Repeated Intra-Arterial Therapy via the Cystic Artery for Hepatocellular Carcinoma

Abstract

Purpose To evaluate the postprocedural imaging findings and safety of repeated intra-arterial therapy via the cystic artery in patients with hepatocellular carcinoma (HCC). Methods This retrospective study was approved by our institutional review board. From February 2002 to January 2012, we performed repeated (two or more) chemotherapeutic infusion or chemoembolization via the cystic artery using iodized oil in 132 patients with HCCs. Computed tomographic (CT) scans, digital subtraction angiograms, and medical records were retrospectively reviewed by consensus. Results A total of 340 sessions of intra-arterial therapy (160 sessions of chemotherapeutic infusion and 180 sessions of chemoembolization) via the cystic artery were undertaken in 132 patients. Fifty-five of 132 patients received both chemotherapeutic infusion and chemoembolization. The incidence of gallbladder wall thickening on follow-up contrast-enhanced CT was significantly higher in chemoembolization (48 of 180, 26.7 %) than in chemotherapeutic infusion (27 of 160, 16.9 %) (P = 0.035). Persistent gallbladder wall thickening was more frequently observed in chemoembolization (48 of 107, 44.9 %) than in chemotherapeutic infusion (27 of 90, 30 %) (P = 0.039). The major complication rate was 15 of 340 sessions (4.4 %) with 11 of 132 patients (8.3 %). Acute cholecystitis, which was related to intra-arterial therapy via the cystic artery, developed in two patients and was managed by conservative treatment. Conclusion HCC supplied by the cystic artery can be safely treated by repeated intra-arterial chemotherapeutic infusion or chemoembolization using iodized oil through the cystic artery.

Complications Related to Transarterial Treatment of Hepatocellular Carcinoma: A Comprehensive Review

“…Superselective chemoembolization or chemoinfusion at the deep branch of the cystic artery is relatively safe [ 74 ]. Chu et al [ 75 ] reported that transient or persistent gallbladder wall thickening was the most frequent CT finding following 340 sessions of intra-arterial therapy through the cystic artery. In their study, acute cholecystitis was observed in only two patients, who responded well to conservative management.…”

Transcatheter arterial embolization of cystic artery bleeding

“…Bleeding originating from the cystic artery may be associated with surgical cholecystectomy, hemorrhagic cholecystitis, gallbladder cancer, and prior percutaneous drainage of the gallbladder (6)(7)(8)(9). Several case studies have documented the successful use of TAE in treating cystic artery bleeding (6)(7)(8)(9), and embolization procedures through the cystic artery have been safely attempted for the management of hepatocellular carcinoma (10)(11)(12).…”