Unsatisfactory hepatic perfusion after placement of an implanted pump and catheter system: angiographic correlation.

Abstract

Thirty-five patients with scintigrams showing unsatisfactory hepatic artery perfusion after surgical placement of an implanted pump and catheter system were examined with selective angiography (33 cases) or digital subtraction angiography (DSA) during which the contrast material was injected through the side port of the pump (six cases). In 34 of 35 cases, the cause of the unsatisfactory (either extrahepatic or incomplete) hepatic perfusion was defined. DSA was definitive in only two cases, in which extrahepatic flow through collateral vessels was demonstrated. The cause of the perfusion defect was hepatic artery thrombosis in 14 cases, extrahepatic flow through collateral vessels in 14 cases, a misplaced catheter in four cases, and a short proper hepatic artery without adequate length for mixing in two cases. Although hepatic artery perfusion scintigraphy is the primary tool for evaluation of hepatic perfusion after catheter placement, angiography plays an important role in treating the subset of patients with unsatisfactory hepatic perfusion.

Clinical anatomy of the inferior phrenic artery

“…It has been reported (Andrews et al, 1989;Okazaki et al, 1991Okazaki et al, , 1993Tanabe et al, 1998;Gokan et al, 2001) that in patients with HCC, parasitic, ''non-hepatic'' collateral arteries will develop with or without occlusion of the hepatic arteries themselves. In the present study, we found that HCC that have not had previous treatment or occlusion of the hepatic arteries, receive branches from a RIPA, in addition to an hepatic artery.…”

“…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.…”

“…Accordingly, with the appropriately targeted utilization of certain current cancer treatments hinging on a thorough knowledge of both the origins and distribution of the IPA, our current study was aimed at establishing these very facts. Few publications have appeared concerning the role and detailed anatomy of the IPA with respect to their involvement in HCC (Andrews et al, 1989;Tanabe et al, 1998;Gokan et al, 2001) and, similarly, few have been produced with direct focus on the elucidation of the origin and distribution of these arteries (Piao et al, 1998;Tanabe et al, 1998;Gokan et al, 2001).…”

Intra-arterial infusion of N-isopropyl-p[123I]iodoamphetamine for assessing effective blood supply to pulmonary and hepatic neoplasms

“…Partial or complete hepatic arterial thrombosis and catheter thrombosis have been reported as the major causes of unsatisfactory perfusion after surgical placement for hepatric chemotherapy. [21][22][23] From this point of view, there is the possibility that stenosis of the catheter tip due to athrombus or arterial thrombosis adjacent to the catheter might have been overestimated in the s9mTc-MAA study. In the other 2 cases, the left lobe of the liver was not visualized in 99 mTc-MAA scintigraphy but it was seen in 123 I-IMP scintigraphy.…”

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

“…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. 6 Few publications are available in relation to the role and detailed anatomy of the with inferior phrenic artery respect to their involvement in hepatocellular carcinoma 7 and similarly, few have been produced with direct focus on the elucidation of the origin and distribution of these arteries. 8 The study of common variations in origin of these vessels and their respective frequencies of occurrence could help the interventional radiologist or oncologist as the root of the right inferior phrenic artery needs to be found out during transcatheter embolization of hepatocellular carcinoma and other hepatic neoplasms.…”