Transcatheter Arterial Chemoembolization for Hepatocellular Carcinoma Fed by the Reconstructed Inferior Phrenic Artery: Anatomical and Technical Analysis

Miyayama, Shiro; Matsui, Osamu; Taki, Keiichi; Minami, Tetsuya; Ito, Chiharu; Shinmura, Rieko; Takamatsu, Shigeyuki; Kobayashi, Miki; Notsumata, Kazuo; Toya, Daisyu; Tanaka, Nobuyoshi; Kozaka, Kazuto

doi:10.1097/01.rvi.0000136986.34890.d7

Cited by 21 publications

(10 citation statements)

References 12 publications

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“…In the present study, extrahepatic collateral blood supplies to P-HCC commonly arose from gastroduodenal arteries, left gastric arteries, phrenic arteries, superior mesenteric arteries, pancreaticoduodenal arteries and right adrenal arteries. In patients with P-HCC, various extrahepatic collateral vessels develop and supply the tumor (3,(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29). Compared with those observed via angiographies at the initial TACE, up to 79.5% of the patients in the present study had extrahepatic collateral supplies following subsequent TACE; the results also revealed an increasing trend in the number of extrahepatic collateral vessels as the number of TACE treatments increased.…”

Section: Discussionsupporting

confidence: 53%

“…Technically, angiographies of blood supplies to the liver, including the celiac, common hepatic and superior mesenteric arteries, should be initially performed during TACE in all patients with P-HCC, as the intrahepatic arteries manifest as the main blood supply to P-HCC (14). An arteriogram of the inferior phrenic artery, which is a major source of diaphragmatic blood supply to the liver (12,19,(22)(23)(24)(25)(26)29), is routinely performed in patients who have an interrupted hepatic arterial circulation owing to previous treatment, or in patients with tumors located near the diaphragm, which may be identified in the initial angiography.…”

Section: Discussionmentioning

confidence: 99%

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Blood supply characteristics of pedunculated hepatocellular carcinoma prior to and following transcatheter arterial chemoembolization treatment: An angiographic demonstration

et al. 2018

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Abstract. Pedunculated hepatocellular carcinoma (P-HCC) is a rare type of HCC, defined as a carcinoma protruding from the liver with or without a pedicle with a low degree of liver invasion. The present study aimed to evaluate the characteristics of blood supply of P-HCC prior to and following transcatheter arterial chemoembolization (TACE) treatment. Angiographic findings prior to and following TACE treatment in 39 patients with P-HCC were analyzed retrospectively. Angiography performed at the first TACE session revealed 70 tumor-feeding arteries collectively in all patients, including 31/70 (44.0%) extrahepatic parasitic arteries in 23/39 patients (59.0%). The intrahepatic arteries served as the main blood supply to P-HCC in all patients. Extrahepatic collateral blood supplies to P-HCCs were significantly associated with larger tumor diameter (χ 2 =164.000, P<0.001), but not tumor location (χ 2 =7.358, P=0.061). Following repeated TACE treatment, all angiographies revealed a total of 131 tumor feeding arteries collectively in all patients, including intrahepatic arteries (54/131) and extrahepatic collateral arteries (78/131) in 31 patients (79.5%). Compared with angiographies performed at the initial TACE treatment, these results also demonstrated an increase in the number of extrahepatic collateral arteries, which produced 47 new blood vessels (χ 2 = 4.278, P= 0.039). P-HCC tumor lesions readily acquired a parasitic blood supply from adjacent vessels following repeated TACE. Intrahepatic arteries functioned as the main blood supply for P-HCC, whereas extrahepatic collateral arteries were complementary to P-HCC, regardless of whether the patient was pre-or post-TACE. Extrahepatic collateral supplies to P-HCCs that originated from adjacent vessels were rich, were closely associated with tumor size, and were prone to be newly established following repeated TACE. IntroductionPedunculated hepatocellular carcinoma (P-HCC) is a rare type of HCC, which is defined as a carcinoma protruding from the liver with or without a pedicle, and with a low degree of liver invasion (1). P-HCC was first described by Roux in 1897 (2), and represents 0.24-3.00% of all cases of HCC in Japan (3,4). Additionally, to the best of our knowledge, <200 cases have been reported in previous studies (4-6).The majority of P-HCC cases are treated surgically, with higher operability rates and better survival than conventional HCC, which may be due to its unique growth pattern, high rate of tumor capsule formation and lower vascular invasion (4-6). However, up to 39.4% of patients with P-HCC are unable to undergo surgical resection (7). Therefore, palliative treatments may serve a central function in the treatment of unresectable P-HCC. Transcatheter arterial chemoembolization (TACE) is the most widely used locoregional therapy for patients with intermediate HCC, who cannot be treated surgically (8-11). However, the blood supply to P-HCC is complicated, arising from hepatic arteries and extrahepatic collateral vessels (3). P-HCC tumor lesions prot...

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Section: Discussionsupporting

confidence: 53%

Section: Discussionmentioning

confidence: 99%

Blood supply characteristics of pedunculated hepatocellular carcinoma prior to and following transcatheter arterial chemoembolization treatment: An angiographic demonstration

et al. 2018

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“…This anastomosis is part of the retroperitoneal fine network acting as a collateral pathway to the occluded IPA 7 and may be present within the bare area of the liver near the right renal fossa (Fig. 10).…”

Section: Between the Right Posterior Ica And The Right Rcamentioning

confidence: 99%

“…[1][2][3][4][5][6][7][8][9][10][11] Transcatheter arterial chemoembolisation (TACE) via the hepatic artery and extrahepatic collaterals is widely accepted to manage unresectable tumours. [1][2][3][4][5][6][7][8][9][10][11] The hepatic arterial system and extrahepatic collaterals or two or more different extrahepatic collaterals anastomose with each other. 12 Anatomically, anastomoses between the hepatic artery and the extrahepatic collateral or between extrahepatic collaterals are well known; however, there are only a few reports of these imaging findings.…”

Section: Introductionmentioning

confidence: 99%

Anastomosis between the hepatic artery and the extrahepatic collateral or between extrahepatic collaterals: Observation on angiography

et al. 2009

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Transcatheter arterial chemoembolisation for hepatocellular carcinoma is widely carried out not only through the hepatic artery but also through the extrahepatic collateral pathways. Anatomically, there are many anastomoses between the hepatic artery and the extrahepatic collateral as well as among the extrahepatic collaterals. However, these anastomoses may not be shown on angiography because the anastomosing branches are too small. These anastomoses may not only interfere with effective control of hepatocellular carcinoma by transcatheter arterial chemoembolisation but also cause unexpected procedure-related complications. Therefore, radiologists should have sufficient knowledge of these underlying anastomoses. In this report, we present our angiographic images.

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“…13 Information of inferior phrenic artery variations is necessary to avoid unintentional sectioning of these small calibre arteries, as it may be seen during decompression in compression syndrome of the celiac trunk by the median arcuate ligament. 19 …”

Section: Pick and Ansonmentioning

confidence: 99%

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

Thamke

Rani

2015

Int J Res Med Sci

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Transcatheter Arterial Chemoembolization for Hepatocellular Carcinoma Fed by the Reconstructed Inferior Phrenic Artery: Anatomical and Technical Analysis

Cited by 21 publications

References 12 publications

Blood supply characteristics of pedunculated hepatocellular carcinoma prior to and following transcatheter arterial chemoembolization treatment: An angiographic demonstration

Blood supply characteristics of pedunculated hepatocellular carcinoma prior to and following transcatheter arterial chemoembolization treatment: An angiographic demonstration

Anastomosis between the hepatic artery and the extrahepatic collateral or between extrahepatic collaterals: Observation on angiography

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

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