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Analysis of hepatocellular carcinoma fed by internal thoracic artery
Insights
Hepatocellular carcinoma (HCC) in the upper liver can be supplied by the internal thoracic artery (ITA). Repeated transcatheter arterial embolization (TAE) and hepatic artery (HA) occlusion may lead to long-term survival in these cases.
Area of Science:
- Hepatobiliary Surgery
- Interventional Radiology
- Oncology
Background:
- Hepatocellular carcinoma (HCC) is a primary liver malignancy.
- Unusual arterial supply to HCC can complicate treatment.
- The internal thoracic artery (ITA) is an uncommon source of blood supply for HCC.
Purpose of the Study:
- To describe the clinical characteristics of HCC supplied by the ITA.
- To investigate the treatment outcomes for HCC with ITA neovascularization.
Main Methods:
- Retrospective analysis of seven patients with HCC supplied by the ITA.
- Confirmation of ITA supply using digital subtraction angiography.
- Evaluation of prior transcatheter arterial embolization (TAE) history, tumor characteristics, and collateral vessel status.
Main Results:
- HCCs were predominantly located in the anterior superior liver segments (S4, S2-3) and supplied by the ITA.
- Tumor sizes ranged from 3-10 cm.
- Six out of seven patients had hepatic artery (HA) occlusion, and five had occlusion of other collateral vessels (inferior phrenic artery, intercostal artery, epicholedocal artery).
- Patients underwent 2-12 previous TAE procedures.
Conclusions:
- The ITA frequently supplies HCC in the anterior superior liver region.
- Long-term survival is achievable with repeated TAE and hepatic artery occlusion in selected HCC cases.
- Understanding atypical arterial supply is crucial for effective HCC management.
Abstract:
Purpose: The purpose of this study was to elucidate the clinical features of hepatocellular carcinoma (HCC) fed by the internal thoracic artery (ITA). Methods: In seven patients HCC fed by the ITA was confirmed by digital subtraction angiography. The number of previous transcatheter arterial embolization (TAE), the period from the first TAE to TAE of the ITA, tumor location, tumor size, and occlusion of the hepatic artery (HA) and other collateral vessels were explored in each case. Results: The HCCs were located in S4 of the liver (n = 5) and in S8 (n = 1) and were fed by the right ITA and one nodule in S2-3 was fed by the left ITA. Tumor size was 3-10 cm. The number of previous TAE of the HA ranged from 2 to 12. The period from the first TAE to TAE of the ITA was 3-53 months. Angiography of these patients showed occlusion of the HA in six cases, and of the extrahepatic collaterals including the inferior phrenic artery (IPA) in five cases, intercostal artery (ICA) in one case, and epicholedocal artery (EPA) in one case. Conclusion: The ITA often supplies HCC located in the anterior superior region of the liver under the diaphragm; there can be long-term survival with repeated TAE and occlusion of HA.