Skip to main content Accessibility help
×
Hostname: page-component-7c8c6479df-r7xzm Total loading time: 0 Render date: 2024-03-28T17:53:17.931Z Has data issue: false hasContentIssue false

12 - Embolization of liver tumors: Anatomy

from Section III - Organ-specific cancers – primary liver cancers

Published online by Cambridge University Press:  05 September 2016

Hyo-Cheol Kim
Affiliation:
Seoul National University Hospital
Jin Wook Chung
Affiliation:
Seoul National University Hospital
Jean-Francois H. Geschwind
Affiliation:
Yale University School of Medicine, Connecticut
Michael C. Soulen
Affiliation:
Department of Radiology, University of Pennsylvania Hospital, Philadelphia
Get access

Summary

In transcatheter management of hepatic tumors, it is essential to understand hepatic vascular anatomy in detail to enhance therapeutic results and prevent complications due to non-target treatment.

The purpose of this chapter is to review celiac trunk and hepatic artery variations, non-hepatic arteries arising from hepatic arteries, and extrahepatic collateral supply to hepatic tumors.

Celiac trunk anatomy

Normal celiac trunk anatomy and variations

The celiac trunk is a wide branch from the front of the aorta just below the aortic hiatus of the diaphragm. It passes nearly horizontally forward and slightly to the right above the pancreas and the splenic vein, and divides into three major branches of the left gastric artery (LGA), common hepatic artery (CHA), and splenic artery. It may give off one or both inferior phrenic arteries (IPAs), dorsal pancreatic artery, and, rarely, colic or jejunal branches (Figure 12.1). The superior mesenteric artery (SMA) separately arises from the aorta inferior to the origin of the celiac axis. Usually, the LGA is the first major branch of the celiac trunk. However, in about 4% of the population, the LGA directly arises from the supraceliac or juxtaceliac aorta, which represents the most common form of celiac trunk variation. If IPAs arise from the celiac trunk, their origin is almost always located proximal to the LGA (Figure 12.1).

Celiac trunk variation is found in approximately 10% of the general population. Celiac trunk variations can be considered as the result of the origin of the CHA, LGA, splenic artery, and SMA from the aorta in different combinations. Among 15 possible combinations of their origin (Figure 12.2), we could find 13 types in clinical practice.

In describing celiac trunk and hepatic artery variations, it is extremely important to define the terminology used. The CHA should be defined as the common trunk of a hepatic artery (regardless of its size or anatomical distribution) and the gastroduodenal artery (GDA). According to our experience, the most common type of celiac trunk variation was the common trunk of the CHA and splenic artery and the separate origins of the LGA and the SMA from the aorta, which was followed by two separate trunks from the aorta in combination of the CHA and SMA (hepatomesenteric trunk) and that of the LGA and splenic artery (gastrosplenic trunk) (Figure 12.3).

Type
Chapter
Information
Interventional Oncology
Principles and Practice of Image-Guided Cancer Therapy
, pp. 100 - 119
Publisher: Cambridge University Press
Print publication year: 2016

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Williams, PL, Warwick, R. Gray's Anatomy, 36th edn. Philadelphia: Saunders, 1980.
2. Michels, NA. Blood Supply and Anatomy of the Upper Abdominal Organs. Philadelphia: JB Lippincott, 1955; pp. 152–154, 256–259, 374–375.
3. Song, SY, Chung, JW, Yin, YH, et al. Celiac axis and common hepatic artery variations in 5002 patients: Systematic analysis with spiral CT and DSA. Radiology 2010; 255: 278–288.Google Scholar
4. Soo, CS, Chuang, VP, Wallace, S, et al. Treatment of hepatic neoplasm through extrahepatic collaterals. Radiology 1983; 144: 485–494.Google Scholar
5. Bron, KM, Redman, HC. Splanchnic artery stenosis and occlusion: Incidence, arteriographic and clinical manifestations. Radiology 1969; 92: 323–328.Google Scholar
6. David, CL, Harold, AB. High incidence of celiac axis narrowing in asymptomatic individuals. AJR Am J Roentgenol 1972; 116: 426–429.Google Scholar
7. Park, CM, Chung, JW, Kim, HB, et al. Celiac axis stenosis: Incidence and etiologies in asymptomatic individuals. Korean J Radiol 2001; 2: 8–13.Google Scholar
8. Song, SY, Chung, JW, Kwon, JW, et al. Collateral pathways in patients with celiac axis stenosis: Angiographic-spiral CT correlation. Radiographics 2002; 22: 881–893.Google Scholar
9. Kwon, JW, Chung, JW, Song, SY, et al. Transcatheter arterial chemoembolization for hepatocellular carcinomas in patients with celiac axis occlusion. J Vasc Interv Radiol 2002; 13: 689–694.Google Scholar
10. Covey, AM, Brody, LA, Maluccio, MA, et al. Variant hepatic arterial anatomy revisited: Digital subtraction angiography performed in 600 patients. Radiology 2002; 224: 542–547.Google Scholar
11. Couinaud, C. Liver anatomy: Portal (and suprahepatic) or biliary segmentation. Dig Surg 1999; 16: 459–467.Google Scholar
12. Mlakar, B, Gadzijev, EM, Ravnik, D, et al. Anatomical variations of the arterial pattern in the right hemiliver. Eur J Morphology 2002; 40: 267–273.Google Scholar
13. Mlakar, B, Gadzijev, EM, Ravnik, D, et al. Anatomical variations of the arterial pattern in the left hemiliver. Eur J Morphology 2002; 40: 115–120.Google Scholar
14. Couinaud, C. Le foie: Études anatomiques et chirurgicales. Paris, France: Masson, 1957; pp. 9–12.
15. Fasel, J, Selle, D, Evertsz, C, et al. Segmental anatomy of the liver: Poor correlation with CT. Radiology 1998; 206: 151–156.Google Scholar
16. Lee, HY, Chung, JW, Park, JH, et al. A new and simple practical plane dividing hepatic segment 2 and 3 of the liver: Evaluation of its validity. Korean J Radiol 2007; 8: 302–310.Google Scholar
17. Song, SY, Chung, JW, Lim, HG, et al. Nonhepatic arteries originating from the hepatic arteries: Angiographic analysis in 250 patients. J Vasc Interv Radiol 2006; 17: 461–469.Google Scholar
18. Hashimoto, M, Heianna, J, Tate, E, et al. The feasibility of retrograde catheterization of the right gastric artery via the left gastric artery. J Vasc Interv Radiol 2001; 12: 1103–1106.Google Scholar
19. Nakamura, H, Uchida, H, Kuroda, C, et al. Accessory left gastric artery arising from left hepatic artery: Angiographic study. AJR Am J Roentgenol 1980; 134: 529–532.Google Scholar
20. Chuang, PV, Wallace, S, Stroehlein, J, et al. Hepatic artery infusion chemotherapy: Gastroduodenal complications. AJR Am J Roentgenol 1982; 137: 347–350.Google Scholar
21. Williams, DM, Cho, KJ, Ensminger, WD, et al. Hepatic falciform artery: Anatomy, angiographic appearance, and clinical significance. Radiology 1985; 156: 339–340.Google Scholar
22. Bianchi, HF, Albanese, EF. The supraduodenal artery. Surg Radiol Anat 1989; 11: 37–40.Google Scholar
23. Daseler, EH, Anson, BJ, Hambley, WC, et al. The cystic artery and constituents of the hepatic pedicle: A study of 500 specimens. Surg Gynecol Obstet 1947; 85: 47–63.Google Scholar
24. Lie, DM, Salem, R, Bui, JT, et al. Angiographic considerations in patients undergoing liver-directed therapy. J Vasc Interv Radiol 2005; 16: 911–935.Google Scholar
25. Tohma, T, Cho, A, Okazumi, S, et al. Communicating arcade between the right and left hepatic arteries: Evaluation with CT and angiography during temporary balloon occlusion of the right or left hepatic artery. Radiology 2005; 237: 361–365.Google Scholar
26. Stapleton, GN, Hickman, R, Terblanche, J. Blood supply of the right and left hepatic ducts. Br J Surg 1998; 85: 202–207.Google Scholar
27. Kim, HC, Chung, JW, Lee, W, et al. Recognizing extra-hepatic collateral vessels that supply hepatocellular carcinoma to avoid complications of transcatheter arterial chemoembolization. Radiographics 2005; 25: S25–S39.Google Scholar
28. Chung, JW, Kim, HC, Jae, HJ, et al. Transcatheter arterial chemoembolization of hepatocellular carcinoma: Prevalence and causative factors of extrahepatic collateral arteries in 479 patients. Korean J Radiol 2006; 7: 257–266.Google Scholar
29. Michels, NA. Collateral arterial pathways to the liver after ligation of the hepatic artery and removal of the celiac axis. Cancer 1953; 6: 708–724.Google Scholar
30. Chung, JW, Park, JH, Han, JK, et al. Transcatheter oily chemoembolization of the inferior phrenic artery in hepatocellular carcinoma: The safety and potential therapeutic role. J Vasc Interv Radiol 1998; 9: 495–500.Google Scholar
31. Miyayama, S, Matsui, O, Taki, K, et al. Extrahepatic blood supply to hepatocellular carcinoma: Angiographic demonstration and transcatheter chemoembolization. Cardiovasc Intervent Radiol 2006; 29: 39–48.Google Scholar
32. Nakai, M, Sato, M, Kawai, N, et al. Hepatocellular carcinoma: Involvement of the internal mammary artery. Radiology 2001; 219: 147–152.Google Scholar
33. Miyayama, S, Matsui, O, Akakura, Y, et al. Hepatocellular carcinoma with blood supply from omental branches: Treatment with transcatheter arterial embolization. J Vasc Interv Radiol 2001; 12: 1285–1290.Google Scholar
34. Miyayama, S, Matsui, O, Nishida, H, et al. Transcatheter arterial chemoembolization for unresectable hepatocellular carcinoma fed by the cystic artery. J Vasc Interv Radiol 2003; 14: 1155–1161.Google Scholar
35. Kim, HC, Chung, JW, Park, JH, et al. Transcatheter arterial chemoembolization for hepatocellular carcinoma: Prospective assessment of the right inferior phrenic artery with C-arm CT. J Vasc Interv Radiol 2009; 20: 888–895.Google Scholar
36. Kim, HC, Chung, JW, An, S, et al. Left inferior phrenic artery feeding hepatocellular carcinoma: Angiographic anatomy using C-arm CT. AJR Am J Roentgenol 2009; 193: W288–W294.Google Scholar
37. Kim, HC, Chung, JW, Jae, HJ, et al. Hepatocellular carcinoma: prediction of blood supply from an internal mammary artery with multi-detector row CT. J Vasc Interv Radiol 2008; 19: 1419–1425.Google Scholar
38. Kim, HC, Chung, JW, Lee, IJ, et al. Intercostal artery supplying hepatocellular carcinoma: Demonstration of a tumor feeder by C-arm CT and multidetector row CT. Cardiovasc Intervent Radiol 2011; 34: 87–91.Google Scholar
39. Miyayama, S, Matsui, O, Akakura, Y, et al. Use of a catheter with a large side hole for selective catheterization of the inferior phrenic artery. J Vasc Interv Radiol 2001; 12: 497–499.Google Scholar
40. Baek, JH, Chung, JW, Jae, HJ, et al. A new technique for superselective catheterization of arteries originating from a large artery at an acute angle: Shepherd-hook preshaping of a micro-guide wire. Korean J Radiol 2007; 8: 225–230.Google Scholar
41. Miyayama, S, Matsui, O, Taki, K, et al. Transcatheter arterial chemoembolization for hepatocellular carcinoma fed by the reconstructed inferior phrenic artery: Anatomical and technical analysis. J Vasc Interv Radiol 2004; 15: 815–823.Google Scholar
42. Sakamoto, I, Aso, N, Nagaoki, K. Complications associated with transcatheter arterial embolization for hepatic tumors. Radiographics 1998; 18: 605–619.Google Scholar
43. Kim, HC, Chung, JW, Choi, SH, et al. Hepatocellular carcinoma supplied by the internal mammary artery: Angiographic anatomy in 97 patients. Radiology 2007; 242: 925–932.Google Scholar
44. Kim, HC, Chung, JW, An, S, et al. Transarterial chemoembolization of a colic branch of the superior mesenteric artery in patients with unresectable hepatocellular carcinoma. J Vasc Interv Radiol 2011; 22: 47–54.Google Scholar
45. Chung, JW, Park, JH, Han, JK, et al. Hepatic tumors: predisposing factors for complications of transcatheter oily chemoembolization. Radiology 1996; 198: 33–40.Google Scholar

Save book to Kindle

To save this book to your Kindle, first ensure coreplatform@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats
×

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

Available formats
×