Supplemental transcatheter arterial chemoembolization through a collateral omental artery: treatment for hepatocellular carcinoma.
OBJECTIVE
To evaluate the therapeutic efficacy and safety of supplemental transcatheter arterial chemoembolization (TACE) through the extrahepatic collateral omental artery (OA) for the treatment of hepatocellular carcinoma (HCC).


METHODS
We studied 21 patients with extrahepatic collaterals of the OA, among 1,512 patients with HCC who had undergone angiography. HCCs supplied by collateral OAs were located at: segment IV in seven, segment V in five, segment III in three, segment VI in three and segment VIII in three patients (Couinaud classification of segments). On preoperative CT scans, every HCC was abutting the liver surface. Adjacent omental infiltration or engorgement was noted in 11 patients. Celiac and hepatic arteriograms showed hypertrophy of the feeding OA in all patients. TACE of the OA was performed in 19 patients with an emulsion of iodized oil and doxorubicin hydrochloride. Embolization with gelatin sponge particles was added in five patients.


RESULTS
Collaterals of the OA to the HCC were found on the first to seventeenth sessions of TACE. On follow-up CT scans, five patients showed complete uptake of iodized oil in the tumor. Partial uptake of iodized oil was noted in 13 patients and no uptake in one patient. There was no serious complication that related to the omental embolization, such as omental or bowel ischemia. The cumulative survival rates from the time of the TACE of the OA were 81% at 6 months and 68% at 12 months.


CONCLUSIONS
TACE of the OA is safe and has a potential therapeutic effect in the treatment of HCC.
Won
Jong Yun
JY
Department of Diagnostic Radiology, Research Institute of Radiological Science, Yonsei University College of Medicine, 134 Shinchon-Dong, Seodaemun-Gu, Seoul, 120-752, Korea.
Lee
Do Yun
DY
Lee
Jong Tae
JT
Park
Sung Il
SI
Kim
Myeong-Jin
MJ
Yoo
Hyung Sik
HS
Suh
Sang-Hyun
SH
Park
Sang Joon
SJ
D000368:Aged; D000903:Antibiotics, Antineoplastic / Q000008:administration & dosage; D006528:Carcinoma, Hepatocellular / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D002408:Catheters, Indwelling; D016461:Chemoembolization, Therapeutic; D003097:Collateral Circulation / Q000187:drug effects; D003287:Contrast Media / Q000008:administration & dosage / Q000378:metabolism; D018450:Disease Progression; D004317:Doxorubicin / Q000008:administration & dosage; D005260:Female; D005500:Follow-Up Studies; D024405:Gastroepiploic Artery / Q000601:surgery; D006499:Hepatic Artery / Q000000981:diagnostic imaging / Q000601:surgery; D006801:Humans; D007459:Iodized Oil / Q000008:administration & dosage / Q000378:metabolism; D007723:Korea; D008113:Liver Neoplasms / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009852:Omentum / Q000098:blood supply* / Q000000981:diagnostic imaging / Q000473:pathology; D016019:Survival Analysis; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D000509:alpha-Fetoproteins / Q000008:administration & dosage
D000903:Antibiotics, Antineoplastic; D003287:Contrast Media; D000509:alpha-Fetoproteins; D007459:Iodized Oil; D004317:Doxorubicin