Chemoembolization for Hepatocellular Carcinoma via the Inferior Pancreaticoduodenal Artery in Patients with Celiac Artery Stenosis

Abstract

Twenty-one patients with hepatocellular carcinoma (HCC) ac companied by extensive celiac artery stenosis or obstruction were treated by chemoembolization via the inferior pancreaticoduodenal artery (IPDA). The tip of the catheter was placed in the arteries in front of the confluence with the proper hepatic artery in 12 patients (group A: the proximal portion of the IPDA in 10, and common hepatic artery in 2), and in the proper hepatic artery or branches of it (group B) in 9 using a coaxial catheter system. Transient hyperamylasemia was observed in 10 of the 12 patients in group A and in 3 of the 9 patients in group B after chemoembolization. Splenic infarction developed in 8 patients in group A and in none in group B. Intrapancreatic fluid collection was present in 2 patients in group A following chemoembolization. No fatal complications were encountered. The 1-, 2-, and 3-year survival rates of the 10 patients in group A treated by only chemoembolization were 90, 57, and 23%, respectively (mean survival 780 days). The 1-and 2year survival rates of 9 patients in group B were 85.8 and 85.8% (mean 879 days), respectively. Considering the severity of complica tions and the survival rates in groups A and B, chemoembolization by superselective catheterization into the hepatic artery via the IPDA is the treatment of choice. However, chemoembolization from the arteries in front of the confluence with the proper hepatic artery seems to be acceptable in cases of hypervascular HCC which fail to be superselectively catheterized.

Celiac Artery Stenting to Facilitate Hepatic Yttrium-90 Radioembolization Therapy

“…Celiac artery stenosis can result from atherosclerosis (as in the presented case), tumor invasion, localized inflammation, ligament compression, and rarely agenesis limiting the access to the hepatic branches through the celiac axis [14]. In these cases, the SMA usually provides a rich collateral supply predominantly through the PDA arcade, which can easily be utilized for selective access to the hepatic branches [8, 13, 15, 16]. An alternative approach would be celiac artery stenting that involves placement of a stent across the celiac stenosis with subsequent access to the hepatic artery branches.…”