Hepatocellular carcinomas supplied by inferior phrenic arteries

Abstract

HCCs located in segments which form the bare area of the liver (S1, S2, S7) can be supplied by an IPA. This should be suspected when a lesion or part of a lesion is identified on contrast-enhanced CT but not on hepatic arteriography.

Clinical anatomy of the inferior phrenic artery

“…This stems largely from the discovery of the involvement of the right (most frequently) or left inferior phrenic arteries in the arterial supply and growth of hepatocellular carcinoma (HCC) (Tanabe et al, 1998;Gokan et al, 2001). Indeed, the great importance of such knowledge lies in the fact that an unresectable HCC can be treated by transcatheter embolization of not only its typical blood supply, the right or left hepatic arteries, but also by embolization of a RIPA, if involved (Duprat et al, 1988;Chung et al, 1998;Tanabe et al, 1998;Gokan et al, 2001). Such ''extra-hepatic'' collateral arterial supply to HCC may arise after successful embolization of an hepatic artery, or may exist concurrently with the hepatic arterial supply (Andrews et al, 1989;Tanabe et al, 1998;Gokan et al, 2001).…”

“…Indeed, the great importance of such knowledge lies in the fact that an unresectable HCC can be treated by transcatheter embolization of not only its typical blood supply, the right or left hepatic arteries, but also by embolization of a RIPA, if involved (Duprat et al, 1988;Chung et al, 1998;Tanabe et al, 1998;Gokan et al, 2001). Such ''extra-hepatic'' collateral arterial supply to HCC may arise after successful embolization of an hepatic artery, or may exist concurrently with the hepatic arterial supply (Andrews et al, 1989;Tanabe et al, 1998;Gokan et al, 2001). It is also of note that both the internal mammary and omental arteries may be parasitized sources of arterial supply to HCC as well.…”

Normal and variant origin and branching pattern of inferior phrenic arteries and their clinical implications - A cadaveric study.

“…The great importance of such knowledge lies in the fact that an unresectable hepatocellular carcinoma can be treated by transcatheter embolization of not only its typical blood supply, the right or left hepatic arteries, but also by embolization of a right inferior phrenic artery, if involved. 4 The inferior phrenic artery is not only important in the treatment of hepatocellular carcinoma but it is also reported that gastric haemorrhage can occur due to bleeding from the left inferior phrenic artery after treatment of the left gastric artery with embolization. 5 The inferior phrenic arteries also contribute to arterial supply of adrenal glands and are therefore of great importance in angiographic examination for adrenal lesions.…”

Common and separate origins of the left and right inferior phrenic artery with a review of the literature

“…Extrahepatic collateral arteries supply the hepatocellular carcinoma, even when the hepatic artery is patent [14]. This stems largely from the discovery of the involvement of the IPAs in the arterial supply and growth of hepatocellular carcinoma [5,27]. Kim et al [11] analysed the extrahepatic collateral vessels supplying the hepatocellular carcinoma in 3,179 patients and revealed that the RIPA is the most common vessel that supplies peripherally located liver hepatocellular carcinomas.…”