Direct hepatic artery puncture for transarterial therapy in liver cancer.

In the treatment of liver malignancies, therapies such as bland embolization, chemoembolization and radioembolization require access to the hepatic artery by means of conventional transfemoral or brachial catheterization. Challenging vascular anatomy can impede selective access to tumoral vessels, preventing the safe and effective delivery of embolic material. Direct percutaneous hepatic arterial puncture under ultrasonographic guidance may be an alternative method to obtain intrahepatic arterial access for the purposes of hepatic arteriography and delivery of therapeutic agents. In this case series, the authors describe the use of direct hepatic artery puncture to successfully perform two radioembolization procedures and one bland embolization procedure.