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Hepatocellular Carcinoma Supplied by the Inferior Phrenic Artery or Cystic Artery: Anatomic and Technical Considerations

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Bibliographic Details
Title: Hepatocellular Carcinoma Supplied by the Inferior Phrenic Artery or Cystic Artery: Anatomic and Technical Considerations
Authors: Hyo-Cheol Kim, Shiro Miyayama, Jin Woo Choi, Gyoung Min Kim, Jin Wook Chung
Contributors: Hyo-Cheol Kim, Shiro Miyayama, Jin Woo Choi, Gyoung Min Kim, Jin Wook Chung, Kim, Gyoung Min
Source: RadioGraphics. 43
Publisher Information: Radiological Society of North America (RSNA), 2023.
Publication Year: 2023
Subject Terms: Hepatocellular* / therapy, Carcinoma, Hepatocellular, Carcinoma, Liver Neoplasms, Diaphragm, Hepatic Artery / pathology, Therapeutic* / methods, Liver Neoplasms* / blood supply, 3. Good health, 03 medical and health sciences, Hepatic Artery, 0302 clinical medicine, Liver Neoplasms* / diagnostic imaging, Hepatocellular* / diagnostic imaging, Humans, Chemoembolization, Diaphragm / diagnostic imaging, Chemoembolization, Therapeutic, Hepatocellular* / blood supply, Liver Neoplasms* / therapy
Description: Intra-arterial treatment has been identified as one of the mainstays in the management of unresectable hepatocellular carcinoma. A thorough knowledge of tumor arterial supply enables selective therapy, which improves both safety and efficacy. The inferior phrenic artery (IPA) is the most common extrahepatic collateral artery that feeds hepatocellular carcinoma. The bilateral IPAs are known to have a specific vascular anatomy. A systemic-to-pulmonary shunt and a gastric branch from the IPAs may be present and should not be confused with tumor blush. The supraceliac aorta and celiac trunk are the common origin sites of the IPAs, and their orifice may be compressed by the diaphragm. Various techniques and catheters are used for catheterization of the IPAs, depending on their origin sites. Because the IPA is normally connected with the intercostal, internal mammary, retroperitoneal, and hepatic arteries, its hemodynamics may be altered when its orifice is occluded. In general, superselective chemoembolization via the target branch of the IPA is safe and effective. When a systemic-to-pulmonary shunt from the IPA is adequately embolized with coils or particles, radioembolization through the IPA can be performed safely in most cases. The cystic artery branches into deep and superficial cystic arteries; deep cystic arteries often supply tumors near the gallbladder. Chemoembolization through the cystic artery is relatively safe, with transient embolic materials. Radioembolization through the cystic artery has been recently tried, with acceptable efficacy and toxicity results, but it requires further investigation. ©RSNA, 2022.
Document Type: Article
Language: English
ISSN: 1527-1323
0271-5333
DOI: 10.1148/rg.220076
Access URL: https://pubmed.ncbi.nlm.nih.gov/36306220
Rights: CC BY NC ND
Accession Number: edsair.doi.dedup.....5157541f0c884ae9e645534ecb161171
Database: OpenAIRE
Description
Abstract:Intra-arterial treatment has been identified as one of the mainstays in the management of unresectable hepatocellular carcinoma. A thorough knowledge of tumor arterial supply enables selective therapy, which improves both safety and efficacy. The inferior phrenic artery (IPA) is the most common extrahepatic collateral artery that feeds hepatocellular carcinoma. The bilateral IPAs are known to have a specific vascular anatomy. A systemic-to-pulmonary shunt and a gastric branch from the IPAs may be present and should not be confused with tumor blush. The supraceliac aorta and celiac trunk are the common origin sites of the IPAs, and their orifice may be compressed by the diaphragm. Various techniques and catheters are used for catheterization of the IPAs, depending on their origin sites. Because the IPA is normally connected with the intercostal, internal mammary, retroperitoneal, and hepatic arteries, its hemodynamics may be altered when its orifice is occluded. In general, superselective chemoembolization via the target branch of the IPA is safe and effective. When a systemic-to-pulmonary shunt from the IPA is adequately embolized with coils or particles, radioembolization through the IPA can be performed safely in most cases. The cystic artery branches into deep and superficial cystic arteries; deep cystic arteries often supply tumors near the gallbladder. Chemoembolization through the cystic artery is relatively safe, with transient embolic materials. Radioembolization through the cystic artery has been recently tried, with acceptable efficacy and toxicity results, but it requires further investigation. ©RSNA, 2022.
ISSN:15271323
02715333
DOI:10.1148/rg.220076