Angiographic considerations in patients undergoing liver-directed radioembolization with 90Y microspheres

Catheter-directed, transarterial internal brachytherapy, using 90Y radioactive microspheres is gaining acceptance as a valuable treatment option in selected patients with liver malignancies. Knowledge of the radiological anatomy of the visceral arteries, including the variant anatomy of celiac trunk, superior mesenteric artery and end branches as well as technique and catheter skills for careful vessel occlusion prior to 90Y delivery are of major importance to safely and efficiently treat patients with radioembolization. In this review article, normal vascular anatomy, common variants and influence of tumors on the feeding arteries will be discussed. Finally, techniques of pre-treatment vessel occlusion, technique of 90Y-administration and the added value of C-arm computed tomography during work-up and administration of radioactive microspheres will be described.