title: Consolidation of hepatic arterial inflow by embolization of variant hepatic arteries in preparation for yttrium-90 radioembolization.
abstract: OBJECTIVE
  Before yttrium-90 ((90)Y) radioembolization administration, the authors consolidated arterial inflow by embolizing variant hepatic arteries (HAs) to make microsphere delivery simpler and safer. The present study reviews the technical and clinical success of these consolidation procedures.
  
  
  METHODS
  Preparatory and treatment angiograms were retrospectively analyzed for 201 patients. Variant HAs were coil-embolized during preparatory angiography to simplify arterial anatomy. Collateral arterial perfusion of territories previously supplied by variant HAs was evaluated by digital subtraction angiography (DSA), C-arm computed tomography (CT), and technetium-99m ((99m)Tc)-macroaggregated albumin (MAA) scintigraphy, and by follow-up evaluation of regional tumor response.
  
  
  RESULTS
  A total of 47 variant HAs were embolized in 43 patients. After embolization of variant HAs, cross-perfusion into the embolized territory was depicted by DSA and by C-arm CT in 100% of patients and by (99m)Tc-MAA scintigraphy in 92.7%. Uniform progressive disease prevented evaluation in 33% of patients, but regional tumor response in patients who responded supported successful delivery of microspheres to the embolized territories in 95.5% of evaluable patients.
  
  
  CONCLUSIONS
  Embolization of variant HAs for consolidation of hepatic supply in preparation for (90)Y radioembolization promotes treatment of affected territories via intrahepatic collateral channels.
authors.affiliation: Division of Interventional Radiology, Stanford University Medical Center, Stanford, CA 94305-5642, USA.
authors.forename: Mohamed H K
authors.initials: MH
authors.lastname: Abdelmaksoud
authors.forename: John D
authors.initials: JD
authors.lastname: Louie
authors.forename: Nishita
authors.initials: N
authors.lastname: Kothary
authors.forename: Gloria L
authors.initials: GL
authors.lastname: Hwang
authors.forename: William T
authors.initials: WT
authors.lastname: Kuo
authors.forename: Lawrence V
authors.initials: LV
authors.lastname: Hofmann
authors.forename: David M
authors.initials: DM
authors.lastname: Hovsepian
authors.forename: Daniel Y
authors.initials: DY
authors.lastname: Sze
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015901:Angiography, Digital Subtraction; D002140:California; D003097:Collateral Circulation; D004621:Embolization, Therapeutic / Q000009:adverse effects; D005260:Female; D006499:Hepatic Artery / Q000002:abnormalities* / Q000000981:diagnostic imaging / Q000503:physiopathology; D006801:Humans; D008102:Liver Circulation; D008113:Liver Neoplasms / Q000098:blood supply / Q000175:diagnosis / Q000532:radiotherapy*; D008297:Male; D008863:Microspheres; D008875:Middle Aged; D055420:Perfusion Imaging / Q000379:methods; D011237:Predictive Value of Tests; D019275:Radiopharmaceuticals / Q000008:administration & dosage* / Q000009:adverse effects; D012189:Retrospective Studies; D013668:Technetium Tc 99m Aggregated Albumin; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D055815:Young Adult; D015021:Yttrium Radioisotopes / Q000008:administration & dosage* / Q000009:adverse effects
chemical_list: D019275:Radiopharmaceuticals; D013668:Technetium Tc 99m Aggregated Albumin; D015021:Yttrium Radioisotopes