Recognizing Arterial Supply Patterns to Hepatocellular Carcinoma for Optimal Transarterial Therapy: A Pictorial Review

 

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Background: Transarterial therapies including transarterial bland embolization, transarterial chemoembolization TACE), and selective intraarterial radiation treatment (SIRT) are management options offered to select patients suffering from hepatocellular carcinoma (HCC). Most HCCs derive their blood supply from the hepatic artery. However, it is not uncommon for some HCCs to develop extrahepatic arterial supply from a variety of sources including inferior phrenic, internal mammary, and gastroduodenal arteries. Identification of these “parasitic” vessels helps in minimizing the chances of under treatment. In addition, recognition of flow dynamics of hepatic arterial and HCC supply permits operators in optimizing flow for delivery of Y-90 during SIRT. Methods: In this educational poster, we present a series of case vignettes demonstrating the value of recognizing hepatic arterial flow patterns for optimal delivery of transarterial therapy when treating HCC. Results: We aim to highlight imaging features of HCCs which may predict the presence and source of extrahepatic arterial supply. We also demonstrate angiographic techniques that help in optimal delivery of TACE and SIRT. Conclusion: Knowledge of hepatic arterial flow patterns and extrahepatic tumor supply can help in optimizing safe delivery of transarterial therapy for treating HCC.

Publication History

Article published online:
11 May 2021

© 2018. The Arab Journal of Interventional Radiology. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

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