Skip to main content Accessibility help

We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.

Close cookie message
×
Hostname: page-component-6bf8c574d5-k2jvg Total loading time: 0 Render date: 2025-03-09T14:23:44.358Z Has data issue: false hasContentIssue false

15 - Embolization of Liver Tumors: Anatomy

from PART III - ORGAN-SPECIFIC CANCERS

Published online by Cambridge University Press:  18 May 2010

By
Jin Wook Chung  and
Jae Hyung Park
Edited by
Jean-François H. Geschwind  and
Michael C. Soulen
Jin Wook Chung
Affiliation:
Associate Professor, Department of Radiology Seoul National University Hospital Seoul, Korea
Jae Hyung Park
Affiliation:
Professor, Department of Radiology Seoul National University College of Medicine Seoul, Korea
Jean-François H. Geschwind
Affiliation:
The Johns Hopkins University School of Medicine
Michael C. Soulen
Affiliation:
University of Pennsylvania School of Medicine
Get access

Summary

In transcatheter management of hepatic tumors, it is essential to understand hepatic vascular anatomy in detail to enhance therapeutic results and prevent complications due to non-target treatment.

The purpose of this chapter is to review celiac trunk and hepatic artery variations, non-hepatic arteries arising from hepatic arteries and extra-hepatic collateral supply to hepatic tumors.

Celiac Trunk Anatomy

Normal Celiac Trunk Anatomy and Variations

The celiac trunk is a wide branch from the front of the aorta just below the aortic hiatus of the diaphragm. It passes nearly horizontally forward and slightly to the right above the pancreas and the splenic vein, and divides into three major branches of the left gastric artery (LGA), common hepatic artery (CHA) and splenic artery. It may give off one or both inferior phrenic arteries, dorsal pancreatic artery and rarely, colic or jejunal branches (Figure 15.1) (1). The superior mesenteric artery (SMA) separately arises from the aorta inferior to the origin of the celiac axis. Usually, the LGA is the first major branch of the celiac trunk. However, in about 4% of the population, the LGA directly arises from the supraceliac or juxtaceliac aorta, which represents the most common form of celiac trunk variation. If inferior phrenic arteries arise from the celiac trunk, their origin is almost always located proximal to the LGA (Figure 15.1).

Type
Chapter
Information
Interventional Oncology
Principles and Practice
 , pp. 160 - 191
Publisher: Cambridge University Press
Print publication year: 2008

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Williams, P L, Warwick, R. Gray's Anatomy, 36th edition Philadelphia: Saunders 1980.Google Scholar
Michels, N A. Blood Supply and Anatomy of the Upper Abdominal Organs. pp.152–154, 256–259, 374–375. Philadelphia, JBLippincott 1955.Google Scholar
Soo, C S, Chuang, V P, Wallace, S, et al. Treatment of hepatic neoplasm through extrahepatic collaterals. Radiology 1983; 144: 485–494.Google Scholar
Bron, K M, Redman, H C. Splanchnic artery stenosis and occlusion: Incidence, arteriographic and clinical manifestations. Radiology 1969; 92: 323–328.CrossRefGoogle ScholarPubMed
Derrick, J R, Pollard, H S, Moore, R M. The pattern of arteriosclerotic narrowing of the celiac and superior mesenteric arteries. Ann Surg 1959; 149: 684–689.CrossRefGoogle ScholarPubMed
David, C L, Harold, A B. High incidence of celiac axis narrowing in asymptomatic individuals. AJR Am J Roentgenol 1972; 116: 426–429.Google Scholar
Park, C M, Chung, J W, Kim, H B, et al. Celiac axis stenosis: Incidence and etiologies in asymptomatic individuals. Korean J Radiol 2001; 2: 8–13.CrossRefGoogle ScholarPubMed
Reuter, S. Accentuation of celiac compression by the median arcuate ligament of the diaphragm during deep expiration. Radiology 1971; 98: 561.CrossRefGoogle ScholarPubMed
Song, S Y, Chung, J W, Kwon, J W, et al. Collateral pathways in patients with celiac axis stenosis: angiographic-spiral CT correlation. Radiographics 2002; 22: 881–893.CrossRefGoogle ScholarPubMed
Kwon, J W, Chung, J W, Song, S Y, et al. Transcatheter arterial chemoembolization for hepatocellular carcinomas in patients with celiac axis occlusion. J Vasc Interv Radiol 2002; 13: 689–694.CrossRefGoogle ScholarPubMed
Patten, R M, Coldwell, D M, Ben-Menachem, Y. Ligamentous compression of the celiac axis: CT findings in five patients. AJR Am J Roentgenol 1991; 156: 1101–1103.CrossRefGoogle ScholarPubMed
Covey, A M, Brody, L A, Maluccio, M A, et al. Variant hepatic arterial anatomy revisited: Digital subtraction angiography performed in 600 patients. Radiology 2002; 224: 542–547.CrossRefGoogle ScholarPubMed
Lie, D M, Salem, R, Bui, J T, et al. Angiographic considerations in patients undergoing liver-directed therapy. J Vasc Interv Radiol 2005; 16: 911–935.CrossRefGoogle Scholar
VanDamme, J P, Bonte, J. Vascular Anatomy in Abdominal SurgeryNew York: Thieme 1990.Google Scholar
Couinaud, C. Liver anatomy: Portal (and suprahepatic) or biliary segmentation. Dig Surg 1999; 16: 459–467.CrossRefGoogle ScholarPubMed
Mlakar, B, Gadẑijev, E M, Ravnik, D, et al. Anatomical variations of the arterial pattern in the right hemiliver. Eur J Morphology 2002; 40: 267–273.CrossRefGoogle ScholarPubMed
Mlakar, B, Gadzijev, E, Ravnik, D, et al. Anatomical variations of the arterial pattern in the left hemiliver. Eur J Morphology 2002 Apr; 40(2): 115–120.CrossRefGoogle ScholarPubMed
Yoshimura, H, Uchida, H, Ohishi, H, et al. Evaluation of “M-point” in hepatic artery to identify left medial segment of liver: angiographic study. Eur J Radiol 1986 Aug; 6(3): 195–198Google ScholarPubMed
Soyer, P, Bluemke, D A, Bliss, D F, et al. Surgical segmental anatomy of the liver: Demonstration with spiral CT during arterial portography and multiplanar reconstruction. AJR Am J Roentgenol 1994; 163: 99–103.CrossRefGoogle ScholarPubMed
Lafortune, M, Madore, E, Patriquin, H, et al. Segmental anatomy of the liver: A sonographic approach to the Couinaud nomenclature. Radiology 1991; 181: 443–448.CrossRefGoogle ScholarPubMed
Couinaud, C. Le foie: Études anatomiques et chirurgicalesParis, France: Masson 1957; pp. 9–12.Google Scholar
Fasel, J, Selle, D, Evertsz, C, et al. Segmental anatomy of the liver: Poor correlation with CT. Radiology 1998; 206: 151–156.CrossRefGoogle ScholarPubMed
Cho, A, Okazumi, S, Takayama, W, et al. Anatomy of the right anterosuperior area (segment 8) of the liver: Evaluation with helical CT during arterial portography. Radiology 2000; 214: 491–495.CrossRefGoogle ScholarPubMed
Ohashi, I, Ina, H, Okada, Y, et al. Segmental anatomy of the liver under the right diaphragmatic dome: Evaluation with axial CT. Radiology 1996; 200: 779–783.CrossRefGoogle ScholarPubMed
Lee, H Y, Chung, J W, Park, J H, et al. A new and simple practical plane dividing hepatic segment 2 and 3 of the liver: Evaluation of its validity. Korean J Radiol 2007; 8: 302–310.CrossRefGoogle ScholarPubMed
Song, S Y, Chung, J W, Lim, H G, et al. Nonhepatic arteries originating from the hepatic arteries: Angiographic analysis in 250 patients. J Vasc Interv Radiol 2006; 17: 461–469.CrossRefGoogle ScholarPubMed
Ueno, K, Miyazono, N, Inoue, H, et al. Embolization of the hepatic falciform artery to prevent supraumbilical skin rash during transcatheter arterial chemoembolization for hepatocellular carcinoma. Cardiovasc Intervent Radiol 1995; 18: 183–185.CrossRefGoogle ScholarPubMed
Nakamura, H, Hashimoto, H, Sawada, S, et al. Prevention of gastric complications in hepatic arterial chemoembolization: Balloon catheter occlusion technique. Acta Radiol 1991; 32: 81–82.CrossRefGoogle ScholarPubMed
Hashimoto, M, Heianna, J, Tate, E, et al. The feasibility of retrograde catheterization of the right gastric artery via the left gastric artery. J Vasc Interv Radiol 2001; 12: 1103–1106.CrossRefGoogle ScholarPubMed
Yamagami, T, Nakamura, T, Iida, S, et al. Embolization of the right gastric artery before hepatic arterial infusion chemotherapy to prevent gastric mucosal lesions: Approach through the hepatic artery versus the left gastric artery. AJR Am J Roentgenol 2002; 179: 1605–1610.CrossRefGoogle ScholarPubMed
Inaba, Y, Arai, Y, Matsueda, K, et al. Right gastric artery embolization to prevent acute gastric mucosal lesions in patients undergoing repeat hepatic arterial infusion chemotherapy. J Vasc Interv Radiol 2001; 12: 957–963.CrossRefGoogle ScholarPubMed
Nakamura, H, Uchida, H, Kuroda, C, et al. Accessory left gastric artery arising from left hepatic artery: angiographic study. AJR Am J Roentgenol 1980; 134: 529–532.CrossRefGoogle ScholarPubMed
Chuang, P V, Wallace, S, Stroehlein, J, et al. Hepatic artery infusion chemotherapy: Gastroduodenal complications. Am J Roentgenol 1982; 137: 347–350.CrossRefGoogle Scholar
Hirakawa, M, Iida, M, Aoyagi, K, et al. Gastroduodenal lesions after transcatheter arterial chemo-embolization in patients with hepatocelluar carcinoma. Am J Gastroenterol 1988; 83: 837–840.Google Scholar
Williams, D M, Cho, K J, Ensminger, W D, et al. Hepatic falciform artery: Anatomy, angiographic appearance, and clinical significance. Radiology 1985; 156: 339–340.CrossRefGoogle ScholarPubMed
Baba, Y, Miyazono, N, Ueno, K, et al. Hepatic falciform artery: Angiographic findings in 25 patients. Acta Radiol 2000; 41: 329–333.CrossRefGoogle ScholarPubMed
Gibo, M, Hasuo, K, Inoue, A, et al. Hepatic falciform artery: Angiographic observations and significance. Abdom Imaging 2001; 26: 515–519.CrossRefGoogle ScholarPubMed
Kim, D E, Yoon, H K, Ko, G Y, et al. Hepatic falciform artery: Is prophylactic embolization needed before short-term hepatic arterial chemoinfusion?Am J Roentgenol 1999; 172: 1597–1599.CrossRefGoogle ScholarPubMed
Ibukuro, K, Tsukiyama, T, Mori, K, et al. Hepatic falciform ligament artery: Angiographic anatomy and clinical importance. Surg Radiol Anat 1998; 20: 367–371.CrossRefGoogle ScholarPubMed
Dupart, G, Charnsangvej, C, Wallace, S, et al. Inferior phrenic artery embolization in the treatment of hepatic neoplasm. Acta Radiol 1988; 29: 427–429.CrossRefGoogle Scholar
Chung, J W, Park, J H, Han, J K, et al. Transcatheter oily chemoembolization of the inferior phrenic artery in hepatocellular carcinoma: The safety and potential therapeutic role. J Vasc Interv Radiol 1998; 9: 495–500.CrossRefGoogle ScholarPubMed
Sakamoto, I, Aso, N, Nagaoki, K. Complications associated with transcatheter arterial embolization for hepatic tumors. Radiographics 1998; 18: 605–619.CrossRefGoogle ScholarPubMed
Sammon, J, Baron, R. Phase II study of Spherex (degradable starch microspheres) injected into the hepatic artery in conjunction with doxorubicin and cisplatin in the treatment of advanced-stage hepatocellular carcinoma: Interim analysis. Semin Oncol 1997; 24(Suppl 6): S6–S97.Google Scholar
Choplin, R H, Gelfand, D W, Hunt, T H. Gastric perforation from hepatic artery infusion chemotherapy. Gastrointest Radiol 1983; 8: 133–134.CrossRefGoogle ScholarPubMed
Bianchi, H F, Albanese, E F. The supraduodenal artery. Surg Radiol Anat 1989; 11: 37–40.CrossRefGoogle ScholarPubMed
Daseler, E H, Anson, B J, Hambley, W C, et al. The cystic artery and constituents of the hepatic pedicle: A study of 500 specimens. Surg Gynecol Obstet 1947; 85:47–63.Google ScholarPubMed
Chen, W J, Ying, D J, Liu, Z J, et al. Analysis of the arterial supply of the extrahepatic bile ducts and its clinical significance. Clin Anat 1999; 12(4): 245–249.3.0.CO;2-W>CrossRefGoogle ScholarPubMed
Tohma, T, Cho, A, Okazumi, S, et al. Communicating arcade between the right and left hepatic arteries: Evaluation with CT and angiography during temporary balloon occlusion of the right or left hepatic artery. Radiology 2005; 237: 361–365.CrossRefGoogle ScholarPubMed
Stapleton, G N, Hickman, R, Terblanche, J. Blood supply of the right and left hepatic ducts. Br J Surg 1998 Feb; 85(2): 202–207.CrossRefGoogle ScholarPubMed
Kim, H C, Chung, J W, Lee, W, et al. Recognizing extrahepatic collateral vessels that supply hepatocellular carcinoma to avoid complications of transcatheter arterial chemoembolization. Radiographics 2005; 25: S25–39.CrossRefGoogle ScholarPubMed
Chung, J W, Kim, H C, Jae, H J, et al. Transcatheter arterial chemoembolization of hepatocellular carcinoma: Prevalence and causative factors of extrahepatic collateral arteries in 479 patients. Korean J Radiol 2006; 7: 257–266.CrossRefGoogle ScholarPubMed
Michels, N A. Collateral arterial pathways to the liver after ligation of the hepatic artery and removal of the celiac axis. Cancer 1953; 6: 708–724.3.0.CO;2-A>CrossRefGoogle ScholarPubMed
Charnsangavej, C, Chuang, V P, Wallace, S, et al. Angiographic classification of hepatic arterial collaterals. Radiology 1982; 144: 485–494.CrossRefGoogle ScholarPubMed
Takeuchi, Y, Arai, Y, Inaba, Y, et al. Extrahepatic arterial supply to the liver: Observation with a unified CT and angiography system during temporary balloon occlusion of the proper hepatic artery. Radiology 1998; 209: 121–128.CrossRefGoogle ScholarPubMed
Miyayama, S, Matsui, O, Taki, K, et al. Extrahepatic blood supply to hepatocellular carcinoma: Angiographic demonstration and transcatheter chemoembolization. Cardiovasc Intervent Radiol 2006; 29: 39–48.CrossRefGoogle Scholar
Kim, J H, Chung, J W, Han, J K, et al. Transcatheter arterial embolization of the internal mammary artery in hepatocellular carcinoma. J Vasc Interv Radiol 1995; 6: 71–74.CrossRefGoogle ScholarPubMed
Nakai, M, Sato, M, Kawai, N, et al. Hepatocellular carcinoma: Involvement of the internal mammary artery. Radiology 2001; 219: 147–152.CrossRefGoogle ScholarPubMed
Park, S I, Lee, D Y, Won, J Y, et al. Extrahepatic collateral supply of hepatocellular carcinoma by the intercostal arteries. J Vasc Interv Radiol 2003; 14: 461–468.CrossRefGoogle ScholarPubMed
Miyayama, S, Matsui, O, Akakura, Y, et al. Hepatocellular carcinoma with blood supply from omental branches: Treatment with transcatheter arterial embolization. J Vasc Interv Radiol 2001; 12: 1285–1290.CrossRefGoogle ScholarPubMed
Won, J Y, Lee, D Y, Lee, J T, et al. Supplemental transcatheter arterial chemoembolization through a collateral omental artery: treatment for hepatocellular carcinoma. Cardiovasc Intervent Radiol 2003; 26: 136–140.CrossRefGoogle ScholarPubMed
Miyayama, S, Matsui, O, Nishida, H, et al. Transcatheter arterial chemoembolization for unresectable hepatocellular carcinoma fed by the cystic artery. J Vasc Interv Radiol 2003; 14: 1155–1161.CrossRefGoogle ScholarPubMed
Komatsu, T, Matsui, O, Kadoya, M, et al. Cystic artery origin of the segment V hepatic artery. Cardiovasc Intervent Radiol 1999; 22: 165–167.CrossRefGoogle ScholarPubMed
Tanigawa, N, Sawada, S, Okuda, Y, et al. A case of small hepatocellular carcinoma supplied by the cystic artery. Am J Roentgenol 1998; 170: 675–676.CrossRefGoogle ScholarPubMed
Miyayama, S, Matsui, O, Akakura, Y, et al. Use of a catheter with a large side hole for selective catheterization of the inferior phrenic artery. J Vasc Interv Radiol 2001; 12: 497–499.CrossRefGoogle ScholarPubMed
Baek, J H, Chung, J W, Jae, H J, et al. A new technique for superselective catheterization of arteries originating from a large artery at an acute angle: Shepherd-hook preshaping of a micro-guide wire. Korean J Radiol 2007; 8: 225–230.CrossRefGoogle Scholar
Miyayama, S, Matsui, O, Taki, K, et al. Transcatheter arterial chemoembolization for hepatocellular carcinoma fed by the reconstructed inferior phrenic artery: Anatomical and technical analysis. J Vasc Interv Radiol 2004; 15: 815–823.CrossRefGoogle ScholarPubMed
Shin, S W, Do, Y S, Choo, S W, et al. Diaphragmatic weakness after transcatheter arterial chemoembolization of interior phrenic artery for treatment of hepatocellular carcinoma. Radiology 2006; 241: 581–588.CrossRefGoogle Scholar
Kim, H C, Chung, J W, Choi, S H, et al. Hepatocellular carcinoma supplied by the internal mammary artery: Angiographic anatomy in 97 patients. Radiology 2007; 242: 925–932.CrossRefGoogle Scholar
Singh, R N. Radiographic anatomy of the internal mammary arteries. Cathet Cardiovasc Diagn 1981; 7: 373–386.CrossRefGoogle ScholarPubMed
Arora, R, Soulen, M C, Haskal, Z J. Cutaneous complications of hepatic chemoembolization via extrahepatic collaterals. J Vasc Interv Radiol 1999; 10: 1351–1356.CrossRefGoogle ScholarPubMed
Machnicki, A, Grzybiak, M. Variations in testicular arteries in fetuses and adults. Folia Morphol (Warsz) 1997; 56: 277–285.Google ScholarPubMed
Khademi, M, Seebode, J J, Falla, A. Selective spermatic arteriography for localization of an impalpable undescended testis. Radiology 1980; 136: 627–634.CrossRefGoogle ScholarPubMed
Kim, H C, Chung, J W, Jae, H J, et al. Hepatocellular carcinoma: Transcatheter arterial chemoembolization of the gonadal artery. J Vasc Interv Radiol 2006; 17: 703–709.CrossRefGoogle ScholarPubMed
Chung, J W, Park, J H, Han, J K, et al. Hepatic tumors: Predisposing factors for complications of transcatheter oily chemoembolization. Radiology 1996; 198: 33–40.CrossRefGoogle ScholarPubMed

Save book to Kindle

To save this book to your Kindle, first ensure [email protected] is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats
×

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

Available formats
×