Right gastric artery embolization prior to treatment with yttrium-90 microspheres.
OBJECTIVE
Intra-arterial infusion of yttrium-90 microspheres is a form of radiation treatment for unresectable hepatic neoplasms. Misdeposition of particles in the gastroduodenal area such as the right gastric artery (RGA) may occur with serious consequences. We present a series of patients who underwent a detailed vascular study followed by RGA embolization. Special emphasis is placed on anatomic variations and technical considerations.


METHODS
In a 1 year period, 27 patients were treated. Initial vascular evaluation was performed, with careful attention to anatomic variants or extrahepatic arterial supply, especially to the gastroduodenal area. Embolization of such arteries was planned if needed. RGA embolization was performed antegradely from the hepatic artery or retrogradely via the left gastric artery (LGA). Postprocedural follow-up included clinical interview and gastroscopy if necessary.


RESULTS
RGA embolization was performed in 9 patients presenting with primary (n = 3) or metastatic liver tumors (n = 6). Six patients underwent antegrade RGA embolization and 3 had embolization done retrogradely via the LGA. Retrograde access was chosen for anatomic reasons. None of the patients complained of gastroduodenal symptoms.


CONCLUSIONS
RGA embolization can help minimize the gastroduodenal deposition of radioactive particles. RGA embolization should routinely be carried out. The procedure can be performed, with similar technical success, by both anterograde and retrograde approaches.
Cosin
Octavio
O
Departamento de Radiologia, Clinica Universitaria de Navarra, Avd PIO XII 36, Pamplona 31008, Navarra, Spain.
Bilbao
Jose Ignacio
JI
Alvarez
Sergio
S
de Luis
Esther
E
Alonso
Alberto
A
Martinez-Cuesta
Antonio
A
D000970:Antineoplastic Agents / Q000627:therapeutic use; D001943:Breast Neoplasms / Q000473:pathology*; D006528:Carcinoma, Hepatocellular / Q000473:pathology / Q000532:radiotherapy* / Q000556:secondary; D015179:Colorectal Neoplasms / Q000473:pathology*; D004621:Embolization, Therapeutic / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006499:Hepatic Artery / Q000000981:diagnostic imaging; D006801:Humans; D007261:Infusions, Intra-Arterial / Q000379:methods; D008113:Liver Neoplasms / Q000473:pathology / Q000532:radiotherapy* / Q000556:secondary; D008297:Male; D008863:Microspheres; D008875:Middle Aged; D018358:Neuroendocrine Tumors / Q000473:pathology*; D011859:Radiography; D013270:Stomach / Q000098:blood supply*; D016896:Treatment Outcome; D015021:Yttrium Radioisotopes / Q000627:therapeutic use
D000970:Antineoplastic Agents; D015021:Yttrium Radioisotopes