Anastomosis between the hepatic artery and the extrahepatic collateral or between extrahepatic collaterals: Observation on angiography

Abstract

Transcatheter arterial chemoembolisation for hepatocellular carcinoma is widely carried out not only through the hepatic artery but also through the extrahepatic collateral pathways. Anatomically, there are many anastomoses between the hepatic artery and the extrahepatic collateral as well as among the extrahepatic collaterals. However, these anastomoses may not be shown on angiography because the anastomosing branches are too small. These anastomoses may not only interfere with effective control of hepatocellular carcinoma by transcatheter arterial chemoembolisation but also cause unexpected procedure-related complications. Therefore, radiologists should have sufficient knowledge of these underlying anastomoses. In this report, we present our angiographic images.

Superselective Conventional Transarterial Chemoembolization for Hepatocellular Carcinoma: Rationale, Technique, and Outcome

“…Therefore, catheter positioning is very important to minimize liver toxicities. Additionally, some ethiodized oil flows into the neighboring hepatic arterial branches and/or extrahepatic collateral vessels through the microcommunications (Fig 7a,b) (38,39). This flow into microcommunications allows embolization or identification of "an occult tumor feeder" and may prevent the arterial collateral supply to the tumor after transarterial chemoembolization.…”

Arterial blood supply to the caudate lobe of the liver from the proximal branches of the right inferior phrenic artery in patients with recurrent hepatocellular carcinoma after chemoembolization

“…In our study, this branch was the most common blood source from the RIPA to the SP. Anastomosis between this branch and the caudate artery on angiography has also been demonstrated [14]. CT or CBCT obtained during the TACE procedure in our series showed that the first branch directly entered the liver through the liver surface and delivered small branches toward the caudate lobe and posterior segment of the right lobe of the liver.…”

“…The perirenal space is anatomically connected with the bare area on the right side [12]. Therefore, the right renal capsular artery also distributes into the bare area [13], and the RIPA and the right renal capsular artery are potentially connected each other [14]. In addition, the right or left gastric, dorsal pancreatic, and right adrenal arteries are possible collateral vessels that serve to supply the caudate lobe of the liver [7,10].…”

Efficacy of automated tumor‐feeder detection software using cone‐beam computed tomography technology in transarterial embolization through extrahepatic collateral vessels for malignant hepatic tumors

“…Careful observation and control of catheter positioning is necessary during the TACE/TAE procedure. Fifth, there are many anastomoses between extrahepatic collaterals, and some embolic materials may pass through the anastomoses and cause unexpected complications . In the present study, iodized oil was used in all embolization procedures except one performed via the right inferior phrenic artery.…”