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A Selective arteriography via common hepatic artery shows no tumor stain. B CT during arteriography via common hepatic artery demonstrates protruded tumor at the posterioinferior segment. Lack of the enhancement of the lateral part of the tumor (arrowheads) suggests the existence of parasitic blood supply to the tumor.
Source publication
We present a case of spontaneous rupture of
hepatocellular carcinoma (HCC) with poor liver function which was
treated by transcatheter arterial embolization (TAE). The patient’s
bilirubin value was 3.8 mg/dL. The tumor was fed by the right renal
capsular artery according to selective arteriography. It was
subsequently treated by TAE. With successfu...
Contexts in source publication
Context 1
... arteriography through the common hepatic artery (CHA) showed no tumor stain (Fig. 1A), but computed tomography during arte- riography (CTA) via CHA showed two protruded tumors at the posterior- inferior segment (segment 6). On CTA via CHA, the medial tumor was enhanced only partially, but the lateral one was not (Fig. 1B). It was suggested that the part of the tumor that was not enhanced might be supplied by a parasitic ...
Context 2
... arteriography through the common hepatic artery (CHA) showed no tumor stain (Fig. 1A), but computed tomography during arte- riography (CTA) via CHA showed two protruded tumors at the posterior- inferior segment (segment 6). On CTA via CHA, the medial tumor was enhanced only partially, but the lateral one was not (Fig. 1B). It was suggested that the part of the tumor that was not enhanced might be supplied by a parasitic blood supply. Selective arteriography through the right inferior adrenal artery depicted a tumor stain but without evidence of extravasation. The tumor stain corresponded to the lateral lesion on CTA. An emulsion of 2.0 ml iodized oil ...
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Hepatectomy without portal triad clamping may decrease the incidence of liver injury; however, the effects of hepatectomy without portal triad clamping in the treatment of spontaneous rupture of hepatocellular carcinoma (SRHCC) remain unclear. The aims of the present study were to evaluate the therapeutic value of hepatectomy without portal triad c...
Citations
... Nagao et al. (86) reported a case of ruptured chest wall metastasis of HCC that was controlled by TAE. Kodama et al. (70) reported of a case with rHCC supplied by the right renal capsular artery and Child-Pugh C liver function, indicating that TAE may be chosen for poor liver function when tumor feeders are only extrahepatic collateral vessels. However, Bassi et al. (87) reported that the mortality of patients with Child-Pugh C liver function is exceedingly high in the early post-TAE period, but only three patients with Child-Pugh C liver function received TAE in this study. ...
Rupture of HCC (rHCC) is a life-threatening complication of hepatocellular carcinoma (HCC), and rHCC may lead to a high rate of peritoneal dissemination and affect survival negatively. Treatment for rHCC mainly includes emergency surgery, interventional therapies, and palliative treatment. However, the management of rHCC should be carefully evaluated. For patients with severe bleeding, who are not tolerant to open surgery, quick hemostatic methods such as rupture tissue ablation and TAE/TACE can be performed. We described clinical presentation, prognosis, complication, interventional management, and current evidence of rHCC from the perspective of interventional radiologists. Overall, our review summarized that interventional therapies are necessary for most patients with rHCC to achieve hemostasis, even in some patients with Child–Pugh C. Moreover, TAE/TACE followed by staged hepatectomy is a beneficial treatment for rHCC according to current clinical evidence. TAE/TACE is the first choice for most patients with rHCC, and appropriate interventional treatment may provide staged surgery opportunities for those who are not tolerant to emergency surgery to reach an ideal prognosis.
... However, hepatic tumors without previous treatment also have the potential to develop extrahepatic collateral arterial supply (4)(5)(6). This can be an occult source of bleeding; although extrahepatic collateral feeding arteries are well recognized to develop after repetitive transarterial chemoembolization (4)(5)(6)(7)(8)(9) and selective catheterization of those collateral vessels is required to adequately treat such tumors (5,6), the potential for such vessels to spontaneously bleed has received little attention (10). Here we report 3 cases of active bleeding from such extrahepatic collateral arteries associated with previously untreated hepatic tumors. ...
This report describes 3 patients with previously untreated hepatic tumors who underwent embolization for the treatment of extravasation from extrahepatic arteries. Although development of extrahepatic collateral blood supply is well known, its importance in the presentation of rupture of liver tumors may be underrecognized. Findings that suggest bleeding from extrahepatic arteries include a discrepancy in the pattern of extravasation on computed tomography vs hepatic angiography and a lack of stabilization of vital signs after embolization of hepatic arteries. To achieve successful hemostasis in embolization, the potential involvement of such extrahepatic arteries should be accurately recognized, suggestive imaging findings considered, and the occult vessels selected and embolized.
... 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. ...
... 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. Therefore, it was hypothesized that the main cause of the development of extrahepatic collaterals was attenuation of the hepatic arterial circulation by TACE (18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28). 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). ...
... Extrahepatic collateral blood supplies may prohibit effective treatment by TACE. For the transcatheter management of P-HCC to be effective, these collateral blood supplies must be adequately embolized (18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28). ...
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 (χ2=164.000, P<0.001), but not tumor location (χ2=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 (χ2=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.
... Preoperative control of these collaterals through TACE may obviate this risk. For transcatheter management of HCC to be effective, these collaterals should be adequately embolized [15,[17][18][19][20][25][26][27][28][29][30]. ...
... [6][7][8][9] To reduce the incidence of presence of residual HCC, these extrahepatic collaterals need to be adequately embolized. [10][11][12][13][14][15][16][17] Our previous study suggested cTAE/TACE therapy via omental artery can improve the degree of lipiodol uptake of the tumors. [8] However, the value of cTAE/ TACE therapy via extrahepatic collaterals for patients with unresectable HCC are largely unknown. ...
... Multiple extrahepatic collaterals can develop and supply the HCC, [4,[10][11][12][13][14][15][16][17]23] which play an important role in the residual HCC, and can limit the effectiveness of cTAE/TACE therapy. [6][7][8] The incidence of extrahepatic collaterals feeding the HCC has been reported to be 17%-27%. ...
... Although extrahepatic collaterals feeding HCC have been reported in the literature, [9][10][11][12][13][14][15][16] the underlying risk factors are still unclear. [9][10][11][12][13][14][15][16] It was reported there is a close relationship between repeat cTAE/TACE therapy and the formation of extrahepatic collaterals, the repeat cTAE/TACE therapy damaged the hepatic artery which induced the formation of extrahepatic collaterals; [19] also, tumor located at the surface of the liver were likely to be fed by the extrahepatic collaterals. ...
Purpose: To assess the value of conventional transarterial embolization/chemoembolization (cTAE/TACE) therapy via extrahepatic arteries for patients with unresectable hepatocellular carcinoma (HCC).
Methods: Patients with unresectable HCC who underwent cTAE/TACE therapy via extrahepatic arteries between May 2008 and July 2016 across 4 medical centers were identified. The technical success, serum alpha-fetoprotein (AFP) levels changes, tumor response, disease control rate, survival rate, and major complication were analyzed.
Results: A total of 185 patients (167 male and 18 female) were included in this study. A total of 401 procedures were performed of the 185 patients, with 2.2 ± 0.4 procedures for each patient. A total of 197 extrahepatic arteries were identified, including inferior phrenic artery (n = 80), omental artery (n = 39), gastric artery (n = 22), right renal capsular artery (n = 21), adrenal artery (n = 13), cystic artery (n = 11), and right internal mammary artery (n = 11). The technical success rate was 96.8% (179/185). The serum AFP levels were significantly reduced at 1 month after treatment in 71 patients whose AFP ≥400 ng/mL preprocedure (P < 0.01). The disease control rate was 93% (172/185) at 3 months after cTAE/TACE, with partial response, stable disease, or progressive disease of 115, 57, and 13 patients, respectively. The cumulative survival rate from the time of cTAE/TACE via extrahepatic arteries was 100% at 6 months. There were no embolization-related major complications.
Conclusion: cTAE/TACE therapy via the extrahepatic arteries can reduce the incidence of presence of residual HCC, and improve the therapeutic efficacy of cTAE/TACE.
... [7,8] To improve the efficacy of TAE/TACE therapy, these collaterals need to be adequately embolized. [9][10][11][12][13][14][15][16] Adrenal arteries, including the superior, middle, and inferior adrenal artery, arise from the inferior phrenic artery, aorta, and renal artery, respectively. Although it is rare for HCC to be fed by adrenal arteries, the adrenal arteries can form a collateral pathway to HCC. [17] The value of TAE/TACE therapy via adrenal artery for HCC has not been previously reported. ...
To assess the value of transarterial embolization/chemoembolization (TAE/TACE) therapy via adrenal artery for patients with hepatocellular carcinoma (HCC). Patients with HCC who underwent TAE/TACE therapy via adrenal artery between May 2003 and October 2015 across 4 medical centers were identified. Clinical information, procedural data, and imaging data were analyzed to assess technical success, disease control, and survival rates. A t test was used to compare the differences in serum alpha-fetoprotein before and after treatment. A total of 23 patients (23 men; mean age, 54.6 ± 7.5 years; range, 37–72 years) were included in this study. All tumors were located under the capsule of the liver and adjacent to the adrenal gland (median tumor diameter, 8.2 cm). Lesions fed by the adrenal artery were demonstrated during initial TAE/TACE in 7 patients and during repeat TAE/TACE in 16 patients. The superior, middle, and inferior adrenal arteries were involved in 14, 3, and 6 patients, respectively. The technical success rate was 100%. The disease control rate at 3 months was 100%, with partial tumor response seen in 16 (69.6%) patients and stable disease seen in 7 (30.4%) patients. The cumulative survival rate from the time of TAE/TACE was 100% at 1 year. There were no embolization-related complications. TAE/TACE therapy via the adrenal arteries can improve the therapeutic efficacy of TAE/TACE and reduce the incidence of HCC recurrence and/or presence of residual HCC.
... Atypical vessel originating from renal artery and feeding the AML followed an unusual course. Although this artery followed a track similar to renal capsular artery, it was still different because of the fact that it ascended parallel to vena cava, gave branches to surrenal gland and the upper pole of the kidney, and disappeared in a mass at the posterio-lateral of the renal area [15]. With this characteristic structure, the artery which did not have features of accessory renal artery was considered an aberrant artery. ...
... A surface tumor location is a prerequisite for and the most important factor associated with the formation of EHAs (7,31). EHAs develop to supply the peripheral zone of the liver parenchyma, with the subsequent recurrence of tumor at remote sites in the peripheral zone supplied by the EHAs (32,33). In the present study, it was found that tumors located in the bare area may be associated with a higher prevalence of EHAs than tumors not in the bare area. ...
To improve the efficacy of transcatheter arterial chemoembolization (TACE) for hepatocellular carcinoma (HCC), this study evaluated the prevalence and causes of extrahepatic arteries (EHAs) and identified feeding arteries in HCCs in three independent clinical groups in a single inverventional radiology center. Between November 2011 and September 2012, 942 cases of HCC were included in this retrospective study. The patients were treated in three independent groups of 285, 301 and 356 patients, respectively. Enhanced computed tomography, enhanced magnetic resonance imaging and digital subtraction angiography were reviewed retrospectively and correlations between the presence of tumor-feeding EHAs and tumor number, size and location in the liver, number of repeat TACE procedures and complications were assessed. There were 698 EHAs in the 942 cases of HCC, with 182, 233 and 283 EHAs in the three independent groups, respectively. Tumor size was associated with EHA formation; the percentages of patients with EHAs were 2.7±3.0, 5.5±0.5, 43.2±4.0, 61.8±5.2 and 93.4±1.8% with tumor sizes of 2-3, 3-5, 5-7, 7-9 and >9 cm, respectively. There were 159±19 EHAs in each group feeding tumors in peripheral locations in the liver, but only 48.7±6.8 in the central zone. The most common EHA was the right inferior phrenic artery, with a mean of 101.0±14.1 per group. The number of EHAs increased proportionally with the number of TACE sessions. The number of EHAs was positively associated with tumor size, peripheral location of the tumor and number of TACE sessions.
... Hepatocellular carcinoma (HCC) frequently recurs after chemoembolization and development of extrahepatic collateral pathways is one of the causes of local tumor recurrence. Several extrahepatic collateral pathways supplying HCC have been reported [1][2][3][4][5][6][7][8][9][10][11][12][13][14]. ...
... Extrahepatic collateral supplies can inhibit the effectiveness of chemoembolization. For transcatheter management of HCC to be effective, these collaterals should be adequately embolized [1][2][3][4][5][6][7][8][9][10][11][12][13][14]. Therefore, interventional radiologists should have sufficient knowledge of extrahepatic blood supply to HCCs. ...
The purpose of this study was to evaluate changes in vascular supply to hepatocellular carcinoma (HCC) located in the bare area of the liver in patients who were mainly treated with chemoembolization. Twenty-six patients with HCC showing a mean diameter of 3.1 +/- 1.4 cm (mean +/- standard deviation) were mainly treated with chemoembolization. All patients underwent 2.7 +/- 2.3 chemoembolization sessions over 40.1 +/- 25.2 months. Tumor feeding branches demonstrated in each chemoembolization session were retrospectively evaluated. Initially, 18 tumors (59.2%) were supplied by the hepatic artery (H) and 8 (30.8%) by both the hepatic and the extrahepatic arteries (H + C). Fourteen tumors (53.8%) recurred at the posterior aspect of the tumor and were supplied by H (n = 4), H + C (n = 5), and extrahepatic collaterals (C) (n = 5). Several tumors recurred despite repeated chemoembolization, and these were supplied by H (n = 1), H + C (n = 7), and C (n = 2) at the second recurrence, by H (n = 1), H + C (n = 2), and C (n = 3) at the third, by H + C (n = 2) and C (n = 2) at the fourth, by H + C (n = 2) and C (n = 2) at the fifth, and by H (n = 1) and C (n = 1) at the sixth. One tumor was supplied by H at the seventh and by H + C at the eighth recurrence. As the number of local recurrences increased, the feeding vessel shifted from H to C. Especially, the right inferior phrenic artery (IPA) and renal capsular artery (RCA) supplied the tumor early, while the small right RCAs, adrenal arteries, and intercostal and lumbar artery supplied late recurrences in turns. In conclusion, HCCs located in the bare area are frequently supplied by extrahepatic vessels initially, while recurrence after chemoembolization is mainly due to extrahepatic blood supply. The right IPA and RCA are common feeding vessels demonstrated early, while other extrahepatic collateral supply from the retroperitoneal circulation occurs in turns during the later course.
... However, most hepatocellular carcinomas will recur at the same site or in another segment in the liver. Thus proximal embolization including the proper hepatic artery shown in the image may induce extrahepatic collaterals including the inferior phrenic artery [2], internal mammary artery [3], intercostal artery [4], renal capsular artery [5], or the omental branches [6], in addition to the epicholedochal plexus [2]. As the authors mentioned in the Discussion, peripheral targeted occlusion of tumor vessels by small particles might induce a more permanent occlusion with a longer steady state. ...
