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Namous N, Kushner D, Dadparvar S. 99m Tc-Macroaggregated Albumin Liver Lung Shunt Study With Uptake Indicative of Patent Falciform Artery. Clin Nucl Med 2023; 48:510-511. [PMID: 36179332 DOI: 10.1097/rlu.0000000000004428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT Intra-arterial injection of radioactive isotope 90-yttrium 90 Y has been used for elective internal radiation therapy for the treatment of localized hepatocellular carcinoma deemed surgically unresectable. It has also been used to treat intrahepatic cholangiocarcinoma and colorectal cancer that has metastasized to the liver. To prepare for 90 Y treatment, preprocedural mapping via hepatic angiography and 99m Tc-macroaggregated albumin liver lung shunt study followed by postprocedural 90 Y SPECT/CT is essential to ensure a targeted therapy. Therapy is contraindicated if lung shunt fraction is greater than 20% for SIR-Spheres. Anatomic variation in hepatic angiography may be present that can lead to complications if unaccounted for.
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Affiliation(s)
- Nadia Namous
- From the Lewis Katz School of Medicine, Temple University
| | - Daniel Kushner
- Department of Radiology, Division of Nuclear Medicine and Molecular Imaging, Temple University Hospital, Philadelphia, PA
| | - Simin Dadparvar
- Department of Radiology, Division of Nuclear Medicine and Molecular Imaging, Temple University Hospital, Philadelphia, PA
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2
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Ruiz I, Maalouf NS, Bentridi A, Holderbaum do Amaral R, Olivié D, Perreault P, Fenyves D, Hill A, Bouchard L. Abdominal Skin Injury due to Non-Target Embolization of Hepatocellular Carcinoma Vascularized by the Internal Mammary Artery. Cardiovasc Intervent Radiol 2021; 45:142-146. [PMID: 34476579 DOI: 10.1007/s00270-021-02951-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 08/16/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Isaac Ruiz
- Department of Hepatology and Liver Transplantation, Centre Hospitalier de l'Université de Montréal (CHUM), 1051 rue Sanguinet, Montréal, Qc, H2X 0C1, Canada. .,Institut Mondor de Recherche Biomédicale (IMRB), Université Paris-Est, Hôpital Henri Mondor, INSERM U955 Team 18, Créteil, France.
| | - Nadine S Maalouf
- Department of Dermatology, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, Canada
| | - Ahmed Bentridi
- Department of Radiology, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, Canada
| | | | - Damien Olivié
- Department of Radiology, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, Canada
| | - Pierre Perreault
- Department of Radiology, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, Canada
| | - Daphna Fenyves
- Department of Hepatology and Liver Transplantation, Centre Hospitalier de l'Université de Montréal (CHUM), 1051 rue Sanguinet, Montréal, Qc, H2X 0C1, Canada
| | - Ashley Hill
- Department of Dermatology, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, Canada
| | - Louis Bouchard
- Department of Radiology, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, Canada
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3
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Cheung E, Chen X, Kutaiba N. Case report: hepatic falciform artery - an important anatomical variant. ANZ J Surg 2020; 91:E67-E68. [PMID: 32592607 DOI: 10.1111/ans.16119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 06/10/2020] [Accepted: 06/14/2020] [Indexed: 12/01/2022]
Affiliation(s)
- Ernest Cheung
- Department of Medical Imaging, Austin Health, Melbourne, Victoria, Australia
| | - Xiao Chen
- Department of Medical Imaging, Austin Health, Melbourne, Victoria, Australia
| | - Numan Kutaiba
- Department of Medical Imaging, Austin Health, Melbourne, Victoria, Australia
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Retiform Purpura as a Complication of Microsphere Emboli Following Transarterial Chemoembolization for Primary Hepatocellular Carcinoma: A Case Report and Literature Review. Am J Dermatopathol 2019; 42:e108-e110. [DOI: 10.1097/dad.0000000000001586] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Hansen T, Olsen K, White K, Keller J. Retiform Purpura After Transcatheter Arterial Chemoembolization: A Case Report. Am J Dermatopathol 2018; 40:e25-e27. [DOI: 10.1097/dad.0000000000000950] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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6
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Elsayed AG, Martin JM, Pacioles T. Rash and subcutaneous fat necrosis after DEB-TACE with doxorubicin. BMJ Case Rep 2018; 2018:bcr-2017-222394. [PMID: 29305365 DOI: 10.1136/bcr-2017-222394] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
A 73-year-old woman with hepatocellular carcinoma localised to the liver was treated with doxorubicin-loaded drug-eluting beads through transcatheter arterial chemoembolisation (DEB-TACE). She developed subcutaneous, erythematous, tender nodules in her abdomen 3 days after the procedure. PET/CT scan that was done to evaluate for evidence of disease progression showed mild avidity of these nodules. Biopsy showed fatty necrosis. Nodules started to improve spontaneously 2 weeks after onset. At 8 weeks after onset, lesions stabilised in size and the associated tenderness and erythema resolved. This represents a rare side effect of TACE procedure in general. It can happen secondary to non-target embolisation of hepatic falciform artery, planned embolisation of extrahepatic collateral supplies and even when there is no clear cause. Spontaneous resolution of acute symptoms usually occurs over the course of few weeks, though subcutaneous lesions consisting of necrotic fat tissue may persist for longer periods.
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Affiliation(s)
- Ahmed Gamal Elsayed
- Department of Hematology/Oncology, Edwards Comprehensive Cancer Center, Huntington, West Virginia, USA
| | - James M Martin
- Interventional radiology, Radiology Inc, Huntington, West Virginia, USA
| | - Toni Pacioles
- Department of Hematology/Oncology, Edwards Comprehensive Cancer Center, Huntington, West Virginia, USA
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Hur S, Chung JW, Zhou CG, Lee JH, Cho S, Kim M, Lee M, Kim HC, Jae HJ. Arteries of the falciform ligament on C-arm CT hepatic arteriography: The hepatic falciform artery and the Sappey's superior artery. Eur Radiol 2016; 27:1440-1447. [PMID: 27510629 DOI: 10.1007/s00330-016-4523-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Revised: 07/19/2016] [Accepted: 07/21/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND AND AIM To investigate the prevalence, anatomy and distribution of the hepatic falciform artery (HFA) and Sappey's superior artery (SSA) using C-arm CT hepatic arteriography (C-arm CTHA). MATERIALS AND METHODS From January 2011 to December 2012, 220 patients who underwent C-arm CTHA during initial transarterial treatment for hepatocellular carcinoma were included in this retrospective study. The HFAs and SSAs prevalence and origin were evaluated using axial images of C-arm CTHA. A 5-point scale for HFAs and a 4-point scale for SSAs were used to designate the radiologically conspicuous arteries. RESULTS The prevalences of the total HFAs and SSAs were 95 % (n=209) and 22 % (n=49), while those of radiologically conspicuous HFAs and SSAs were 62 % (n=137) and 10 % (n=22), respectively. Thirty HFAs (22 % of radiologically conspicuous HFAs and 14 % of the total study population) were distributed in the subcutaneous layer of the anterior abdominal wall, while the majority of SSAs ran through the superior part of the falciform ligament in the left-anterior direction and anastomosed with left inferior phrenic artery. CONCLUSION Our study using C-arm CTHA revealed that the prevalence of the HFA is higher than the existing knowledge and proved the existence of the SSA radiologically for the first time. KEY POINTS • Prevalence of hepatic falciform artery is 95 %, higher than previously known. • 22 % of conspicious hepatic falciform arteries distributed in subcutaneous tissue around umbilicus. • The existence of Sappey's superior artery was proved with a radiological method.
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Affiliation(s)
- Saebeom Hur
- Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongro-gu, Seoul, Republic of Korea, 110-744
| | - Jin Wook Chung
- Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongro-gu, Seoul, Republic of Korea, 110-744.
| | - Chun Gao Zhou
- Department of Interventional Radiology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, Jangsu, China
| | - Jae Hwan Lee
- Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongro-gu, Seoul, Republic of Korea, 110-744
| | - SooBeum Cho
- Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongro-gu, Seoul, Republic of Korea, 110-744
| | - Minuk Kim
- Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongro-gu, Seoul, Republic of Korea, 110-744
| | - Myungsu Lee
- Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongro-gu, Seoul, Republic of Korea, 110-744
| | - Hyo-Cheol Kim
- Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongro-gu, Seoul, Republic of Korea, 110-744
| | - Hwan Jun Jae
- Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongro-gu, Seoul, Republic of Korea, 110-744
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Abdominal Skin Rash After TACE Due to Non-Target Embolization of Hepatic Falciform Artery. ACG Case Rep J 2016; 3:217-20. [PMID: 27144210 PMCID: PMC4843162 DOI: 10.14309/crj.2016.55] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Accepted: 12/11/2015] [Indexed: 12/22/2022] Open
Abstract
Transcatheter arterial chemoembolization (TACE) is a well-recognized procedure for management of hepatocellular carcinoma. We present a 54-year-old man who presented with a periumbilical maculopapular skin rash that developed after an otherwise uneventful TACE procedure. A retrospective review of imaging was consistent with non-target embolization of the hepatic falciform artery (HFA). He was treated with oral non-steroidal antiinflammatory medication for 3 weeks with improvement, but had slight skin induration and an excoriated papule at 6-month follow-up. Non-target embolization of HFA is very rare, but clinicians and interventionalists should be aware of this complication, especially in patients predisposed to enlargement of HFA.
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Smith MT, Johnson DT, Gipson MG. Skin Necrosis Resulting from Nontarget Embolization of the Falciform Artery during Transarterial Chemoembolization with Drug-Eluting Beads. Semin Intervent Radiol 2015; 32:22-5. [PMID: 25762844 DOI: 10.1055/s-0034-1396960] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Intra-arterial embolic therapies are a mainstay of liver-directed therapies to palliate symptoms, improve survival, and bridge patients to transplantation. Vascular anatomy and type of embolic used can lead to complications of nontarget embolization with varying clinical consequences. This case report describes a rare, nontarget embolization of the falciform artery leading to supraumbilical skin necrosis.
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Affiliation(s)
- Mitchell T Smith
- Department of Radiology, University of Colorado, Aurora, Colorado
| | | | - Matthew G Gipson
- Department of Radiology, University of Colorado, Aurora, Colorado
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Durack JC, Hope TA, Seo Y, Saeed M, He J, Wilson MW, Kerlan RK, Ring EJ. Intravenous Vasopressin for the Prevention of Nontarget Gastrointestinal Embolization during Liver-directed Cancer Treatment: Experimental Study in a Porcine Model. J Vasc Interv Radiol 2012; 23:1505-12. [DOI: 10.1016/j.jvir.2012.07.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2012] [Revised: 07/06/2012] [Accepted: 07/10/2012] [Indexed: 11/17/2022] Open
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Kim HY, Bae SH, Park CH, Song MJ, Choi JY, Yoon SK, Jung ES, Chun HJ. Supraumbilical Subcutaneous Fat Necrosis After Transcatheter Arterial Chemoembolization with Drug-Eluting Beads: Case Report and Review of the Literature. Cardiovasc Intervent Radiol 2012; 36:276-9. [DOI: 10.1007/s00270-012-0356-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2011] [Accepted: 01/15/2012] [Indexed: 10/28/2022]
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Chemoembolization for Hepatocellular Carcinoma Supplied Exclusively by the Hepatic Falciform Artery. Cardiovasc Intervent Radiol 2011; 35:845-51. [DOI: 10.1007/s00270-011-0236-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2011] [Accepted: 07/15/2011] [Indexed: 10/17/2022]
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JANG MS, BAEK JW, KANG DY, KANG JS, SUH KS, KIM ST. Supraumbilical skin rash after transcatheter arterial chemoembolization: Successful treatment with pentoxifylline. J Dermatol 2011; 38:1188-91. [DOI: 10.1111/j.1346-8138.2011.01231.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Hepatic falciform ligament Tc-99m-macroaggregated albumin activity on SPECT/CT prior to Yttrium-90 microsphere radioembolization: prophylactic measures to prevent non-target microsphere localization via patent hepatic falciform arteries. Ann Nucl Med 2011; 25:365-9. [DOI: 10.1007/s12149-010-0464-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2010] [Accepted: 12/16/2010] [Indexed: 10/18/2022]
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Kanzaki H, Nouso K, Miyahara K, Kajikawa N, Kobayashi S, Sakakihara I, Iwadow S, Uematsu S, Okamoto R, Shiraga K, Mizuno M, Araki Y. A case of hepatocellular carcinoma with skin injury of the upper abdominal wall after transcatheter arterial chemoembolization: a case report. CASES JOURNAL 2009; 2:7197. [PMID: 19918514 PMCID: PMC2769344 DOI: 10.4076/1757-1626-2-7197] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/12/2009] [Accepted: 08/03/2009] [Indexed: 02/05/2023]
Abstract
INTRODUCTION Transcatheter arterial chemoembolization has been widely used to treat advanced hepatocellular carcinoma that cannot be treated by local ablation therapies or surgical resection. The effectiveness of transcatheter arterial chemoembolization in prolonging survival has been well established, and approximately one third of newly discovered hepatocellular carcinoma patients were repeatedly treated by transcatheter arterial chemoembolization in Japan. Various kinds of complications have been reported, and many of which are general complications such as hepatic coma, jaundice, fever-up, ascites, and bile duct injury. The hepatic falciform artery is found frequently during postmortem anatomic dissection and the incidence of hepatic falciform artery is reported to be over 60%. Hepatic falciform artery is known to be the responsible artery for supraumbilical skin rash development after arterial chemo infusion therapy; however, skin complications after transcatheter arterial chemoembolization are rare. CASE PRESENTATION A 70-year-old female with chronic hepatitis C infection was diagnosed as having hepatocellular carcinoma (S4, 20 mm in diameter). Transcatheter arterial chemoembolization was performed via the left hepatic artery, which was a feeding artery of the hepatocellular carcinoma. Two days after that, supraumbilical skin rash with local tenderness and redness appeared. Retrospective analysis revealed that occlusion of the hepatic falciform artery branching from the left hepatic artery with micromaterials caused the skin lesion. CONCLUSION We should keep in mind that anticancer drugs or embolic materials can flow into the HFA and may cause abdominal wall injury after transcatheter arterial chemoembolization.
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Affiliation(s)
- Hiromitsu Kanzaki
- Department of Internal Medicine, Hiroshima City Hospital7-33, Moto-machi, Naka-ku, Hiroshima-city, Hiroshima, 730-8518Japan
| | - Kazuhiro Nouso
- Department of Internal Medicine, Hiroshima City Hospital7-33, Moto-machi, Naka-ku, Hiroshima-city, Hiroshima, 730-8518Japan
| | - Koji Miyahara
- Department of Internal Medicine, Hiroshima City Hospital7-33, Moto-machi, Naka-ku, Hiroshima-city, Hiroshima, 730-8518Japan
| | - Naoko Kajikawa
- Department of Internal Medicine, Hiroshima City Hospital7-33, Moto-machi, Naka-ku, Hiroshima-city, Hiroshima, 730-8518Japan
| | - Sayo Kobayashi
- Department of Internal Medicine, Hiroshima City Hospital7-33, Moto-machi, Naka-ku, Hiroshima-city, Hiroshima, 730-8518Japan
| | - Ichiro Sakakihara
- Department of Internal Medicine, Hiroshima City Hospital7-33, Moto-machi, Naka-ku, Hiroshima-city, Hiroshima, 730-8518Japan
| | - Shota Iwadow
- Department of Internal Medicine, Hiroshima City Hospital7-33, Moto-machi, Naka-ku, Hiroshima-city, Hiroshima, 730-8518Japan
| | - Shuji Uematsu
- Department of Internal Medicine, Hiroshima City Hospital7-33, Moto-machi, Naka-ku, Hiroshima-city, Hiroshima, 730-8518Japan
| | - Ryoichi Okamoto
- Department of Internal Medicine, Hiroshima City Hospital7-33, Moto-machi, Naka-ku, Hiroshima-city, Hiroshima, 730-8518Japan
| | - Kunihiro Shiraga
- Department of Internal Medicine, Hiroshima City Hospital7-33, Moto-machi, Naka-ku, Hiroshima-city, Hiroshima, 730-8518Japan
| | - Motowo Mizuno
- Department of Internal Medicine, Hiroshima City Hospital7-33, Moto-machi, Naka-ku, Hiroshima-city, Hiroshima, 730-8518Japan
| | - Yasuyuki Araki
- Department of Internal Medicine, Hiroshima City Hospital7-33, Moto-machi, Naka-ku, Hiroshima-city, Hiroshima, 730-8518Japan
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Lee E, Kim GM, Kim SY. Fixed drug eruption mimicking supraumbilical skin rash: one of rare complication of transarterial chemoembolization. J Eur Acad Dermatol Venereol 2008; 23:324-5. [PMID: 18631209 DOI: 10.1111/j.1468-3083.2008.02863.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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