Liver parenchyma access and lesion marker via the endovascular route.
BACKGROUND
Neoadjuvant chemotherapeutic regimens for metastatic colorectal cancer are now so effective that they can cause "vanishing" lesions. With new advances such as local ablation, intra-arterial treatments in bolus with pumps or with beads, and isolation of hepatic perfusion, the need for a working channel to the liver may be warranted, ideally reducing the risk of spreading neoplastic cells.


METHODS
The endovascular trans-vessel wall Extroducer device makes it possible to gain direct access to the liver parenchyma. The distal tip is then detached, to act as both a marker and a securing plug in the vessel defect. We used ex vivo and in vivo tests to evaluate the device as a working channel for local administration of substances to the parenchyma and as a marker for detection with both transabdominal and intraoperative ultrasonography.


RESULTS
We could deploy the Extroducer device without any hemorrhagic or thromboembolic complications in vivo, and we were able to detect all markers ex vivo and in vivo using both transabdominal and intraoperative ultrasonography. Furthermore, we found that it is possible to administer substances to the liver parenchyma using the catheter.


CONCLUSIONS
The trans-vessel wall technique can be used to establish a working channel to the liver parenchyma for administration of any substance, such as chemotherapeutic agents or cells. The detached device can also be used as a marker for ultrasound-guided partial liver resection in "vanishing lesions." The technique should have a low risk of seeding of neoplastic cells. This study in large animals forms a strong basis for translation to clinical studies.
Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Department of Neuroradiology, Karolinska University Hospital, Stockholm, Sweden.
Johan
J
Lundberg
Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
Anton
A
Razuvaev
Division of Surgery, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden.
Bengt
B
Isaksson
Division of Surgery, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden.
Thorhallur
T
Agustsson
Department of Materials Science and Engineering, Royal Institute of Technology, Stockholm, Sweden.
Stefan
S
Jonsson
Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Department of Neuroradiology, Karolinska University Hospital, Stockholm, Sweden. Electronic address: staffan.holmin@ki.se.
Staffan
S
Holmin
D000818:Animals; D000970:Antineoplastic Agents / Q000008:administration & dosage*; D057785:Catheters; D057510:Endovascular Procedures / Q000379:methods*; D005260:Female; D006498:Hepatectomy / Q000379:methods*; D006499:Hepatic Artery / Q000601:surgery; D008099:Liver / Q000000981:diagnostic imaging; D059629:Signal-To-Noise Ratio; D013552:Swine; D014463:Ultrasonography
D000970:Antineoplastic Agents
Endovascular; Liver metastasis; Parenchymal access; Vanishing lesions