title: Usefulness of Y-shaped sheaths in CT angiography for examination of liver tumors.
abstract: OBJECTIVE
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Gastroenterology and Hepatology, Saiseikai Niigata Second Hospital, Niigata 950-1104, Japan. toruishi@ngt.saiseikai.or.jp
authors.forename: Toru
authors.initials: T
authors.lastname: Ishikawa
authors.forename: Kazuo
authors.initials: K
authors.lastname: Higuchi
authors.forename: Tomoyuki
authors.initials: T
authors.lastname: Kubota
authors.forename: Kei-ichi
authors.initials: K
authors.lastname: Seki
authors.forename: Terasu
authors.initials: T
authors.lastname: Honma
authors.forename: Toshiaki
authors.initials: T
authors.lastname: Yoshida
authors.forename: Takeo
authors.initials: T
authors.lastname: Nemoto
authors.forename: Keiko
authors.initials: K
authors.lastname: Takeda
authors.forename: Tomoteru
authors.initials: T
authors.lastname: Kamimura
mesh_terms: D000792:Angiography / Q000295:instrumentation / Q000379:methods; D006528:Carcinoma, Hepatocellular / Q000175:diagnosis / Q000000981:diagnostic imaging; D057785:Catheters; D006801:Humans; D008113:Liver Neoplasms / Q000175:diagnosis / Q000000981:diagnostic imaging*; D010360:Patient Transfer; D011172:Portography / Q000295:instrumentation / Q000379:methods; D014057:Tomography, X-Ray Computed / Q000295:instrumentation / Q000379:methods