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

Abstract

Objective: To analyze angiographic appearance of hepatocellular carcinoma (HCC) with blood supply from parasitized omental artery (POA), and evaluate the technical feasibility, safety and therapeutic efficacy of chemoembolization via the POAs.Methods: A total of 1,221 HCC patients who had undergone chemoembolization procedures were evaluated retrospectively. The evaluated indexes included the incidence rate of POAs, success rate of superselective catheterization, post-reaction after chemoembolization, and the cumulative survival rates.Results: Totally 1,221 HCC patients had undergone 3,639 chemoembolization procedures, and 32 patients with POAs were enrolled, with 97 POAs found in 76 angiography procedures, giving an incidence rate of 2.09%. POA was observed mostly at the right lobe and left medial lobe except the segment II, and 62 POAs underwent superselective catheterization with microcatheter, giving a success rate of 63.9%. The angiographic appearance was: (1) hypertrophic POAs participating in tumor staining (n=28); (2) stiff and distorted POA (n=11), displaced due to tumor's oppression (n=8); and (3) defective tumor staining close to either gastrocolic omentum distribution or liver capsule (n=7). In 19 patients, chemoembolization via POAs was performed successfully (A group), while the remaining 13 patients failed (B group). Except 1 acute edema pancreatitis case, no serious complication was recorded. The cumulative survival rates of 6-, 12-, 18-and 24-month were 78.9%, 47.4%, 31.6% and 21.1% respectively for A group; correspondingly, 61.5%, 30.8%, 15.4% and 7.7%% for B group, in which 2 patients died of ruptured HCC.Conclusion: Chemoembolization with microcatheter via POAs is a relatively safe, feasible and valuable method.

Segmental Arterial Mediolysis of Omental Arteries with Haemoperitoneum: Case Report with Embolization of the Left Omental Artery and Brief Review of Literature

“…One reason for this might be that omental branches usually are small and branch at an acute angle from the gastroepiploic artery [ 18 ] and so superselective catheterization of them might be technically challenging and not always be feasible. Even in cases of hepatocellular carcinomas with additional blood supply from parasitized omental arteries these can be catheterized only in 64-73%, depending on the calibre of the used microcatheter [ 10 , 19 ].…”

Hybrid Modelling of Transarterial Chemoembolisation Therapies (TACE) for Hepatocellular Carcinoma (HCC)

“…During embolisation, small particles are injected in the hepatic artery. Following transport through the vascular system, small blood vessels are occluded 8 , resulting in oxygen deprivation and areas of necrosis within the tumour. This process is modeled as follows.…”

“…Embolisation refers to the selective occlusion of blood vessels by agents such as gelatin sponges, lipiodol or drug-eluting beads (DEBs). Prior to embolisation, an angiography is conducted to identify the artery that supplies the tumour 8 . Following successful detection of a feeding vessel, embolisation is achieved by injecting it with microparticles or DEBs.…”