Evaluation of extrahepatic collateral arteries in hepatocellular carcinoma in three independent groups in a single center

Abstract

Abstract.To improve the efficacy of transcatheter arterial chemoembolization (TACE) for hepatocellular carcinoma (HCC), this study evaluated the prevalence and causes of extrahepatic arteries (EHAs) and identified feeding arteries in HCCs in three independent clinical groups in a single inverventional radiology center. Between November 2011 and September 2012, 942 cases of HCC were included in this retrospective study. The patients were treated in three independent groups of 285, 301 and 356 patients, respectively. Enhanced computed tomography, enhanced magnetic resonance imaging and digital subtraction angiography were reviewed retrospectively and correlations between the presence of tumor-feeding EHAs and tumor number, size and location in the liver, number of repeat TACE procedures and complications were assessed. There were 698 EHAs in the 942 cases of HCC, with 182, 233 and 283 EHAs in the three independent groups, respectively. Tumor size was associated with EHA formation; the percentages of patients with EHAs were 2.7±3.0, 5.5±0.5, 43.2±4.0, 61.8±5.2 and 93.4±1.8% with tumor sizes of 2-3, 3-5, 5-7, 7-9 and >9 cm, respectively. There were 159±19 EHAs in each group feeding tumors in peripheral locations in the liver, but only 48.7±6.8 in the central zone. The most common EHA was the right inferior phrenic artery, with a mean of 101.0±14.1 per group. The number of EHAs increased proportionally with the number of TACE sessions. The number of EHAs was positively associated with tumor size, peripheral location of the tumor and number of TACE sessions.

Chemoembolization of Hepatocellular Carcinoma with Extrahepatic Collateral Blood Supply: Anatomic and Technical Considerations

“…A positive correlation between the development of a parasitic arterial supply to HCC and the number of previous TACE procedures also has been reported (7,8). Because patients who have never undergone TACE also may have an EHC arterial supply to tumors, it is important to be vigilant in looking for this condition in this population (7). Omental and peritoneal adhesions resulting from exophytic HCC growth or extrahepatic tumor infiltration or that manifest as postoperative sequelae are other factors that favor the development of a parasitic blood supply to HCC (9).…”

“…Many studies to investigate the etiologic factors underlying the development of EHC arteries in patients with HCC have been published (1,6,7). Ligation of the hepatic artery, the previous treatment for HCC, was initially believed to be the primary cause of the development of EHC arteries supplying HCC (1).…”

“…Ligation of the hepatic artery, the previous treatment for HCC, was initially believed to be the primary cause of the development of EHC arteries supplying HCC (1). That treatment modality has become obsolete, and TACE attenuation of the hepatic artery, surgical intervention, dissection, and stenosis are now considered the main factors influencing the development of EHC arterial supplies to HCC (7).…”

“…The right suprarenal arteries may provide an EHC arterial supply to HCC located at the posteroinferior segment of the right hepatic lobe (segment VI) and to a lesser extent to HCC located in liver segments VII and VIII. The prevalence of a parasitic blood supply from the suprarenal arteries ranges from 9% to 11% (7,14,19).…”

“…Owing to their adherence to and direct contact with the diaphragm, tumors arising at the bare area of the liver usually recruit EHC arteries (8,9). A positive correlation between the development of a parasitic arterial supply to HCC and the number of previous TACE procedures also has been reported (7,8). Because patients who have never undergone TACE also may have an EHC arterial supply to tumors, it is important to be vigilant in looking for this condition in this population (7).…”