Abstract
Radioembolization offers a novel way to treat the nonresectable, liver predominant hepatic malignancies with better tumor response and overall progression-free survival rates. Transarterial catheter-based radioembolization procedure involves the hepatic arterial administration of glass- or resin-based beta emitting Yttirum-90 microspheres. Safe delivery of the tumoricidal radiation dose requires careful angiogram planning and coil embolization to quantify lung shunting and prevent systemic toxicity, respectively. Diagnostic pretreatment angiogram also serves to identify the hepatic arterial variant anatomy and other coexisting pathologies that might require a different or alternative approach. We describe a complex case of celiac artery stenosis with tortuous pancreaticoduodenal arterial arcade precluding access to the right hepatic artery for performing radioembolization. Celiac artery stenting of the stenosis was performed to facilitate subsequent safe and successful Yttrium-90 microsphere radioembolization.
Highlights
A 74-year-old female with metastatic colorectal carcinoma to the right hepatic lobe (T4 N2 M1 at presentation) is status post colon and segment VI hepatic resection, and chemotherapy
Microsphere radioembolization therapy is currently approved for unresectable hepatic metastatic disease from colorectal cancer (SIR-Spheres, Sirtex Medical, Lane Cove, NSW, Australia) and unresectable hepatocellular carcinoma as a humanitarian device exemption (TheraSphere, MDS Nordion, Ottawa, ON, Canada) within the United States. 90Y microspheres are permanent biocompatible and nonbiodegradable medical devices with a 90Y beta emitter within glass spheres or adsorbed onto resin spheres
Celiac artery stenosis can result from atherosclerosis, tumor invasion, localized inflammation, ligament compression, and rarely agenesis limiting the access to the hepatic branches through the celiac axis [14]
Summary
A 74-year-old female with metastatic colorectal carcinoma to the right hepatic lobe (T4 N2 M1 at presentation) is status post colon and segment VI hepatic resection, and chemotherapy. The liver and renal function tests and hematological indices were within normal range
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