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

Purpose: To evaluate the therapeuticefficacy and safety of supplemental transcatheter arterialchemoembolization (TACE) through the extrahepatic collateral omentalartery (OA) for the treatment of hepatocellular carcinoma (HCC). Methods: We studied 21 patients with extrahepaticcollaterals of the OA, among 1,512 patients with HCC who had undergoneangiography. HCCs supplied by collateral OAs were located at: segmentIV in seven, segment V in five, segment III in three, segment VI inthree and segment VIII in three patients (Couinaud classification ofsegments). On preoperative CT scans, every HCC was abutting the liversurface. Adjacent omental infiltration or engorgement was noted in 11patients. Celiac and hepatic arteriograms showed hypertrophy of thefeeding OA in all patients. TACE of the OA was performed in 19 patientswith an emulsion of iodized oil and doxorubicin hydrochloride.Embolization with gelatin sponge particles was added in fivepatients. Results: Collaterals of the OA to the HCC werefound on the first to seventeenth sessions of TACE. On follow-up CTscans, five patients showed complete uptake of iodized oil in thetumor. Partial uptake of iodized oil was noted in 13 patients and nouptake in one patient. There was no serious complication that relatedto the omental embolization, such as omental or bowel ischemia. Thecumulative survival rates from the time of the TACE of the OA were 81%at 6 months and 68% at 12 months. Conclusion: TACE ofthe OA is safe and has a potential therapeutic effect in the treatmentof HCC.