Collateral Arterial Blood Supply of the Liver after Hepatic Artery Ligation, Angiographic Study of Twenty Patients

Plengvanit, U; Chearanai, O; Sindhvananda, K; Dambrongsak, D; Tuchinda, S; Viranuvatti,

doi:10.1097/00000658-197201000-00016

Cited by 89 publications

(27 citation statements)

References 7 publications

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“…38,46 TAE was used in the present study based on the fact that TAE is a standard treatment for unresectable HCC in clinic, and the effect of hepatic artery ligation is even shorter as shown in one report that the development of collateral arterial circulation could happen one week after ligation. 47 While the antiangiogenic activity of angiostatin seemed to be independent of VEGF, in accordance with our previous report, 14 both sodium salicylate 38 and PTK787 46 blocked hypoxia related angiogenesis, indicating these 2 approaches might synergize to further strengthen the efficacy of TAE to combat HCC.…”

Section: Discussionsupporting

confidence: 88%

Antiangiogenic therapy enhances the efficacy of transcatheter arterial embolization for hepatocellular carcinomas

Jiang

Meng

Tan

et al. 2007

Intl Journal of Cancer

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Transcatheter arterial embolization (TAE) is a well-established technique for unresectable hepatic malignancies. However, TAE can temporally halt the growth of hepatic tumors by blocking their arterial supply, but often tumors rapidly develop collateral blood vessels via angiogenesis. We have previously demonstrated that intraportal delivery of adeno-associated viral particles expressing angiostatin leads to long-term expression of angiostatin capable of inhibiting angiogenesis and suppressing the outgrowth of tumors in the liver. Thus, we hypothesize that adeno-associated virus (AAV)-mediated antiangiogenic therapy could enhance the efficacy of TAE to combat liver cancers. To achieve this objective, we engineered a recombinant AAV vector encoding rat angiostatin. Intraportal delivery of this vector led to long term and stable transgenic expression of angiostatin locally in rat hepatocytes and suppressed the growth of CBRH7919 hepatocellular carcinomas established in rat livers by inhibiting formation of neovessels. Although TAE therapy led to necrosis of liver tumors and suppressed their growth, the neovessels of tumors were rapidly reformed 3 weeks after TAE. However, intraportal injection of AAV-angiostatin inhibited the angiogenesis stimulated by TAE, synergized with TAE in suppressing growth of tumors established in livers and prolonged the survival of rats. In conclusion, these encouraging results warrant future investigation of the use of antiangiogenic therapy for enhancing the therapeutic efficacy of TAE to treat unresectable liver cancers. ' 2007 Wiley-Liss, Inc.Key words: hepatocellular carcinoma; transcatheter arterial embolization; angiogenesis; adeno-associated virus; angiostatin; gene therapy Hepatocellular carcinoma (HCC) is one of the most common malignancies in the world with an estimated incidence of more than one million new cases per year.1,2 HCC has a very poor prognosis with less than a 6% 5-year survival rate. Only surgery offers a cure, but liver resection is feasible for less than 15% of patients, and recurrence rates remain high after tumor resection.3 Chemotherapy and radiotherapy offer unsatisfactory response rates. Therefore, new strategies to combat HCC are urgently needed.The application of transcatheter arterial embolization (TAE) to treat liver cancers has developed conceptually based on the observation that both primary and secondary liver tumors derive their blood supply mainly from the hepatic artery, 4 while blood supply to normal liver mainly depends on the portal system. 5,6 Thus, artery obstruction by embolization can cause extensive ischemic tumor necrosis, which provides the rational for its wide use as a standard treatment for unresectable HCC. 7,8 However, the effectiveness of TAE in treating HCC is debatable as any beneficial results are short-lived because collateral arterial circulations rapidly develop. It has been reported that TAE enhances the rate of intrahepatic and extrahepatic metastases, and even results in a shorter survival.9-11 Recanalization of the embo...

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Section: Discussionsupporting

confidence: 88%

Antiangiogenic therapy enhances the efficacy of transcatheter arterial embolization for hepatocellular carcinomas

Jiang

Meng

Tan

et al. 2007

Intl Journal of Cancer

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“…A decrease in tumor volume occurred more rarely. These effects were, however, transitory: repeated arteriographies indeed showed that collateral vascularization developed rapidly (1-4 weeks) through minor arteries [29]. Our 3rd case is a perfect illustration of this evolution since the symptoms reappeared in our patient 5 weeks or so after operation.…”

Section: Treatmentsupporting

confidence: 57%

Spontaneous Hemoperitoneum through Rupture of a Primary Malignant Tumor of the Liver

Palot¹,

Flament²,

Delattre³

et al. 1985

Dig Surg

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The authors report 6 cases of spontaneous hemoperitoneum due to rupture of a hepatoma. This complication occurs most often in cirrhotic liver and reveals the tumor. Diagnosis can then only be made during autopsy or urgent laparotomy. Hepatic resection is most often highly problematic or impracticable owing to cirrhosis or the tumor involving both lobes. Among palliative operations, ligation of the hepatic artery seems to be an elective procedure. It enabled the authors to stop the bleeding in 2 cases and obtain a survival of more than 1 year in 1 case.

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“…it was reported that in most patients who undergo angiography within 1 or 2 wk after hepatic arterial ligation, collateral arteries are present and subsequent angiograms show progressive enlargement [11] . We scheduled embolization of the PRHA, ARHA, and proper HA at 2 week intervals.…”

Section: Discussionmentioning

confidence: 99%

“…An impairment of the blood supply to the bile duct stump could cause disruption of the bilioenteric anastomosis. However, Plengvanit et al [11] showed that collateral vessels enter the liver peripherally after ligation of HA, and the blood fills the branches of HA to the occluded portion in a retrograde fashion. It is presumed that a breakdown of the bilioenteric anastomosis does not occur because sufficient arterial blood flow can reach the bile duct stump via the intrahepatic shunts which mainly come from the IPA.…”

Section: Discussionmentioning

confidence: 99%

Resection of a locally advanced hilar tumor and the hepatic artery after stepwise hepatic arterial embolization: A case report

Miura¹,

Hakamada²,

Ohata³

et al. 2008

WJG

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We herein report a case of a hilar tumor with extensive invasion to the proper hepatic artery, which was successfully treated with a radical resection in a 57-year-old female patient after a stepwise hepatic arterial embolization. She underwent right colectomy and partial hepatectomy for advanced colon cancer two years ago and radiofrequency ablation therapy for a liver metastasis one year ago, respectively. A recurrent tumor was noted around the proper hepatic artery with invasion to the left hepatic duct and right hepatic artery 7 mo previously. We planned a radical resection for the patient 5 mo after the absence of tumor progression was confirmed while he was undergoing chemotherapy. To avoid surgery-related liver failure, we tried to promote the formation of collateral hepatic arteries after stepwise arterial embolization of the posterior and anterior hepatic arteries two weeks apart. Finally, the proper hepatic artery was occluded after formation of collateral flow from the inferior phrenic and superior mesenteric arteries was confirmed. One month later, a left hepatectomy with hepatic arterial resection was successfully performed without any major complications.

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Collateral Arterial Blood Supply of the Liver after Hepatic Artery Ligation, Angiographic Study of Twenty Patients

Cited by 89 publications

References 7 publications

Antiangiogenic therapy enhances the efficacy of transcatheter arterial embolization for hepatocellular carcinomas

Antiangiogenic therapy enhances the efficacy of transcatheter arterial embolization for hepatocellular carcinomas

Spontaneous Hemoperitoneum through Rupture of a Primary Malignant Tumor of the Liver

Resection of a locally advanced hilar tumor and the hepatic artery after stepwise hepatic arterial embolization: A case report

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