Hepatic falciform artery: is prophylactic embolization needed before short-term hepatic arterial chemoinfusion?

OBJECTIVE: The purpose of this study was to assess the need for prophylactic embolization of the hepatic falciform artery (HFA) to prevent supraumbilical skin rash before short-term hepatic arterial chemoinfusion with or without subsequent embolization. MATERIALS AND METHODS: Transcatheter arterial chemoinfusions or chemoembolizations were performed on 127 consecutive patients with hepatocellular carcinoma between August 1997 and September 1997. Hepatic angiography findings regarding the anatomic variations of the hepatic artery and the presence and origin of the HFA were analyzed. The patients were followed up for 35-143 days (mean, 78 days). The incidence of supraumbilical skin rash was assessed for two groups of patients, those with an HFA and those without. We also evaluated other factors that seemed closely related to the presence of an HFA. RESULTS: An HFA was identified in 16 (13%) of 127 patients. Each HFA originated either in the left hepatic artery (n = 14) or the middle hepatic artery (n = 2). In the 16 patients with an HFA, serum bilirubin levels were significantly higher than in patients without one (p < .05), whereas serum albumin levels and prothrombin times were significantly lower (p < .05) and more prolonged (p = .02) than in patients without one. Portal venous collateral vessels were more frequently seen in patients with an HFA (50%) than in those without one (31%), but the frequency was not significant (p = .157). However, supraumbilical skin rash was not seen in any patient. CONCLUSION: We found no need for prophylactic embolization of the HFA to prevent supraumbilical skin rash before short-term hepatic arterial chemoinfusion with or without subsequent embolization.     

Embolization of the hepatic falciform artery to prevent supraumbilical skin rash during transcatheter arterial chemoembolization for hepatocellular carcinoma

A dilated hepatic falciform artery (HFA) arising from the left hepatic artery was demonstrated on arteriography prior to chemoembolization of an unresectable hepatocellular carcinoma (HCC) located predominantly in the left lobe of the liver. The HFA was occluded by microcoils to prevent a possible toxic supraumbilical skin rash following chemoembolization of the HCC via the left hepatic artery. There were no postprocedure complications. We consider this procedure useful for improving the safety of chemoembolization.     

Hepatic falciform artery. Angiographic findings in 25 patients

Purpose: To determine the frequency of hepatic falciform artery (HFA) occurrence on celiac or hepatic angiograms and elucidate the anatomy and clinical importance.Material and Methods: Among 1,250 patients who underwent celiac or hepatic arteriography, we encountered 25 patients (2%) with a HFA. Prospectively, CT hepatic falciform arteriography (CTHA) was performed in 4 patients. Indigocarmine dye was injected into the HFA in 6 patients to evaluate whether the abdominal skin was stained. Embolization of the HFA before chemoembolization for hepatocellular carcinoma was performed in 4 patients to prevent abdominal wall injury.Results: Among 25 patients, the HFA arose as a terminal branch of the middle hepatic artery in 14 patients (56%) and of the left hepatic artery in 11 patients (44%). The vessel was single in 18 patients (72%) and double in 7 patients (28%). Two vessels ran side by side along the hepatic falciform ligament. On CTHA, the HFA ran within the hepatic falciform ligament and the branches were connected with the liver around the hepatic falciform ligament. After indigocarmine dye injection, the stain of abdominal skin was recognized in all 6 patients. No abdominal wall injury occurred in any of the 4 patients who were subjected to hepatic chemoembolization.Conclusion: HFA is an extrahepatic pathway which runs to the abdominal wall. Before chemoembolization of the middle or left hepatic artery for hepatic malignancy, the HFA should be recognized.     

原发性肝癌寄生性供血的介入治疗

目的:探讨原发性肝癌的寄生性供血及其对肝癌介入治疗的意义。方法:本组32例原发性肝癌患者行常规腹腔动脉造影及寄生性血管探查,并对其行超选择性插管及化疗栓塞治疗(TACE)。结果:32例患者共见36条肝外寄生性血管,其中膈动脉(12/36);胃十二指肠动脉及胃网膜动脉(10/36);胃左动脉(6/36)占多数。6条肝外营养血管因未能成功行超选择性插管而只予化疗药灌注治疗,其余30条肝外营养血管均行超选择性插管和化疗栓塞治疗。结论:原发性肝癌,特别是晚期肝癌,寄生性供血较为常见和多变,对肝癌的TACE治疗具有重要的意义。     

Is prophylactic embolization of the hepatic falciform artery needed before radioembolization in patients with <Superscript>99m</Superscript>Tc-MAA accumulation in the anterior abdominal wall?

Purpose  

While influx of chemoembolic agents into the hepatic falciform artery (HFA) from the hepatic artery can cause supraumbilical skin rash, epigastric pain and even skin necrosis, the significance of a patent HFA in patients undergoing radioembolization is not completely clear. Furthermore, the presence of tracer in the anterior abdominal wall seen in ^99mTc-macroaggregated albumin (^99mTc-MAA) images, which is generally performed prior to radioembolization, has been described as a sign of a patent HFA. The aim of this retrospective study was to evaluate the incidence and consequences of ^99mTc-MAA accumulation in the anterior abdominal wall, indicating a patent HFA, in patients undergoing radioembolization of liver tumours.     

Interventional radiology for advanced hepatocellular carcinoma: comparison of hepatic artery infusion chemotherapy and transcatheter arterial lipiodol chemoembolization

OBJECTIVE: The prognosis of advanced hepatocellular carcinoma remains poor. The aim of this study was to compare the efficacy of hepatic artery infusion chemotherapy and transcatheter arterial Lipiodol chemoembolization for treatment of advanced tumor. SUBJECTS AND METHODS. Thirty-seven patients with hepatocellular carcinoma and unresectable tumors were enrolled. In the hepatic artery infusion chemotherapy group (n = 16), cisplatin (10 mg/person, on days 1-5) and subsequent 5-fluorouracil (250 mg/person, on days 1-5) were administered for four serial courses. In the transcatheter arterial Lipiodol chemoembolization group (n = 21), an emulsion of Epirubicin (20-30 mg/person) and Lipiodol was administered every 3-4 weeks. RESULTS: The tumor response rates (complete response plus partial response for all cases) of the hepatic artery infusion chemotherapy and transcatheter arterial Lipiodol chemoembolization groups were 56.3% and 23.8%, respectively, showing the significantly higher rate in the former than in the latter group. The cumulative survival rates between the two groups were not significantly different; whereas in those patients whose tumors were classified as TNM stage IV or as having the maximal tumor size of greater than 5 cm, patients tended to have higher survival rates in the hepatic artery infusion chemotherapy group than in the transcatheter arterial Lipiodol chemoembolization group. Univariate analysis identified the serum aspartate aminotransferase value as solely significant. Patients' adverse reactions were successfully managed by treatment of symptoms. Adverse events, such as obstructions of the catheter or hepatic artery or infection around the catheter, rarely occurred. CONCLUSION: Hepatic artery infusion chemotherapy had a better antitumor effect than transcatheter arterial Lipiodol chemoembolization and may be a useful therapeutic option for more advanced hepatocellular carcinoma.     

原发性肝癌合并糖尿病的介入治疗及围手术期处理

目的 :探讨原发性肝癌合并糖尿病患者的介入治疗和围手术期处理。方法 :2 2例患者均超选择插管行肝动脉化疗栓塞术。结果 :治疗后 3周复查 ,肿瘤缩小 >5 0 %者 6例 ( 2 7.3 % ) ,肿瘤缩小 2 5 %～ 5 0 %者 10例 ( 4 5 .5 % )。肝功能损害轻。全部患者术后无严重并发症。结论 :经过充分的术前准备 ,及时准确的术中、术后处理 ,原发性肝癌合并糖尿病患者介入治疗效果令人满意     

变异起源于胃十二指肠动脉的肝动脉及其临床意义

目的:分析和探讨变异起源于胃十二指肠动脉的肝动脉及其临床意义。方法:回顾分析1000例肝癌患者肝动脉的DSA,观察肝动脉的走行、起源和分布情况。并分别统计其变异类型和发生率。结果:正常型肝动脉727例,占72.7%,变异肝动脉273例,占27.3%。273例变异肝动脉中变异起源于胃十二指肠动脉的肝动脉27例,占2.7%。结论:在实施肝癌化疗药物灌注术和化疗栓塞术和肝移植时,分清变异起源于胃十二指肠动脉的肝动脉供血,对于提高手术的成功率和疗效,减少并发症的发生有重要意义。     

Prevention of gastric complications in hepatic arterial chemoembolization. Balloon catheter occlusion technique.

Gastric complications may be a problem in transcatheter arterial chemoembolization, if the right gastric artery branches distally from the proper hepatic artery or its branch, or the accessory left gastric artery arises from the left hepatic artery. We occluded the proper hepatic artery with a balloon catheter to redirect blood flow in these gastric branches toward the liver. This procedure prevented chemoembolic agents from flowing into the gastric branches, and accordingly protected against gastric complications even when chemoembolization was performed by injecting the agents proximally to the gastric branches.     

少见类型变异肝动脉的DSA研究

目的提高对少见起源部位的变异肝动脉的血管造影表现特点的认识.材料和方法回顾分析1000例肝动脉数字减影血管造影资料,将Michels肝动脉解剖分型中未提及的所有迷走肝动脉统称之为少见类型的变异肝动脉,进一步分析其起源部位、分支、走行及在肝内的分布范围等解剖学特征.结果共发现25例存在少见类型的变异肝动脉,占2.5%.起源于胃十二指肠动脉、腹腔动脉干、胃右动脉分别为13例(1.3%,13/1000)、10例(1%,10/1000)和2例(0.2%,2/1000).结论认识少见类型的变异肝动脉,在肝癌的经导管动脉内化疗栓塞术中,对于有效地寻找肿瘤的血供来源、提高疗效具有重要的意义.     

原发性肝癌肝外血供的血管造影分析及介入治疗

目的 探讨原发性肝癌的肝外血供的血管造影表现及其对肝癌介入治疗的意义.方法 本组32例原发性肝癌患者行常规腹腔动脉造影及肝外血供探查,并对其行超选择性插管及化疗栓塞治疗(TACE).结果 32例患者共见37支肝外营养血管,分别为肠系膜上动脉12支,右膈下动脉9支,左膈下动脉1支,胃左动脉6支,胰十二指肠动脉弓2支,胃网膜动脉2条,胃十二指肠动脉2支,右胸廓内动脉1支,右肋间动脉1支,脾动脉1支.大多数肝外血供为肠系膜上动脉和右膈下动脉;4支肝外营养血管因未能成功行超选择性插管而只予化疗药灌注治疗,其余33支肝外血供均行超选择性插管和化疗栓塞治疗.结论 原发性肝癌的肝外血供较为常见和多变,对肝外血供的化疗栓塞在肝癌的介入治疗中具有重要的意义.     

艾滋病合并肝癌患者TACE术相关问题的探讨

目的 探讨艾滋病合并肝癌患者TACE术的相关问题.方法 收集5例艾滋病合并肝癌患者的临床资料,其中1例合并脾功能亢进.5例患者TACE术前均行肝脏CT扫描,经肝动脉注入低于常规剂量的化疗药和栓塞剂进行化疗栓塞术,并对合并脾功能亢进患者行部分脾栓塞术(脾脏栓塞约60%).术后1周及1个月复查CD4T淋巴细胞、肝功能及血常...     

Three-Dimensional Quantitative Color-Coding Analysis of Hepatic Arterial Flow Change during Chemoembolization of Hepatocellular Carcinoma

Purpose

To evaluate feasibility of using three-dimensional (3D) quantitative color-coding analysis (QCA) to quantify substasis endpoints after transcatheter arterial chemoembolization of hepatocellular carcinoma (HCC).

125例中晚期肝癌介入治疗近期疗效分析

目的：评价经肝动脉灌注化疗与化疗加栓塞治疗中晚期肝癌的近期疗效.方法：采用Seldinger技术,经皮股动脉穿刺插管,对125例无手术指征的中晚期肝癌行肝动脉灌注化疗（TATC）和化疗加栓塞治疗（TACE）.35例行单纯肝动脉灌注化疗,90例行肝动脉化疗加栓塞治疗.结果：单纯肝动脉灌注化疗者生存率0.5年为62.9%;1年为25.7%;2年为0.3%;总有效率为68.6%;肝动脉化疗加栓塞者生存率0.5年为92.3%,1年为65.5%,2年为28.9%,总有效率为94.4%.结论：肝动脉灌注化疗与化疗栓塞是中晚期肝癌行之有效的治疗方法,肝动脉化疗加栓塞治疗疗效优于肝动脉灌注化疗.     

原发性肝癌肝外动脉供血的临床意义及介入治疗

目的 :探讨肝癌的肝外动脉供血规律、插管技术及介入治疗。方法 :4 6例原发性肝癌患者发现肝外动脉供血5 1条 ,分别超选择插管行化疗栓塞。结果 :肝外动脉供血与肿瘤部位、大小密切相关。治疗三周后复查 ,肿瘤缩小 >5 0 %者 14例 (30 .4 % ) ;肿瘤缩小 <5 0 %而 >2 5 %者 2 2例 (47.8% ) ;肿瘤无明显变化 10例 (2 1.7% )。AFP下降 >5 0 %者 2 8例(80 .0 % )。肝功能损害轻 ,全部患者术后无严重并发症。结论 :肝癌有丰富的肝外动脉供血。对肝外动脉供血支超选择性栓塞治疗 ,对提高中晚期肝癌患者介入治疗疗效具有重要的临床意义     

经皮左锁骨下动脉穿刺植入药盒治疗晚期恶性肿瘤

目的 评价经皮左锁骨下动脉植入药盒在晚期恶性肿瘤治疗中的应用价值。方法 对200例中晚期恶性肿瘤病人采用经皮左锁骨下动脉植入药盒治疗。其中原发性肝癌178例,转移性肝癌10例,盆腔肿瘤5例,胆囊癌4例,肺部3例。依据肿瘤供血情况,在DSA路标及透视监控下,施行药盒植入术,药盒体埋置在穿刺点下方的左前胸壁皮下,药盒导管端植入靶动脉内。术后经药盒行规则性化疗或磺油化疗乳剂栓塞。结果 随访3个月－3年,200例病人共植入202个药盒,其中2例肝癌病人因左、右肝动脉各自供血肿瘤,故在右股动脉加埋一个药盒（双药盒）。植入成功率为99％。并发症有9例（4．5％）：导管移位2例（1％）、导管－药盒松脱1例（0．5％）、气胸2例（1％）、皮肤溃烂1例（0．5％）、皮下大量渗血1例（0．5％）,靶血管闭塞2例（1％）。无严重并发症。结论 经皮左锁骨下动脉行药盒植入术安全可行、操作简便易行、创伤小,为动脉内化疗灌注和碘油化疗乳剂栓塞提供了一条安全可靠的途径。     

脾动脉供血在肝癌介入栓塞治疗中的价值

目的 探讨脾动脉在肝癌供血中的DSA表现和治疗价值.方法 3例肝癌患者在栓塞治疗中行DSA检查发现肿瘤有脾动脉供血,对DSA影像特点进行分析,并同时进行超选择动脉栓塞治疗.结果 3例肝癌患者经超选择性栓塞治疗后,所有病例的供血血管均显著减少,病灶均明显缩小.结论 脾动脉供血型肝癌是一种比较少见的肝动脉变异性供血,熟悉其血管变异的特点对肝动脉化疗栓塞术具有重要的意义.     

Chemoembolization for Hepatocellular Carcinoma Supplied Exclusively by the Hepatic Falciform Artery

Purpose

The purpose of this study was to describe imaging appearances of hepatocellular carcinoma (HCC) supplied exclusively by the hepatic falciform artery (HFA) and safety of chemoembolization via the HFA.

Methods

During the past 6?years, we have performed chemoembolization for the treatment of 12 patients with HCCs supplied exclusively by the HFA. Computed tomography (CT) scans, digital subtraction angiograms, and medical records were retrospectively reviewed by consensus.

Results

Tumors were located in Couinaud segments IV (n?=?7) and III (n?=?5) and in subcapsular areas around the falciform ligaments. Tumor size ranged from 1.0 to 1.8?cm (mean, 1.3?cm; median, 1.3?cm). HFAs originated from A4 (n?=?7), A3 (n?=?4), and the left hepatic artery near the umbilical point (n?=?1). All tumors were supplied exclusively by the HFA. Prophylactic embolization of the distal HFA before chemoembolization was performed using gelatin sponge particles in only one patient, and selective chemoembolization via the HFA was achieved in all patients. One patient suffered from a skin rash after chemoembolization and recovered after conservative management. Individual responses of tumors supplied exclusively by the HFA were complete response (n?=?8), partial response (n?=?1), and stable disease (n?=?2) at the first follow-up enhanced CT scan.

Conclusions

The HFA can supply HCC located in subcapsular areas around the falciform ligament, and the tumors can be safely chemoembolized without significant complications.     

多层螺旋CT在肝细胞肝癌肝动脉化疗栓塞中的表现及介入治疗中的意义

目的探讨多层螺旋CT(MSCT)在肝细胞癌(HCC)肝动脉化疗栓塞中的表现特点及其介入治疗中的指导意义。方法45例肝癌患者行肝动脉化疗栓塞前同期分别行MSCT和DSA2种检查。MSCT应用三维容积再现(VRT)、最大密度投影(MIP)或多平面重组(MPR)技术观察腹腔动脉的解剖及走行分支,比较CT与DSA对病灶、合并症的显示情况及肿瘤的血供情况等。结果45例患者,MSCT发现病灶167个、门静脉癌栓11例、动脉静瘘12例;DSA发现病灶172个、门静脉癌栓8例,动静脉瘘15例。MSCT与DSA比较,DSA对肿瘤的数目显示率略高于MSCT,但差异无统计学意义。MSCT能够显示腹腔动脉及其主要分支的三维结构,优于DSA,观察与腹主动脉夹角较DSA更方便;MSCT发现肝动脉起源变异4例,与DSA完全符合。结论MSCT对肝细胞肝癌肝动脉化疗栓塞有重要指导意义。