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He Z, Ma L, Dan W, Cai X, Liu H, Mao L, Zhou X, Li G, Ding C, Wang T. Anomalous origin of the left suprarenal, inferior phrenic arteries and left ovarian artery in a human cadaver. Anat Sci Int 2024; 99:146-150. [PMID: 37566319 DOI: 10.1007/s12565-023-00738-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 08/02/2023] [Indexed: 08/12/2023]
Abstract
This report addresses three variants identified within a female cadaver. Specifically, these were an anomalous origin of the right suprarenal artery, an abnormal bilateral ovarian vein branch, and a arterial tortuosity of the left ovarian artery. Indeed, the cadaver evinced abnormal origins in the case of the middle suprarenal artery (MSA), right inferior phrenic artery (IPA), and the renal capsule artery (emanating from the right renal artery). The MSA and IPA shared a common trunk with the inferior suprarenal artery. It was additionally observed that the right ovarian vein anastomoses the branches from the right kidney posterior inferior along with those to the renal fat capsule. Abnormal origin was evident in the case of the left ovarian artery, and arterial tortuosity was apparent in the lower region of the vessels. This report addresses both the clinical import of these variations and their likely causes. In the subdiaphragmatic region, surgical success and prognosis may be impacted by such anomalies; accordingly surgeons must be aware of anatomical variants of the ovarian and suprarenal arteries.
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Affiliation(s)
- Zhicheng He
- Department of Clinical Medicine, Medical College of Wuhan University of Science and Technology, Wuhan, 430065, Hubei, People's Republic of China
| | - Lixin Ma
- Department of Clinical Medicine, Medical College of Wuhan University of Science and Technology, Wuhan, 430065, Hubei, People's Republic of China
| | - Wenyi Dan
- Department of Clinical Medicine, Medical College of Wuhan University of Science and Technology, Wuhan, 430065, Hubei, People's Republic of China
| | - Xinyi Cai
- Department of Clinical Medicine, Medical College of Wuhan University of Science and Technology, Wuhan, 430065, Hubei, People's Republic of China
| | - Hongrong Liu
- Department of Clinical Medicine, Medical College of Wuhan University of Science and Technology, Wuhan, 430065, Hubei, People's Republic of China
| | - Liyi Mao
- Department of Clinical Medicine, Medical College of Wuhan University of Science and Technology, Wuhan, 430065, Hubei, People's Republic of China
| | - Xuan Zhou
- Department of Clinical Medicine, Medical College of Wuhan University of Science and Technology, Wuhan, 430065, Hubei, People's Republic of China
| | - Guohui Li
- Department of Clinical Medicine, Medical College of Wuhan University of Science and Technology, Wuhan, 430065, Hubei, People's Republic of China
| | - Chugui Ding
- Department of Clinical Medicine, Medical College of Wuhan University of Science and Technology, Wuhan, 430065, Hubei, People's Republic of China
| | - Tao Wang
- Department of Anatomy, Medical College of Wuhan University of Science and Technology, Wuhan, People's Republic of China.
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Amir S, Musa A, Salman KM, Hashmi H, Basit S, Brathwaite CEM. Hepatocellular carcinoma with extrahepatic blood supply from right renal artery. J Surg Case Rep 2021; 2021:rjab391. [PMID: 34650787 PMCID: PMC8504920 DOI: 10.1093/jscr/rjab391] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 08/11/2021] [Indexed: 01/17/2023] Open
Abstract
Extrahepatic blood supply is seen in around 17–27% of hepatocellular carcinoma lesions. Evidence suggests that this extrahepatic supply most commonly originates from a right intercostal artery (70–83%) followed by left intercostal, omental and right renal arteries. Thus a comprehensive knowledge of variations in standard vascular anatomy and cognisance of factors influencing or predicting extrahepatic blood supply in HCC is instrumental in ensuring the success of surgical and interventional procedures. We present the unusual case of a 66-year-old male with HCC in Segment I of the liver with aberrant blood supply from the right renal artery in the absence of any risk factors for extrahepatic circulation. He successfully underwent transarterial chemoembolization. There was no evidence of residual disease on repeat imaging.
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Affiliation(s)
- Sohail Amir
- NYU Langone Hospital - Long Island, Mineola, NY, USA
| | - Ahmad Musa
- NYU Langone Hospital - Long Island, Mineola, NY, USA
| | - Khan Muhammad Salman
- University of Tennessee Health Science Center Bookstore, Radiology, Memphis, TN, USA
| | - Hassan Hashmi
- NYU Langone Hospital - Long Island, Mineola, NY, USA
| | - Salam Basit
- The Aga Khan University, Radiology, Karachi, Sindh, Pakistan
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Gaba RC, Lokken RP, Hickey RM, Lipnik AJ, Lewandowski RJ, Salem R, Brown DB, Walker TG, Silberzweig JE, Baerlocher MO, Echenique AM, Midia M, Mitchell JW, Padia SA, Ganguli S, Ward TJ, Weinstein JL, Nikolic B, Dariushnia SR. Quality Improvement Guidelines for Transarterial Chemoembolization and Embolization of Hepatic Malignancy. J Vasc Interv Radiol 2017; 28:1210-1223.e3. [PMID: 28669744 DOI: 10.1016/j.jvir.2017.04.025] [Citation(s) in RCA: 74] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2017] [Accepted: 04/29/2017] [Indexed: 02/07/2023] Open
Affiliation(s)
- Ron C Gaba
- Division of Interventional Radiology, Department of Radiology, University of Illinois Hospital & Health Sciences System, 1740 West Taylor Street, MC 931, Chicago, IL 60612.
| | - R Peter Lokken
- Division of Interventional Radiology, Department of Radiology, University of Illinois Hospital & Health Sciences System, 1740 West Taylor Street, MC 931, Chicago, IL 60612
| | - Ryan M Hickey
- Section of Vascular and Interventional Radiology, Department of Radiology, Northwestern Memorial Hospital, Chicago, Illinois
| | - Andrew J Lipnik
- Division of Interventional Radiology, Department of Radiology, University of Illinois Hospital & Health Sciences System, 1740 West Taylor Street, MC 931, Chicago, IL 60612
| | - Robert J Lewandowski
- Section of Vascular and Interventional Radiology, Department of Radiology, Northwestern Memorial Hospital, Chicago, Illinois
| | - Riad Salem
- Section of Vascular and Interventional Radiology, Department of Radiology, Northwestern Memorial Hospital, Chicago, Illinois
| | - Daniel B Brown
- Department of Radiology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - T Gregory Walker
- Division of Interventional Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | | | | | - Ana Maria Echenique
- Department of Interventional Radiology, University of Miami School of Medicine, Coral Gables, Florida
| | - Mehran Midia
- Interventional Radiology, McMaster University, Hamilton, Ontario, Canada
| | - Jason W Mitchell
- Interventional Radiology and Image Guided Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Siddharth A Padia
- Division of Interventional Radiology, Department of Radiology, David Geffen School of Medicine at University of California, Los Angeles, California
| | - Suvranu Ganguli
- Division of Interventional Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; Center for Image Guided Cancer Therapy, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Thomas J Ward
- Vascular and Interventional Radiology, Florida Hospital, Orlando, Florida
| | - Jeffrey L Weinstein
- Vascular and Interventional Radiology, Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Boris Nikolic
- Department of Radiology, Stratton Medical Center, Albany, New York
| | - Sean R Dariushnia
- Interventional Radiology and Image Guided Medicine, Emory University School of Medicine, Atlanta, Georgia
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Moustafa AS, Abdel Aal AK, Ertel N, Saad N, DuBay D, Saddekni S. Chemoembolization of Hepatocellular Carcinoma with Extrahepatic Collateral Blood Supply: Anatomic and Technical Considerations. Radiographics 2017; 37:963-977. [PMID: 28362557 DOI: 10.1148/rg.2017160122] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Transarterial chemoembolization (TACE) is considered a standard local-regional treatment for intermediate-stage hepatocellular carcinoma (HCC) and the most common bridging therapy. This treatment is offered to more than 70% of patients who are on the waiting list for liver transplantation in the United States. HCC typically receives its blood supply from the hepatic artery; however, it can recruit a parasitic supply from extrahepatic collateral (EHC) arteries. The development of an EHC arterial blood supply can interfere with the therapeutic efficacy of TACE and result in treatment failure and poor outcome. Cross-sectional imaging-specifically computed tomography and magnetic resonance imaging-has some limitations in depicting the presence or absence of an EHC arterial supply during the pre-TACE evaluation. Catheterization and angiography of every possible EHC artery during a routine TACE procedure would be time consuming and technically challenging and would not always be feasible. Therefore, the prediction of a potential EHC arterial supply on the basis of tumor location before, during, and after TACE is fundamental to achieving optimal therapeutic efficacy. To perform TACE through EHC arteries, special considerations are necessary to avoid potentially serious complications. The authors review the factors influencing the development of an EHC arterial blood supply to HCC and describe a systematic approach to enhance the ability to predict the presence of EHC arteries. They also describe the proper technique for TACE of each EHC artery and how to avoid potential technique-related complications. ©RSNA, 2017.
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Affiliation(s)
- Amr Soliman Moustafa
- From the Department of Radiology, University of Arkansas for Medical Science, Little Rock, Ark, and Department of Radiology, Zagazig University, Zagazig, Egypt (A.S.M.); Departments of Radiology (A.K.A.A., N.E., S.S.) and Surgery (D.D.), University of Alabama at Birmingham, 619 19th St South, Birmingham, AL 35249; Department of Radiology, University of Cairo, Cairo, Egypt (A.K.A.A.); and Department of Radiology, Washington University School of Medicine, St Louis, Mo (N.S.)
| | - Ahmed Kamel Abdel Aal
- From the Department of Radiology, University of Arkansas for Medical Science, Little Rock, Ark, and Department of Radiology, Zagazig University, Zagazig, Egypt (A.S.M.); Departments of Radiology (A.K.A.A., N.E., S.S.) and Surgery (D.D.), University of Alabama at Birmingham, 619 19th St South, Birmingham, AL 35249; Department of Radiology, University of Cairo, Cairo, Egypt (A.K.A.A.); and Department of Radiology, Washington University School of Medicine, St Louis, Mo (N.S.)
| | - Nathan Ertel
- From the Department of Radiology, University of Arkansas for Medical Science, Little Rock, Ark, and Department of Radiology, Zagazig University, Zagazig, Egypt (A.S.M.); Departments of Radiology (A.K.A.A., N.E., S.S.) and Surgery (D.D.), University of Alabama at Birmingham, 619 19th St South, Birmingham, AL 35249; Department of Radiology, University of Cairo, Cairo, Egypt (A.K.A.A.); and Department of Radiology, Washington University School of Medicine, St Louis, Mo (N.S.)
| | - Nael Saad
- From the Department of Radiology, University of Arkansas for Medical Science, Little Rock, Ark, and Department of Radiology, Zagazig University, Zagazig, Egypt (A.S.M.); Departments of Radiology (A.K.A.A., N.E., S.S.) and Surgery (D.D.), University of Alabama at Birmingham, 619 19th St South, Birmingham, AL 35249; Department of Radiology, University of Cairo, Cairo, Egypt (A.K.A.A.); and Department of Radiology, Washington University School of Medicine, St Louis, Mo (N.S.)
| | - Derek DuBay
- From the Department of Radiology, University of Arkansas for Medical Science, Little Rock, Ark, and Department of Radiology, Zagazig University, Zagazig, Egypt (A.S.M.); Departments of Radiology (A.K.A.A., N.E., S.S.) and Surgery (D.D.), University of Alabama at Birmingham, 619 19th St South, Birmingham, AL 35249; Department of Radiology, University of Cairo, Cairo, Egypt (A.K.A.A.); and Department of Radiology, Washington University School of Medicine, St Louis, Mo (N.S.)
| | - Souheil Saddekni
- From the Department of Radiology, University of Arkansas for Medical Science, Little Rock, Ark, and Department of Radiology, Zagazig University, Zagazig, Egypt (A.S.M.); Departments of Radiology (A.K.A.A., N.E., S.S.) and Surgery (D.D.), University of Alabama at Birmingham, 619 19th St South, Birmingham, AL 35249; Department of Radiology, University of Cairo, Cairo, Egypt (A.K.A.A.); and Department of Radiology, Washington University School of Medicine, St Louis, Mo (N.S.)
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Hu S, Tu J, Jia Z, Huang Y, Jiang G. Transarterial embolization/chemoembolization therapy for hepatocellular carcinoma fed by adrenal artery: Preliminary results. Medicine (Baltimore) 2016; 95:e5762. [PMID: 28033293 PMCID: PMC5207589 DOI: 10.1097/md.0000000000005762] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
To assess the value of transarterial embolization/chemoembolization (TAE/TACE) therapy via adrenal artery for patients with hepatocellular carcinoma (HCC). Patients with HCC who underwent TAE/TACE therapy via adrenal artery between May 2003 and October 2015 across 4 medical centers were identified. Clinical information, procedural data, and imaging data were analyzed to assess technical success, disease control, and survival rates. A t test was used to compare the differences in serum alpha-fetoprotein before and after treatment. A total of 23 patients (23 men; mean age, 54.6 ± 7.5 years; range, 37-72 years) were included in this study. All tumors were located under the capsule of the liver and adjacent to the adrenal gland (median tumor diameter, 8.2 cm). Lesions fed by the adrenal artery were demonstrated during initial TAE/TACE in 7 patients and during repeat TAE/TACE in 16 patients. The superior, middle, and inferior adrenal arteries were involved in 14, 3, and 6 patients, respectively. The technical success rate was 100%. The disease control rate at 3 months was 100%, with partial tumor response seen in 16 (69.6%) patients and stable disease seen in 7 (30.4%) patients. The cumulative survival rate from the time of TAE/TACE was 100% at 1 year. There were no embolization-related complications. TAE/TACE therapy via the adrenal arteries can improve the therapeutic efficacy of TAE/TACE and reduce the incidence of HCC recurrence and/or presence of residual HCC.
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Affiliation(s)
- Shibing Hu
- Department of Radiology, Gaochun People's Hospital, Gaochun
| | - Jianfei Tu
- Department of Radiology and Interventional Radiology, Li shui Central Hospital, Li shui
| | - Zhongzhi Jia
- Department of Interventional Radiology, The Second People's Hospital of Changzhou
| | - Yuanquan Huang
- Department of Interventional Radiology, The First People's Hospital of Changzhou, Changzhou, China
| | - Guomin Jiang
- Department of Interventional Radiology, The Second People's Hospital of Changzhou
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Yoshimatsu R, Yamagami T, Ishikawa M, Kajiwara K, Aikata H, Chayama K, Awai K. Change in Imaging Findings on Angiography-Assisted CT During Balloon-Occluded Transcatheter Arterial Chemoembolization for Hepatocellular Carcinoma. Cardiovasc Intervent Radiol 2015; 39:865-74. [PMID: 26711803 DOI: 10.1007/s00270-015-1279-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2015] [Accepted: 11/22/2015] [Indexed: 01/18/2023]
Abstract
PURPOSE To evaluate changes in imaging findings on CT during hepatic arteriography (CTHA) and CT during arterial portography (CTAP) by balloon occlusion of the treated artery and their relationship with iodized oil accumulation in the tumor during balloon-occluded transcatheter arterial chemoembolization (B-TACE). METHODS Both B-TACE and angiography-assisted CT were performed for 27 hepatocellular carcinomas. Tumor enhancement on selective CTHA with/without balloon occlusion and iodized oil accumulation after B-TACE were evaluated. Tumorous portal perfusion defect size on CTAP was compared with/without balloon occlusion. Factors influencing discrepancies between selective CTHA with/without balloon occlusion and the degree of iodized oil accumulation were investigated. RESULTS Among 27 tumors, tumor enhancement on selective CTHA changed after balloon occlusion in 14 (decreased, 11; increased, 3). In 18 tumors, there was a discrepancy between tumor enhancement on selective CTHA with balloon occlusion and the degree of accumulated iodized oil, which was higher than the tumor enhancement grade in all 18. The tumorous portal perfusion defect on CTAP significantly decreased after balloon occlusion in 18 of 20 tumors (mean decrease from 21.9 to 19.1 mm in diameter; p = 0.0001). No significant factors influenced discrepancies between selective CTHA with/without balloon occlusion. Central area tumor location, poor tumor enhancement on selective CTHA with balloon occlusion, and no decrease in the tumorous portal perfusion defect area on CTAP after balloon occlusion significantly influenced poor iodized oil accumulation in the tumor. CONCLUSIONS Tumor enhancement on selective CTHA frequently changed after balloon occlusion, which did not correspond to accumulated iodized oil in most cases.
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Affiliation(s)
- Rika Yoshimatsu
- Department of Diagnostic Radiology, Institute and Graduate School of Biomedical Sciences, Hiroshima University, 1-2-3 Kasumi, Minamiku, Hiroshima, 734-8551, Japan.,Department of Radiology, Kochi University, Kohasu, Okocho, Nankoku, Kochi, 783-8505, Japan
| | - Takuji Yamagami
- Department of Diagnostic Radiology, Institute and Graduate School of Biomedical Sciences, Hiroshima University, 1-2-3 Kasumi, Minamiku, Hiroshima, 734-8551, Japan. .,Department of Radiology, Kochi University, Kohasu, Okocho, Nankoku, Kochi, 783-8505, Japan.
| | - Masaki Ishikawa
- Department of Diagnostic Radiology, Institute and Graduate School of Biomedical Sciences, Hiroshima University, 1-2-3 Kasumi, Minamiku, Hiroshima, 734-8551, Japan
| | - Kenji Kajiwara
- Department of Diagnostic Radiology, Institute and Graduate School of Biomedical Sciences, Hiroshima University, 1-2-3 Kasumi, Minamiku, Hiroshima, 734-8551, Japan
| | - Hiroshi Aikata
- Department of Gastroenterology and Metabolism, Institute of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minamiku, Hiroshima, 734-8551, Japan
| | - Kazuaki Chayama
- Department of Gastroenterology and Metabolism, Institute of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minamiku, Hiroshima, 734-8551, Japan
| | - Kazuo Awai
- Department of Diagnostic Radiology, Institute and Graduate School of Biomedical Sciences, Hiroshima University, 1-2-3 Kasumi, Minamiku, Hiroshima, 734-8551, Japan
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Kim HM, Kim HC, Woo S, Son KR, Cho SW, Chung JW. Chemoembolization for hepatocellular carcinoma supplied by a lumbar artery. Cardiovasc Intervent Radiol 2014; 38:121-8. [PMID: 24849301 DOI: 10.1007/s00270-014-0906-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2014] [Accepted: 04/03/2014] [Indexed: 11/24/2022]
Abstract
PURPOSE To describe the radiologic findings and imaging response of hepatocellular carcinoma (HCC) supplied by the lumbar artery. METHODS Between April 2004 and December 2012, we encountered HCC supplied by a lumbar artery in 21 patients. Two investigators retrospectively reviewed clinical and radiological findings of HCC supplied by the lumbar artery using computed tomography (CT) scans and digital subtraction angiograms. RESULTS Patients had received 1-27 sessions of previous chemoembolization procedures (mean 7.7 sessions, median 4 sessions). Mean tumor size was 5.3 cm. The locations of HCC supplied by lumbar artery were the bare area (n = 14, 67 %) and segment VI (n = 7, 33 %). Tumor-feeding arteries arose from the main lumbar artery (n = 7), proximal anterior division (n = 4), and distal anterior division (n = 14). In 20 patients, selective chemoembolization through the tumor-feeding arteries of the lumbar artery was achieved. In 1 patient, nonselective embolization at the main lumbar artery was performed. There was no complication such as skin necrosis or paralysis. On the first follow-up enhanced CT scan, target tumors fed by the lumbar artery showed complete response (n = 6), partial response (n = 4), stable disease (n = 3), and progressive disease (n = 8), but overall tumor response was partial response (n = 1) and progressive disease (n = 20). CONCLUSION When HCC is located in the inferior tip or bare area of the liver, a lumbar artery may supply the tumor. Although selective chemoembolization via the tumor-feeding vessel of the lumbar artery can be achieved in most cases, overall tumor response is commonly unfavorable.
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Affiliation(s)
- Han Myun Kim
- Department of Radiology, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea,
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