Abstract
To evaluate the postprocedural imaging findings and safety of repeated intra-arterial therapy via the cystic artery in patients with hepatocellular carcinoma (HCC). This retrospective study was approved by our institutional review board. From February 2002 to January 2012, we performed repeated (two or more) chemotherapeutic infusion or chemoembolization via the cystic artery using iodized oil in 132 patients with HCCs. Computed tomographic (CT) scans, digital subtraction angiograms, and medical records were retrospectively reviewed by consensus. A total of 340 sessions of intra-arterial therapy (160 sessions of chemotherapeutic infusion and 180 sessions of chemoembolization) via the cystic artery were undertaken in 132 patients. Fifty-five of 132 patients received both chemotherapeutic infusion and chemoembolization. The incidence of gallbladder wall thickening on follow-up contrast-enhanced CT was significantly higher in chemoembolization (48 of 180, 26.7 %) than in chemotherapeutic infusion (27 of 160, 16.9 %) (P = 0.035). Persistent gallbladder wall thickening was more frequently observed in chemoembolization (48 of 107, 44.9 %) than in chemotherapeutic infusion (27 of 90, 30 %) (P = 0.039). The major complication rate was 15 of 340 sessions (4.4 %) with 11 of 132 patients (8.3 %). Acute cholecystitis, which was related to intra-arterial therapy via the cystic artery, developed in two patients and was managed by conservative treatment. HCC supplied by the cystic artery can be safely treated by repeated intra-arterial chemotherapeutic infusion or chemoembolization using iodized oil through the cystic artery.
Highlights
The cystic artery arises from the first branch of the main right hepatic artery and subsequently divides into the deep and superficial branches
A total of 340 sessions of intra-arterial therapy (160 sessions of chemotherapeutic infusion and 180 sessions of chemoembolization) via the cystic artery were undertaken in 132 patients
The inclusion criteria were as follows: (1) a confirmative diagnosis of hepatocellular carcinoma (HCC) based on clinical or laboratory test findings in combination with typical computed tomographic (CT) and angiographic findings; (2) intra-arterial therapy via the cystic artery in two or more sessions; (3) adequate angiographic findings, demonstrating the entire cystic artery anatomy and tumors fed by the cystic artery; (4) baseline Computed tomographic (CT) performed with contrast enhancement before the interventional procedure; and (5) follow-up unenhanced CT scan and contrast-enhanced CT scan after the interventional procedure
Summary
The cystic artery arises from the first branch of the main right hepatic artery and subsequently divides into the deep and superficial branches. The cystic artery usually supplies the liver parenchyma near the gallbladder bed as well as the gallbladder [1, 2]. The clinical significance of the cystic artery during chemoembolization is the possibility of ischemic complications of the gallbladder [3,4,5,6,7,8,9,10,11,12]. Hirota et al [13] suggested that it was impossible to embolize the cystic artery when it fed hepatocellular carcinoma (HCC) and that the HCC should be treated with surgical resection or percutaneous alcohol injection. The development of small-caliber microcatheter systems has made it possible to perform highly selective chemoembolization, leading to safer embolization of the cystic artery than occurred several decades ago. Kang et al [14] described 27 patients with HCC that were supplied
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