Fig. 7. Schema and photographs of the proximal side-hole opened microballoon catheter (Logosswitch; Piolax Co., Yokohama, Japan). (A) The side-hole above the proximal radiopaque marker is located 17 mm from the tip of the microballoon catheter and has a diameter of 0.48 mm. (B) With the microballoon inflation, material injected through the lumen of the catheter tip flows only through the side hole (white arrow). (C) A 81-year-old female presented with hepatocellular carcinoma (HCC) at the border of the posterior segment and caudate lobe. Contrast-enhanced computed tomography (CT) imaging of the arterial phase showed hypervascular tumor (white arrow) and the right branch of the portal vein was clearly delineated, and arterial-portal (AP) shunt formation was suspected (white arrow head). (D) Common hepatic arteriography showed diffuse fine AP shunt (white arrow) in the peripheral portion of the liver parenchyma in the posterior segment. HCC suspected on enhanced CT was obscure. (E) A side-hole opened microballoon catheter was inserted into the proximal portion of the posterior segment branch, and angiography was performed under balloon inflation (black arrowhead). A small feeding artery (white arrow) was visualized proximal to the side-hole, and tumor staining (white open arrow) was depicted. A slight AP shunt was observed (white arrowhead). (F) The sufficient accumulation of ethiodized oil was well depicted in HCC 1 week and 1 year (G) after conventional transarterial chemoembolization. There was no local recurrence of HCC.
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