Supplemental Transcatheter Arterial Chemoembolization Through a Collateral Omental Artery: Treatment for Hepatocellular Carcinoma

Abstract

TACE of the OA is safe and has a potential therapeutic effect in the treatment of HCC.

Hepatocellular carcinoma with blood supply from parasitized omental artery: Angiographic appearance and chemoembolization

“…The prevalence and causative factors of HCC's extrahepatic collateral and parasitized arteries were studied by some interventional radiologists [6,7,17,18] , and OA is a rare one, with an incidence rate of 1.4%−2.6% [19,20] , which is similar to 2.09% found in our study. The mechanism of POA occurrence may be related to huge-block HCC type, liver surgery with omentum to suture and hemostasis at the surgical margin, hepatic artery stenosis and occlusion [10] (Figure 2).…”

“…If damages to the POA such as vasospasm, dissection and occlusion occur, new extrahepatic parasitized arterys may emerge and may cause new difficulties for superselective catheterization [19] , in addition, the risks of reflux and mis-embolization will increase (Figure 4). Due to rich collateral branches, even if a small number of normal OAs were embolized, serious complications such as ischemia or infarction of the intestine (which usually is supplied by one of the mesenteric arteries) would not occur [7,10,19] . However, POAs may communicated with dorsal pancreatic artery, middle-colic artery, and mesenteric arteries.…”

“…[6] . However, due to its variable distribution, POA does not traverse via the above mentioned anatomical structures [7,19] A pre-chemoembolization contrast abdominal CT or MRI would be helpful for making the diagnosis whether the POA occurred or not: if the CT scan demonstrated tumor breaking through the liver capsule and an enlarged serpiginous artery was near the tumor edge (Figure 3), a POA may be strongly suggested . Where the HCC is covered by or adhered to omentum, where a POA may occur.…”

“…In our study, except for the segment II of the liver, the POA was observed at all the other segments, and the most location was at the right lobe and left medial lobe. [19] 1 .…”

Arterial Embolization of Unresectable Hepatocellular Carcinoma with Use of Microspheres, Lipiodol, and Cyanoacrylate

“…However, most hepatocellular carcinomas will recur at the same site or in another segment in the liver. Thus proximal embolization including the proper hepatic artery shown in the image may induce extrahepatic collaterals including the inferior phrenic artery [2], internal mammary artery [3], intercostal artery [4], renal capsular artery [5], or the omental branches [6], in addition to the epicholedochal plexus [2]. As the authors mentioned in the Discussion, peripheral targeted occlusion of tumor vessels by small particles might induce a more permanent occlusion with a longer steady state.…”