Clinical study
Consolidation of Hepatic Arterial Inflow by Embolization of Variant Hepatic Arteries in Preparation for Yttrium-90 Radioembolization

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Abstract

Purpose

Before yttrium-90 (90Y) radioembolization administration, the authors consolidated arterial inflow by embolizing variant hepatic arteries (HAs) to make microsphere delivery simpler and safer. The present study reviews the technical and clinical success of these consolidation procedures.

Materials and Methods

Preparatory and treatment angiograms were retrospectively analyzed for 201 patients. Variant HAs were coil-embolized during preparatory angiography to simplify arterial anatomy. Collateral arterial perfusion of territories previously supplied by variant HAs was evaluated by digital subtraction angiography (DSA), C-arm computed tomography (CT), and technetium-99m (99mTc)–macroaggregated albumin (MAA) scintigraphy, and by follow-up evaluation of regional tumor response.

Results

A total of 47 variant HAs were embolized in 43 patients. After embolization of variant HAs, cross-perfusion into the embolized territory was depicted by DSA and by C-arm CT in 100% of patients and by 99mTc-MAA scintigraphy in 92.7%. Uniform progressive disease prevented evaluation in 33% of patients, but regional tumor response in patients who responded supported successful delivery of microspheres to the embolized territories in 95.5% of evaluable patients.

Conclusions

Embolization of variant HAs for consolidation of hepatic supply in preparation for 90Y radioembolization promotes treatment of affected territories via intrahepatic collateral channels.

Section snippets

Patient Cohort

We retrospectively reviewed all preparatory and treatment angiograms in 201 patients treated for unresectable hepatic malignancy from June 2004 to November 2010. Patients ranged in age from 20 to 92 years (mean, 60.1 y; median, 61 y), and underwent radioembolization treatment with SIR-Spheres (Sirtex, Lane Cove, Australia) or TheraSphere (MDS Nordion, Ottawa, Ontario, Canada). Iterative data on seven patients who underwent repeat radioembolization were also included. All data were handled in

Arterial Anatomy in Patient Cohort

A total of 73 patients (36.3%) had variant HAs; the other 128 patients (63.7%) had standard HA anatomy or underwent previous resection that eliminated variant HAs. The 73 patients had a total of 85 variant HAs amenable to consolidation (42 men, 31 women; age range, 22–81 y). Details about demographics, type of radioembolization microsphere used, and territory of liver treated are listed in Table 1. The majority of patients had diffuse bilobar metastatic disease and required whole-liver

Discussion

Hepatic radioembolization with 90Y-impregnated microspheres is a promising emerging treatment for patients with primary or metastatic hepatic malignancy, but the presence of variant HA anatomy poses certain risks and inconveniences. The potential complications resulting from nontarget radioembolization can be far more severe than those resulting from nontarget chemoembolization or bland embolization (13). Administration of radioembolic microspheres into variant HAs originating from the SMA,

Acknowledgments

The authors thank Dr. A.K. Hosni for expert statistical advice.

References (16)

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None of the authors have identified a conflict of interest.

From the SIR 2010 Annual Meeting.

This article includes an appendix available online at www.jvir.org.

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