Extrahepatic collateral blood supply of hepatocellular carcinoma : Prevalence and success rate of chemoembolization in King Chulalongkorn Memorial Hospital

Abstract

Background : Extrahepatic collaterals that supply hepatocellular carcinoma (HCC) were frequently encountered. Transarterial chemoembolization (TACE) of these vessels increased the efficiency control of tumor. Impact of these collaterals in term of prevalence, success rate of TACE and complication were described.

Objective : To find the prevalence of each extrahepatic collateral that supplied HCC and clarify technical success rates and postprocedural complications following TACE of these vessels.

Design : Retrospective descriptive study.

Materials and Methods : We retrospectively reviewed angiograms and angiographic reports of 1,351 TACE sessions from 602 HCC patients between 2008 - 2010. Patients with tumor supply from extrahepatic collaterals were included. Then patient demographics, prevalence of the each extrahepatic collateral, technical success rates of TACE and post-TACE complications were recorded.

Results : From the total of 141 cases of HCC, 119 men and 22 women with their median age 58 years old were found extrahepatic arterial supplies to the tumor on angiogram. Most patients had chronic viral hepatitis or liver cirrhosis. The right inferior phrenic artery was the most common extrahepatic collateral vessel, followed by the right intercostal artery and the right gastroepiploic artery. There were high technical success rates of TACE via the right adrenal artery (100%), cystic artery (100%), right intercostal artery (96.3%), left inferior phrenic artery (94.7%) and right inferior phrenic artery (92.86%). TACE via the gastroduodenal artery (64.7%), superior mesenteric artery (65%) and right renal artery (66.7%) showed less technical success rates. Of the total 195 extrahepatic vessels that we embolized, only 4 patients developed complications. There was no procedure related mortality.

Conclusions : HCCs with extrahepatic arterial blood supply were frequently founded in our institute (23%). There were varying branches of extrahepatic collateral arteries, which the right inferior phrenic artery was the most common. Selective chemoembolization of these vessels was safe. Postprocedural complications were seldom observed. Therefore, extrahepatic collateral supply to HCC should be sought and treated for effective tumor control.