Hepatocellular Carcinoma Supplied by the Right Lumbar Artery

Abstract

This study evaluated the clinical features of hepatocellular carcinoma (HCC) supplied by the right lumbar artery. Eleven patients with HCC supplied by the right lumbar artery were treated with chemoembolization. The patients' medical records were retrospectively analyzed. All patients underwent 6.7 +/- 3.7 (mean +/- SD) chemoembolization sessions, and the hepatic arterial branches were noted as being attenuated. The right inferior phrenic artery (IPA) was also embolized in 10 patients. The interval between initial chemoembolization and chemoembolization of the lumbar artery supply was 53.2 +/- 26.9 months. Mean tumor diameter was 3.1 +/- 2.4 cm and was located at the surface of S7 and S6. The feeding-branch arose proximal to the bifurcation of the dorsal ramus and muscular branches (n = 8) or from the muscular branches (n = 3) of the right first (n = 10) or second lumbar artery (n = 1). The anterior spinal artery originated from the tumor-feeding lumbar artery in one patient. All feeders were selected, and embolization was performed after injection of iodized oil and anticancer drugs (n = 10) or gelatin sponge alone in a patient with anterior spinal artery branching (n = 1). Eight patients died from tumor progression 10.1 +/- 4.6 months later, and two patients survived 2 and 26 months, respectively. The remaining patient died of bone metastases after 32 months despite liver transplantation 10 months after chemoembolization. The right lumbar artery supplies HCC located in the bare area of the liver, especially in patients who undergo repeated chemoembolization, including chemoembolization by way of the right IPA. Chemoembolization by way of the right lumbar artery may be safe when the feeder is well selected.

Biloma after Transcatheter Arterial Chemoembolization with Drug-Eluting Beads Managed with Sclerotherapy and Stent Placement

“…The biliary tree is supplied primarily by arterial blood alone; therefore, ischemia of the bile ducts can easily occur after TACE [1,4]. In our patient, we performed DEB-TACE via the proximal right posterior segmental artery supplying the peribiliary plexus artery; thus, it is possible that the greater amount of embolization agent perfused a larger liver area, resulting in the large biloma.…”

“…Transcatheter arterial chemoembolization (TACE) is accepted as a standard therapy for unresectable hepatocellular carcinomas (HCCs) [1]. Although the incidence of liver abscess and biloma formations after TACE is low, high mortality rates, ranging from 13.3% to 50%, have been reported after TACE with an abscess as a complication [2,3].…”

Ectopic Blood Supply of Hepatocellular Carcinoma as Depicted by Angiography with Computed Tomography: Associations with Morphological Features and Therapeutic History

“…Right RA, AA and LA which derive from abdominal aorta locate in retroperitoneal space along with bare area of liver. If HCC invades retroperitoneal space through the bare area of the liver, these three arteries may participate in blood supply of lesion [11].…”

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

“…The inferior phrenic artery (29), omental branch (38), adrenal artery, intercostal artery, internal mammary artery, renal capsular artery (39), left gastric artery (40), gastroduodenal artery, cystic artery and mesenteric superior artery are among the EHAs known to feed tumors (41). Considering the broad contact between the liver and the diaphragm, it may be expected that diaphragmatic blood supplies, including the inferior phrenic, internal mammary and intercostal arteries, are major sources of collateral circulation.…”