CardioVascular and Interventional Radiology

, Volume 37, Issue 2, pp 523–528 | Cite as

Posttreatment PET-CT-Confirmed Intrahepatic Radioembolization Performed Without Coil Embolization, by Using the Antireflux Surefire Infusion System

  • Andor F. van den HovenEmail author
  • Jip F. Prince
  • Morsal Samim
  • Aravind Arepally
  • Bernard A. Zonneberg
  • Marnix G. E. H. Lam
  • Maurice A. A. J. van den Bosch
Case Report


Intra-arterial radioembolization with yttrium-90 microspheres is a safe and effective treatment option for patients with unresectable liver tumors. Pretreatment coil embolization of extrahepatic vessels is recommended to avoid extrahepatic deposition of radioactive microspheres. A novel infusion system with an expandable tip, the Surefire Infusion System (SIS), has recently been developed to minimize reflux. We report three cases of radioembolization with the use of the SIS. In all cases, yttrium-90 radioembolization was performed successfully without coil embolization of extrahepatic vessels. In all patients, positron emission tomography-computed tomography confirmed intrahepatic biodistribution of the microspheres in all targeted liver segments, and no extrahepatic deposition. With the use of the SIS, the need for coil embolization of extrahepatic vessels might be eliminated, and treatment may be extended to patients who were previously deemed unfit.


Antireflux catheter  PET-CT  Radioembolization  Surefire Infusion System 


Conflict of interest

Andor F. van den Hoven, Jip F. Prince, Morsal Samim, Bernard A. Zonneberg, Marnix G. E. H. Lam, and Maurice A. A. J. van den Bosch have no conflict of interest. Aravind Arepally has indicated that he is consultant for Surefire Medical Inc.


  1. 1.
    Vente MA, Wondergem M, van der Tweel I et al (2009) Yttrium-90 microsphere radioembolization for the treatment of liver malignancies: a structured meta-analysis. Eur Radiol 19:951–959PubMedCrossRefGoogle Scholar
  2. 2.
    Yip D, Allen R, Ashton C, Jain S (2004) Radiation-induced ulceration of the stomach secondary to hepatic embolization with radioactive yttrium microspheres in the treatment of metastatic colon cancer. J Gastroenterol Hepatol 19:347–349PubMedCrossRefGoogle Scholar
  3. 3.
    Lam MG, Banerjee S, Louie JD et al (2013) Root cause analysis of gastroduodenal ulceration after yttrium-90 radioembolization. Cardiovasc Intervent Radiol. doi: 10.1007/s00270-013-0579-1
  4. 4.
    Kennedy A, Coldwell D, Sangro B et al (2012) Radioembolization for the treatment of liver tumors general principles. Am J Clin Oncol 35:91–99PubMedCrossRefGoogle Scholar
  5. 5.
    Ahmadzadehfar HSA, Reichmann K, Muckle M et al (2011) Imaging of Y90 distribution with PET/CT and bremsstrahlung SPECT/CT after radioembolization: a patient based study. J Nucl Med 52(suppl 1):92Google Scholar
  6. 6.
    Riaz A, Lewandowski RJ, Kulik LM et al (2009) Complications following radioembolization with yttrium-90 microspheres: a comprehensive literature review. J Vasc Interv Radiol 20:1121–1130PubMedCrossRefGoogle Scholar
  7. 7.
    Wright CL, Werner JD, Tran JM et al (2012) Radiation pneumonitis following yttrium-90 radioembolization: case report and literature review. J Vasc Interv Radiol 23:669–674PubMedCrossRefGoogle Scholar
  8. 8.
    Kennedy A, Nag S, Salem R et al (2007) Recommendations for radioembolization of hepatic malignancies using yttrium-90 microsphere brachytherapy: a consensus panel report from the radioembolization brachytherapy oncology consortium. Int J Radiat Oncol Biol Phys 68:13–23PubMedCrossRefGoogle Scholar
  9. 9.
    Gates VL, Esmail AA, Marshall K et al (2011) Internal pair production of 90Y permits hepatic localization of microspheres using routine PET: proof of concept. J Nucl Med 52:72–76PubMedCrossRefGoogle Scholar
  10. 10.
    Elschot M, Vermolen BJ, Lam MG et al (2013) Quantitative comparison of PET and Bremsstrahlung SPECT for imaging the in vivo yttrium-90 microsphere distribution after liver radioembolization. PLoS One 8:e55742PubMedCentralPubMedCrossRefGoogle Scholar
  11. 11.
    Rose SC, Kikolski SG, Chomas JE (2012) Downstream hepatic arterial blood pressure changes caused by deployment of the Surefire AntiReflux expandable tip. Cardiovasc Intervent Radiol. doi: 10.1007/s00270-012-0538-2
  12. 12.
    Song SY, Chung JW, Kwon JW et al (2002) Collateral pathways in patients with celiac axis stenosis: angiographic–spiral CT correlation. Radiographics 22:881–893PubMedCrossRefGoogle Scholar
  13. 13.
    Arepally A, Chomas J, Kraitchman D, Hong K (2013) Quantification and reduction of reflux during embolotherapy using an AntiReflux catheter and Tantalum microspheres: ex vivo analysis. J Vasc Interv Radiol 24:575–580PubMedCrossRefGoogle Scholar
  14. 14.
    Louie JD, Wang EA, Broadwell S et al (2012) First in man experience with the surefire infusion system: a dedicated microcatheter system to eliminate reflux during embolotherapy. J Vasc Interv Radiol 23(suppl):80Google Scholar

Copyright information

© Springer Science+Business Media New York and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) 2013

Authors and Affiliations

  • Andor F. van den Hoven
    • 1
    Email author
  • Jip F. Prince
    • 1
  • Morsal Samim
    • 1
  • Aravind Arepally
    • 2
  • Bernard A. Zonneberg
    • 1
  • Marnix G. E. H. Lam
    • 1
  • Maurice A. A. J. van den Bosch
    • 1
  1. 1.Department of Radiology and Nuclear MedicineUniversity Medical Center UtrechtUtrechtThe Netherlands
  2. 2.Department of Interventional RadiologyPiedmont HealthcareAtlantaUSA

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