Portal Vein Stenting Combined with Iodine-125 Seeds Endovascular Implantation Followed by Transcatheter Arterial Chemoembolization for Treatment of Hepatocellular Carcinoma Patients with Portal Vein Tumor Thrombus

Figure 1

Images of ¹²⁵I seed strand implantation in a 53-year-old man. (a) After the patent 2nd-order branch of the left portal vein was catheterized, a 5-F Cobra catheter was placed in the main portal vein (MPV). Tumor thrombus in the proximal MPV and sagittal segment of the left portal vein was clearly shown in the right anterior oblique portography projection. (b) Transcatheter implantation of ¹²⁵I seed strand. (c) Under guidance of the second guide wire, the portal vein stent was implanted. (d) Angiography after vein stent and ¹²⁵I seed strand implantation showing the portal vein blood flow and that the seeds position is good. (e) A 14 × 120-mm self-expandable stent and ¹²⁵I seed strand with 20 seeds were placed precisely in the obstructed MPV. The ¹²⁵I seed strand was fixed steadily between the stent and MPV. Good flow through the patent stent from distal MPV to left portal vein is shown on the portography. (f) Images from single-photon emission computed tomography (SPECT)/computed tomography (CT) 1 day after procedure. The stent and ¹²⁵I seed strand were placed correctly, without displacement. Radiation emitted by the ¹²⁵I seed strand was distributed homogeneously. It presented as a cylindrical shape with a diameter of 20 mm covering the target lesion completely.

(a)

(b)

(c)

(d)

(e)

(f)