The most common application of radioembolization is in the treatment of primary and secondary liver tumors, and the most common radioisotope is Yttrium-90. This form of treatment has proven to be successful in achieving reduction of tumor size and ultimately improving survival. Fatigue and nausea/vomiting are the most common side effects related to radioembolization and are usually self-limiting. This report describes a case of abdominal pain caused by shunting of yttrium-90 microspheres to the anterior abdominal wall via a patent hepatic falciform artery. This case highlights the need for vigilant angiography and awareness of the falciform artery with prophylactic embolization when necessary/warranted.KEYWORDS: Radioembolization, yttrium-90, falciform artery
CASE REPORTThe patient is a 57-year-old woman diagnosed with stage II colorectal cancer in December 2004. She underwent a left hemicolectomy and was subsequently treated with FOLFOX and Avastin. In January 2007, she was diagnosed with liver metastases and her regimen was changed to Erbitux and Irinotecan (CPT-11). Secondary to progressive hepatic metastases, she was referred to the interventional oncology service for liver-directed therapy. Given her progressive hepatic metastases and failure on systemic chemotherapy, preserved performance status and hepatic functions, the patient was deemed a good candidate for radioembolization.Planning angiography revealed nonvariant hepatic anatomy. The right gastric artery, which arose from the proximal left hepatic artery, was coil embolized. Technetium (Tc) 99-labeled macroaggregrated albumin was delivered into the right hepatic artery. Planar and tomographic imaging was performed to calculate the degree of hepatopulmonary shunting. The relative pulmonary uptake was estimated from geometric mean data to be 10%, a shunt magnitude acceptable for radioembolization.Radioembolization was initially performed to the right hepatic lobe. The patient tolerated the procedure well and returned for treatment of the left hepatic lobe 2 months later. A microcatheter was advanced into the left hepatic artery, beyond the previously coil embolized right gastric artery, and angiography demonstrated hypervascular tumors in hepatic segments II, III, and IV. Radioembolization to the left hepatic lobe was performed.Imaging follow-up revealed a decrease in the size and enhancement of multiple hepatic tumors and no evidence of extrahepatic metastatic disease. However, the patient's CEA levels remained slightly elevated and there was a focal tumor in segment 4 that demonstrated increased uptake on a positron emission tomography