Incidence and therapeutic frequency of extrahepatic collateral arteries in transcatheter arterial chemoembolization of hepatocellular carcinoma: Experience from 182 patients with survival time more than 3 years.
OBJECTIVE
To retrospectively evaluate the incidence of each extrahepatic collateral artery (EHCA) supplying to hepatocellular carcinoma (HCC) in sessions of transcatheter arterial chemoembolization (TACE) and its therapeutic frequency.


METHODS
Between February 2002 and May 2008, 182 patients with HCC underwent TACE and survived more than 3 years. For TACE procedure, angiographic evaluation of all suspected EHCAs that could supply the tumor were performed. The incidence of EHCAs in TACE sessions and therapeutic frequency were analyzed. Correlations between the number of collaterals and the number of TACE sessions were investigated.


RESULTS
162 patients showed 647 EHCAs supplying tumors in a total of 795 sessions of TACE. The initially confirmed EHCAs in TACE sessions were the right inferior phrenic artery (RIPA, n=150), left inferior phrenic artery (LIPA, n=8), right internal mammary artery (RIMA, n=4), right adrenal artery (RAA, n=2) and left gastric artery (LGA, n=5), respectively. The incidences of EHCAs were 51.1%, 68.1%, 50.0%, 50.0%, 42.3%, 34.6%, 29.1%, 19.8%, 6.6%, 3.3% and 0.6% from 1 to 11 session of TACE, respectively. The RIPA was accounted for 62.5% of EHCAs and other EHCAs often occurred after the attenuation of RIPA. There were correlations between the number of TACE sessions and either the sum number of collaterals (r=-0.961; p<0.001), the number of RIPA(r=-0.948; p<0.001) or the number of LGA(r=-0.670; p=0.024). The mean therapeutic frequencies of TACE were 2.6, 1.5, 1.6, 1.3, 1.5, 1.2, 3.3, 1.1, 1.0 and 7.0 times for the RIPA, LIPA, RIMA, left internal mammary artery (LIMA), omental artery (OMA), LGA, right intercostal artery (RICA), RAA, right renal capsular artery (RRCA) and colic artery (COA), respectively.


CONCLUSIONS
The RIPA angiography should be routinely performed in TACE procedure. EHCAs should be searched during the sessions of TACE in the following order: RIPA, RIMA, LIPA and other collaterals of lower incidence.
Department of Radiology, 309th Hospital of PLA, China. Electronic address: liqiang309@sina.com.
Qiang
Q
Li
Department of Radiology, 309th Hospital of PLA, China. Electronic address: aoguokun@126.com.
Guo-Kun
GK
Ao
Department of Interventional Radiology, PLA General Hospital, China. Electronic address: lwndog@sina.com.
Feng
F
Duan
Department of Interventional Radiology, PLA General Hospital, China. Electronic address: wangzj301hospital@163.com.
Zhi-Jun
ZJ
Wang
Department of Interventional Radiology, PLA General Hospital, China. Electronic address: mczlks@sina.com.
Jie-Yu
JY
Yan
Department of Interventional Radiology, PLA General Hospital, China. Electronic address: wangmq@vip.sina.com.
Mao-Qiang
MQ
Wang
D000792:Angiography; D006528:Carcinoma, Hepatocellular / Q000098:blood supply* / Q000628:therapy*; D002445:Celiac Artery / Q000000981:diagnostic imaging / Q000473:pathology; D016461:Chemoembolization, Therapeutic; D003097:Collateral Circulation; D005260:Female; D006801:Humans; D015994:Incidence; D008099:Liver / Q000098:blood supply / Q000000981:diagnostic imaging / Q000473:pathology; D008113:Liver Neoplasms / Q000098:blood supply* / Q000628:therapy*; D008279:Magnetic Resonance Imaging; D008297:Male; D008638:Mesenteric Arteries / Q000000981:diagnostic imaging / Q000473:pathology; D017538:Mesenteric Artery, Superior / Q000000981:diagnostic imaging; D008875:Middle Aged; D012077:Renal Artery / Q000000981:diagnostic imaging / Q000473:pathology; D012189:Retrospective Studies; D016019:Survival Analysis; D014057:Tomography, X-Ray Computed
Angiography; Blood supply; Extrahepatic collateral artery; Hepatocellular carcinoma; Transcatheter arterial chemoembolization