Influential factors and formation of extrahepatic collateral artery in unresectable hepatocellular carcinoma.
OBJECTIVE
To analyze the influence factors and formation of extrahepatic collateral arteries (ECAs) in unresectable hepatocellular carcinoma (HCC) with or without chemoembolization.


METHODS
Detailed histories of 35 patients with 39 ECAs of HCC and images including computerized tomography scan, digital subtraction angiography were reviewed carefully to identify ECAs of HCC, ECAs arising from, and anatomic location of tumors in liver. Tumor sizes were measured, and relations of ECAs with times of chemoembolization, tumor size, and the anatomic tumor location were analyzed. Complications were observed after chemoembolization through ECAs of HCC with different techniques.


RESULTS
Influence factors of formation of ECAs of HCC included the times of repeated chemoembolization, the location of tumors in liver, the tumor size and the types of chemoembolization. ECAs in HCC appeared after 3-4 times of chemoembolization (17.9%), but a higher frequency of ECAs occurred after 5-6 times of chemoembolization (56.4%). ECAs presented easily in peripheral areas (71.8%) of liver abutting to the anterior, posterior abdominal walls, the top right of diaphragm and right kidney. ECAs also occurred easily after complete obstruction of the trunk arteries supplying HCCs or the branches of proper hepatic arteries. Extrahepatic collaterals of HCC originated from right internal thoracic (mammary) artery (RITA, 5.1%), right intercostal artery (RICA, 7.7%), left gastric artery (LGA, 12.8%), right inferior phrenic artery (RIPA, 38.5%), omental artery (OTA, 2.6%), superior mesenteric artery (SMA, 23.1%), and right adrenal and renal capsule artery (RARCA, 10.3%), respectively. The complications after chemoembolization attributed to no super selective catheterization.


CONCLUSIONS
The formation of ECAs in unresectable HCC is obviously correlated with multiple chemoembolization, tumor size, types of chemoembolization, anatomic location of tumors. Extrahepatic collaterals in HCC are corresponding to the tumor locations in liver.
Wang
Yong-Li
YL
Department of Diagnostic and Interventional Radiology, The Affiliated Sixth People's Hospital of Shanghai Jiaotong University, 600 Yi Shan Rd, Shanghai 200233, China. wylzxy@tom.com
Li
Ming-Hua
MH
Cheng
Ying-Sheng
YS
Shi
Hai-Bing
HB
Fan
Hai-Lun
HL
D000328:Adult; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000098:blood supply* / Q000453:epidemiology / Q000628:therapy*; D004621:Embolization, Therapeutic; D005260:Female; D006801:Humans; D015994:Incidence; D008102:Liver Circulation / Q000502:physiology; D008113:Liver Neoplasms / Q000098:blood supply* / Q000453:epidemiology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009389:Neovascularization, Pathologic / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000628:therapy; D011859:Radiography