Procedures & Techniques

Procedures & Techniques

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Using Lipiodol® Ultra-Fluid (Iodinated ethyl esters of fatty acids of poppy seed oil) in cTACE procedure


Lipiodol®-drug droplets are deformable & heterogeneous in size(1,2)

10 & 20µm Microscopic image

Lipiodol® + doxorubicin droplets

Droplet deformability

Extract of in vivo video microscopy of rat cremastervessels perfused with Lipiodol® - Courtesy of Prof. Th. de Baère

Droplet division

Extract of in vivo video microscopy of rat cremastervessels perfused with Lipiodol® - Courtesy of Prof. Th. de Baère

Lipiodol®-drug droplets allow both proximal & distal anticancer drug delivery(1)

Lipiodol® + anticancer agent
Droplet deformability

Lipiodol®-drug droplets achieve transient dual embolization (arterial & portal vessels)(3)

PV = Portal Venule
HA = Hepatic Arteriole
BD = Bile Duct
HV = Hepatic Venule
HC = Hepatocytes

Peribiliary plexa allow Lipiodol®-Drug droplets shunting from hepatic artery to portal vein(4)

Radiological evidence of dual vascularization of HCC


Arterial enhancement of the tumor


Early venous enhancement thanks to the peribiliary vascular plexa


Full visualization of the arterioportal vascular bed

Annotation 2020 07 24 134706

Step1: Withdrawing

Lipiodol® Ultra Fluid – anticancer drug mixture preparation

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Annotation 2020 07 24 134729

Step 2: Mixing

Lipiodol® Ultra Fluid – anticancer drug mixture preparation5

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Step 3: Injecting

Lipiodol® Ultra Fluid – anticancer drug mixture injection

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2.Kan Z. et al. Liver anatomy: microcirculation of the liver, Sem. Intervent. Radiology 2008; 25: 77-85.

3.Kan Z. et al. Distribution and effect of iodized poppyseed oil in the liver after hepatic artery embolization :experimental study in several animal species, Radiology 1993; 186: 861-866.

4.Miyayama S. et al. Ultraselective Transcatheter Arterial Chemoembolization with a 2-F Tip Microcatheter for Small Hepatocellular Carcinomas: Relationship Between Local Tumor Recurrence and Visualization of the Portal Vein with Iodized Oil J Vasc Interv Radiol 2007; 18:365–376

5.Thierry de Baere et al., Treatment of Liver Tumors with Lipiodol TACE: Technical Recommendations from Experts Opinion. Cardiovasc Intervent Radiol,2016;39:334–343.

6.Loffroy R. et al., Endovascular Therapeutic Embolisation: An Overview of Occluding Agents and their Effects on Embolised Tissues, Curr. Vasc. Pharmacol., 2009; 7:250-263.

7.Kwak H.S. et al, Percutaneous Transportal Sclerotherapy with N-Butyl-2-Cyanoacrylate for Gastric Varices: Technique and Clinical Efficacy, Korean J. Radiol. 2008; 9:526-533.

8.Van der Bom I.M.J. et al., Target delineation for radiosurgery of a small brain arteriovenous malformation using high-resolution contrast-enhanced cone beam CT, J. NeuroIntervent. Surg,2014; 6:e34.

9.Jaberi A. et al., Comparison of Clinical Outcomes following Glue versus Polyvinyl Alcohol Portal Vein Embolization for Hypertrophy of the Future Liver Remnant prior to Right Hepatectomy, J. Vasc. Interv. Radiol., 2016; 27:1897–1905.

10.Pearl M.S. et al., Preoperative Embolization of Primary Spinal Aneurysmal Bone Cysts by Direct Percutaneous Intralesional Injection of n-Butyl-2-Cyanoacrylate, J. Vasc. Interv. Radiol. 2012; 23:841–845

11.Madhusudhan KS. et al., Endovascular Embolization of Visceral Artery Pseudoaneurysms Using Modified Injection Technique with N-Butyl Cyanoacrylate Glue, J VascInterv Radiol, 2015;26:1718–1725.