title: Blood supply of the main bile duct from the caudate artery and medial subsegmental artery of the hepatic artery: Evaluation using images obtained during transcatheter arterial chemoembolization for hepatocellular carcinoma.
abstract: OBJECTIVE
  Main bile duct necrosis develops after transcatheter arterial chemoembolization (TACE) through the caudate artery (A1) and medial subsegmental artery (A4) of the hepatic artery in the treatment of hepatocellular carcinoma. The aim of this study was to evaluate the bile duct branch (BD branch) from A1 and A4.
  
  
  METHODS
  We evaluated the origin and vascular territory of the BD branch in 11 patients who underwent selective A1 and/or A4 arteriography using arteriograms, cone-beam computed tomography (CBCT) and CT obtained 1 week after TACE. Follow-up CT and/or magnetic resonance imaging were also evaluated.
  
  
  RESULTS
  The BD branch arose from the first branch (n = 4), the second branch (n = 1), and both the first and second branches (n = 1) of A1, and from the first branch of A4 (n = 5). It supplied the bilateral hepatic ducts and common hepatic duct (CHD) (n = 4), the right hepatic duct (RHD) and CHD (n = 2), RHD, CHD and common bile duct (n = 1), the left hepatic duct (LHD) and CHD (n = 2), and LHD alone (n = 2). Anastomosis between A1 or A4 and other branches was demonstrated in seven patients. Bile duct stricture developed in all nine patients 2-8 months after TACE of the BD branch and percutaneous transhepatic bile duct drainage and metallic stent placement was required in one because of jaundice.
  
  
  CONCLUSIONS
  The BD branch arises from the proximal portion of A1 and A4 and mainly supplies the hepatic ducts and CHD.
authors: Department of Diagnostic Radiology, Fukuiken Saiseikai Hospital, Fukui, Japan.
authors: Shiro
authors: S
authors: Miyayama
authors: Masashi
authors: M
authors: Yamashiro
authors: Masahiro
authors: M
authors: Hashimoto
authors: Nanako
authors: N
authors: Hashimoto
authors: Masaya
authors: M
authors: Ikuno
authors: Kenichiro
authors: K
authors: Okumura
authors: Miki
authors: M
authors: Yoshida
authors: Osamu
authors: O
authors: Matsui
keywords: bile duct necrosis; caudate artery; hepatocellular carcinoma; medial subsegmental artery; transcatheter arterial chemoembolization