title: Extrahepatic blood supply to hepatocellular carcinoma: angiographic demonstration and transcatheter arterial chemoembolization.
abstract: OBJECTIVE
  To evaluate the incidence of each extrahepatic collateral pathway to hepatocellular carcinoma (HCC) and to assess technical success rates and complications of transcatheter arterial chemoembolization (TACE) through each collateral.
  
  
  METHODS
  We retrospective evaluated extrahepatic collateral pathways to HCC on angiography in 386 procedures on 181 consecutive patients. One hundred and seventy patients had previously undergone TACE. TACE through extrahepatic collaterals using iodized oil and gelatin sponge particles was performed when a catheter was advanced into the tumor-feeding branch to avoid nontarget embolization.
  
  
  RESULTS
  A single collateral was revealed in 275 TACE procedures, two were revealed in 74, and three or more were revealed in 34. Incidences of collateral source to HCC were 83% from the right inferior phrenic artery (IPA), 24% from the cystic artery, 13% from the omental artery, 12% from the right renal capsular artery (RCA) and left IPA, 8% from the right internal mammary artery (IMA) and right intercostal artery (ICA), and 7% from the right inferior adrenal artery (IAA). Technical success rates of TACE were 53% in the right ICA, 70% in the cystic artery, 74% in the omental artery, 93% in the left IPA, 96% in the right IPA, and 100% in the right RCA, right IMA, and right IAA. Complications included skin necrosis after TACE through the right IMA (n = 1), cholecystitis after TACE through the cystic artery (n = 1), and ulcer formation after TACE through the right gastric artery (n = 1), in addition to pleural effusion and basal atelectasis after TACE through the IPA and IMA.
  
  
  CONCLUSIONS
  Our study suggests that TACE through extrahepatic collaterals is possible with high success rates, and is also relatively safe.
authors.affiliation: Department of Diagnostic Radiology, Fukuiken Saiseikai Hospital, Wadanaka-cho, Fukui 918-8503, Japan. s-miyayama@fukui.saiseikai.or.jp
authors.forename: Shiro
authors.initials: S
authors.lastname: Miyayama
authors.forename: Osamu
authors.initials: O
authors.lastname: Matsui
authors.forename: Keiichi
authors.initials: K
authors.lastname: Taki
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Minami
authors.forename: Yasuji
authors.initials: Y
authors.lastname: Ryu
authors.forename: Chiharu
authors.initials: C
authors.lastname: Ito
authors.forename: Koichi
authors.initials: K
authors.lastname: Nakamura
authors.forename: Dai
authors.initials: D
authors.lastname: Inoue
authors.forename: Kazuo
authors.initials: K
authors.lastname: Notsumata
authors.forename: Daisyu
authors.initials: D
authors.lastname: Toya
authors.forename: Nobuyoshi
authors.initials: N
authors.lastname: Tanaka
authors.forename: Takeshi
authors.initials: T
authors.lastname: Mitsui
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000792:Angiography; D006528:Carcinoma, Hepatocellular / Q000098:blood supply* / Q000000981:diagnostic imaging / Q000628:therapy*; D016461:Chemoembolization, Therapeutic / Q000379:methods*; D003097:Collateral Circulation; D005260:Female; D006801:Humans; D007459:Iodized Oil / Q000008:administration & dosage; D008113:Liver Neoplasms / Q000098:blood supply* / Q000000981:diagnostic imaging / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D007459:Iodized Oil