Hepatocellular Carcinoma with Blood Supply from Omental Branches: Treatment with Transcatheter Arterial Embolization

Hepatocellular carcinoma with blood supply from parasitized omental artery: Angiographic appearance and chemoembolization

“…The mechanism of POA occurrence may be related to huge-block HCC type, liver surgery with omentum to suture and hemostasis at the surgical margin, hepatic artery stenosis and occlusion [10] (Figure 2). The occlusion (1 case) and stenosis (6 cases) of the hepatic artery were also found in our study, and avoiding hepatic artery stenosis and occlusion may decrease the incidence rate of the POA [17,18] The extrahepatic parasitized arteries mainly traverse in the hepatogastric ligament, hepato-duodenal ligament, falciform ligament, coronary ligament, and the bare area of liver to feed the HCC .…”

“…Microcatheter may help to improve the success rate of catheterization and decrease potential damage to the vessels . [10] . But even with the 2.7F microcatheter, the success rate of our superselective OA catheterization was only 63.9%.…”

“…If damages to the POA such as vasospasm, dissection and occlusion occur, new extrahepatic parasitized arterys may emerge and may cause new difficulties for superselective catheterization [19] , in addition, the risks of reflux and mis-embolization will increase (Figure 4). Due to rich collateral branches, even if a small number of normal OAs were embolized, serious complications such as ischemia or infarction of the intestine (which usually is supplied by one of the mesenteric arteries) would not occur [7,10,19] . However, POAs may communicated with dorsal pancreatic artery, middle-colic artery, and mesenteric arteries.…”

“…However, POAs may communicated with dorsal pancreatic artery, middle-colic artery, and mesenteric arteries. When huge tumor had encroached the nearby gastrointestinal tract wall prior to treatment, chemoembolization via POA may worsen the ischemia and edema of the intestine, consequently, gastrointestinal ulceration, perforation or intestinal infarction may occur [10] , In our option, it is important to advance the catheter tip until staining of the stomach or bowel wall is not demonstrated. When gastroepiploica vein and other portal vein branches displayed under fluoroscopy, chemoembolization should stop immediately.…”

“…Many studies [5][6][7][8][9][10][11][12][13][14] Commonly, OA is only 2−3 mm in diameter, so it is not usually obvious during angiography, especially in healthy people. But when OA participates in both the tumor and peritoneal metastatic lesions, it can be easily recognized at digital subtraction angiography (DSA) and contrast abdominal computed tomography (CT) for its' significantly increased diameter had reported chemoembolization through different extrahepatic blood supplies of HCC such as inferior phrenic artery, adrenal artery, internal mammary artery, intercostal artery, and renal capsular artery.…”