting a plastic tube, the tail end should contain 3.84g% sodium citrate or 50u% heparin solution continuously and fill the catheter. At the end of intubation, use a hemostat to clamp the plastic tube or plug the flat head with a plastic plug and a heparin cap. Inject the needle to prevent blood back.

2. Be gentle when intubating to avoid breaking the artery wall.

3. A perfusion chemotherapy pump can be used. The catheter is inserted into the hepatic artery in the same way, and the pump connected to the catheter is buried under the skin. After the skin puncture, the pump is injected into the pump.

1. Rinse with heparin solution or sodium citrate solution once a day after operation to prevent catheter obstruction.

2. Strictly aseptic operation when injecting medicine and flushing tube to prevent iatrogenic bacteremia and sepsis. Anticoagulants should be stored in the refrigerator and replaced once a week.

3. The catheter should be removed in stages within 1 week to prevent bleeding. If bleeding occurs, local compression can be applied. If hemostasis cannot be achieved, surgery should be performed immediately to stop bleeding.