Renal Capsular Artery Research Articles

Blood supply formation of the upper urinary tract in the prenatal period of human ontogenesis

Objective — to clarify peculiarities of blood supply of the upper urinary tract in the fetal period of human ontogenesis.Material and methods. The study was conducted on 58 specimens of human fetuses 81,0–375,0 mm of the parietal-coccygeal length (PCL) (4–10th months of the intrauterine development). A complex of morphological examinations was applied including anthropometry, morphometry, vascular injection followed by radiography and dissection, microscopy, graphic reconstruction and statistical analysis.Results. Definitive topography of the blood vessels of the upper urinary tract is established at the beginning of the fetal period. The abdominal part of the ureter is supplied by the ureteric branches of the testicular (ovarian) artery, the branches of the renal and capsular arteries. In the proximal ureter their anastomosis is determined. Variations of blood supply to the abdominal part of the ureter are arterial branches from the aorta and common glomerular arteries. At the end of the fetal period of human ontogenesis the shape of the ureter’s arteries becomes twisty that coinciding with the accelerated growth rate of their length and the slower increase of the ureter’s length. The paraureteral tissue in the surrounding layers of the retroperitoneal fascia, especially it is more prominent behind the abdominal part of the ureter, is clearly defined in the fetal period of the development. Venous outflow from the abdominal part of the ureter occurs proximally in the kidney, distally — in the ureter, capsular, testicular (ovarian) veins. An arcuate vein is clearly defined on the lateral surface of the pelvic-ureteral segment. It probably plays the role of a venous circular circle between different ways of blood outflow from the abdominal part of the ureter.Conclusions. 1. Blood supply of the abdominal segment of ureter in fetuses is ensured by the branches of the ureteral, testicular (ovarian) and renal capsular arteries. 2. The parapelvic ureteral segment is characterized by the availability of the three intraparietal venous plexuses located in the submucous, muscular and adventitial tunics anastomosing between themselves due to permeable veins. 3. A venous collector of the abdominal segment of ureter is arcuate vein located on its lateral wall. Venous outflow occurs in two directions: cranially — in the capsular and renal veins, caudal — in the capsular, ureteral and testicular (ovarian) veins. 4. 4–5 months of the development are critical periods of the abdominal ureter. This is a time for possible occurrence of congenital defect variants of blood vessels syntopia.

Application of side-hole catheter technique for transradial arterial chemoembolization in patients with hepatocellular carcinoma.

The purpose of this study was to retrospectively evaluate the efficacy and safety of side-hole catheter technique for transarterial chemoembolization (TACE) via transradial artery access (TRA) in patients with hepatocellular carcinoma. From November 2015 to August 2017, a total of 1040 TACE procedures were performed via TRA for hepatocellular carcinoma. In 10 (1%) of these 1040 TACE procedures via TRA, conventional microcatheter technique (CMT) failed and side-hole catheter technique was attempted. Ten procedures of selective catheterizations by CMT failed due to the poor stability of the angiographic catheters or the target artery arising from the very proximal portion of the parent artery. These arteries included the right inferior phrenic artery in eight patients, one left gastric artery, and one right renal capsular artery. Cobra or MPA catheter with the microcatheter through the side-hole yielded a technical success rate of 100%. No procedure-related complications were observed. The mean time required to catheterize the target artery with the side-hole catheter was 9.5min (5-15min). Side-hole catheter technique may enable the completion of chemoembolization in cases that a potential tumor-feeding vessel cannot be catheterized by means of CMT for TACE via TRA.

A Case of Spontaneous Rupture of Hepatocellular Carcinoma Supplied by the Right Renal Capsular Artery Treated by Transcatheter Arterial Embolization

We present a case of spontaneous rupture of hepatocellular carcinoma with poor liver function managed by transcatheter arterial embolization (TAE). The patient’s bilirubin level was 2.1 mg/dL, albumin level was 2.4 g/dL, and prothrombin time international normalized ratio was 2.1. In addition, the patient had also developed a large number of ascites. The tumor was supplied by the right renal capsular artery, as observed on angiography. With successful TAE, no hepatic failure occurred. We believe TAE can be a safe and effective treatment option, even in patients with poor liver function, if tumors are supplied only by extrahepatic collateral vessels. (J Liver Cancer 2019;19:59-63)

Supplemental conventional transarterial embolization/chemoembolization therapy via extrahepatic arteries for hepatocellular carcinoma.

To assess the value of conventional transarterial embolization/chemoembolization (cTAE/TACE) therapy via extrahepatic arteries for patients with unresectable hepatocellular carcinoma (HCC). Patients with unresectable HCC who underwent cTAE/TACE therapy via extrahepatic arteries between May 2008 and July 2016 across 4 medical centers were identified. The technical success, serum alpha-fetoprotein (AFP) levels changes, tumor response, disease control rate, survival rate, and major complication were analyzed. A total of 185 patients (167 male and 18 female) were included in this study. A total of 401 procedures were performed of the 185 patients, with 2.2 ± 0.4 procedures for each patient. A total of 197 extrahepatic arteries were identified, including inferior phrenic artery (n = 80), omental artery (n = 39), gastric artery (n = 22), right renal capsular artery (n = 21), adrenal artery (n = 13), cystic artery (n = 11), and right internal mammary artery (n = 11). The technical success rate was 96.8% (179/185). The serum AFP levels were significantly reduced at 1 month after treatment in 71 patients whose AFP ≥400 ng/mL preprocedure (P < 0.01). The disease control rate was 93% (172/185) at 3 months after cTAE/TACE, with partial response, stable disease, or progressive disease of 115, 57, and 13 patients, respectively. The cumulative survival rate from the time of cTAE/TACE via extrahepatic arteries was 100% at 6 months. There were no embolization-related major complications. cTAE/TACE therapy via the extrahepatic arteries can reduce the incidence of presence of residual HCC, and improve the therapeutic efficacy of cTAE/TACE.

Transcatheter Arterial Embolization of Angiographically Visible and Occult Renal Capsular Artery Hemorrhage in 28 Patients

PurposeTo evaluate the effectiveness and safety of transcatheter arterial embolization to control bleeding from the renal capsular artery (RCA). Materials and MethodsEmbolization was performed in 28 patients (14 men; mean age, 49.7 y). Presence and type of previous invasive procedures, initial presentation, and coagulation profile were reviewed. Any preceding abdominal computed tomography (CT) findings were analyzed. Angiographic findings were categorized as active bleeding, suspicious for bleeding, or no bleeding. Technical and clinical success and clinical outcomes were evaluated. Changes in hemoglobin level and transfusion volume of packed red blood cells (pBRCs) before and after embolization were evaluated with the paired t test and Wilcoxon signed-rank test, respectively. ResultsTechnical and clinical success rates of therapeutic embolization for active bleeding (n = 11) were 90.9% and 80%, respectively. One case of technical failure (5.9%) and 3 cases of postembolization bleeding (18.7%) were noted in the prophylactic embolization group in patients with suspicion of bleeding (n = 13) or no bleeding (n = 4). Transient renal insufficiency occurred in 4 patients (14.3%). The average hemoglobin level and volume of transfused pBRCs changed from 8.1 g/dL to 9.9 g/dL and from 871 mL to 543 mL, respectively (P < .05). Extravasation of contrast media or acute hematoma in the right subhepatic or perirenal space on CT was noted in 21 patients (78%). ConclusionsEmbolization can provide an effective and safe method to control RCA bleeding. Perirenal invasive procedures and signs of active or recent right subhepatic or perirenal hemorrhage should raise the suspicion of an RCA source.

Transarterial embolization of renal VX2 tumors with liquid embolic agent poly 2-hydroxymethyl methacrylate-co-methyl methacrylate in a rabbit model

Objective To study the feasibility and effectiveness of liquid embolic agent HEMA-MMA in the arterial embolization therapy for the rabbit renal VX2 tumor models. Methods Renal VX2 tumor models were inoculated with the method of percutaneous CT-guided implantation of a small fragment of tumor into the inferior pole of the right kidney and were embolized when the max diameter was 1.5 cm. One model was embolized with the mixture of HEMA-MMA and carbonyl iron powder and was harvested immediately after embolization, the sample was fixed by paraformaldehyde for histopathological examination with methylene blue staining and HE staining to demonstrate the sizes of the vessels that the HEMA-MMA could reach. The remaining models were treated with pure HEMA-MMA by superselective or nonselective embolization (SSE or NSE). In SSE group, only the renal artery branch supplying the tumor was superselectively catheterized and embolized until the presence of artery casting change. In NSE group, the microcatheter was catheterized into the main renal artery then the whole renal artery branches and the renal capsular artery were embolized simultaneously until the presence of artery casting shape. Non-enhanced CT scans at immediate postoperation, on postoperative day 1 and day 3 were performed. The enhanced CT scans at the postoperative 1, 2, 4 and 6 weeks were performed. Necrotic zone of the tumor was defined as non-enhancement in parenchyma phase, residual tumor was defined as delayed enhancement around the necrotic zone or obvious thickness and enhancement of the adjacent renal capsule. When detecting residual tumor, the model was followed up another 1 week and then harvested for histopathological examination. If there was no residual tumor and lung metastasis in 6 weeks follow-up after operation, we defined this as complete necrosis and then harvested the kidney for histopathological examination. Results Eleven of the 12 rabbits were successfully inoculated VX2 tumors. The mixture of HEMA-MMA and carbonyl iron powder deposited in the arterial vessels demonstrated mazarine in methylene blue staining and brownness in HE staining. The diameter of the tumor vessels which the agent could reach was 30—150 μm, there was no embolic agent detected in the venous blood vessels. 5 models were performed with superselective embolization and the other 5 were embolized with nonselective embolization. The embolic agent demonstrated high density and obviously deposited in the surrounding zone of the tumor on immediate postoperative CT images, density of the surrounding zone decreased accompanied by density increase in the central area of the tumor on the first day postoperative CT images. Density difference between the embolism zone and normal renal tissue disappeared on the third day postoperative CT images accompanied by swelling changes of the embolized area. Residual tumor was detected in all 5 superselectively treated cases (2 in 1 week, 3 in 2 weeks), which located in the area of junctional zone and subrenal capsule. The necrotic zone was demonstrated coagulative necrosis on histopathologic images, the boundary between the residual tumor and the necrotic zone was clearly showed both on histopathologic images and gross specimen. Renal capsular artery participating in the residual tumor blood supply was also shown on gross specimen. There was no residual tumor and lung metastasis detected in nonselective treated group during the period of 6 weeks follow-up. Atrophy of the whole tumor-burdened kidney was shown on gross specimen and complete coagulative necrosis of the total tumor and the renal capsule adjacent to the tumor was demonstrated on histopathologic images. Conclusions Liquid embolic agent HEMA-MMA can embolize tumor blood vessels with a diameter of 30—150 μm. The renal capsular artery participates in the blood supply of the VX2 kidney tumor, so only superselective embolization of the renal artery branch with this liquid embolic agent may not induce the whole necrosis of the tumor, but complete necrosis of the tumor can be obtained by embolizing of all the tumor vessels and the adjacent normal renal arteries with this liquid embolic agent. Key words: Kidney neoplasms; Embolization, therapeutic; Rabbits

Incidence and therapeutic frequency of extrahepatic collateral arteries in transcatheter arterial chemoembolization of hepatocellular carcinoma: Experience from 182 patients with survival time more than 3 years

PurposeTo retrospectively evaluate the incidence of each extrahepatic collateral artery (EHCA) supplying to hepatocellular carcinoma (HCC) in sessions of transcatheter arterial chemoembolization (TACE) and its therapeutic frequency. Materials and methodsBetween February 2002 and May 2008, 182 patients with HCC underwent TACE and survived more than 3 years. For TACE procedure, angiographic evaluation of all suspected EHCAs that could supply the tumor were performed. The incidence of EHCAs in TACE sessions and therapeutic frequency were analyzed. Correlations between the number of collaterals and the number of TACE sessions were investigated. Results162 patients showed 647 EHCAs supplying tumors in a total of 795 sessions of TACE. The initially confirmed EHCAs in TACE sessions were the right inferior phrenic artery (RIPA, n=150), left inferior phrenic artery (LIPA, n=8), right internal mammary artery (RIMA, n=4), right adrenal artery (RAA, n=2) and left gastric artery (LGA, n=5), respectively. The incidences of EHCAs were 51.1%, 68.1%, 50.0%, 50.0%, 42.3%, 34.6%, 29.1%, 19.8%, 6.6%, 3.3% and 0.6% from 1 to 11 session of TACE, respectively. The RIPA was accounted for 62.5% of EHCAs and other EHCAs often occurred after the attenuation of RIPA. There were correlations between the number of TACE sessions and either the sum number of collaterals (r=−0.961; p<0.001), the number of RIPA(r=−0.948; p<0.001) or the number of LGA(r=−0.670; p=0.024). The mean therapeutic frequencies of TACE were 2.6, 1.5, 1.6, 1.3, 1.5, 1.2, 3.3, 1.1, 1.0 and 7.0 times for the RIPA, LIPA, RIMA, left internal mammary artery (LIMA), omental artery (OMA), LGA, right intercostal artery (RICA), RAA, right renal capsular artery (RRCA) and colic artery (COA), respectively. ConclusionsThe RIPA angiography should be routinely performed in TACE procedure. EHCAs should be searched during the sessions of TACE in the following order: RIPA, RIMA, LIPA and other collaterals of lower incidence.

Efficacy of automated tumor-feeder detection software using cone-beam computed tomography technology in transarterial embolization through extrahepatic collateral vessels for malignant hepatic tumors.

We evaluated the performance of automated tumor-feeder detection (AFD) software using cone-beam computed tomography technology in identifying tumor-feeders of extrahepatic collaterals. AFD was prospectively used in superselective transarterial chemoembolization (TACE) or embolization (TAE) of extrahepatic collaterals for 29 hepatocellular carcinomas and one liver metastasis (mean tumor diameter ± standard deviation, 28 ± 15.6 mm) in 25 patients. The detectability of extrahepatic tumor-feeders with non-selective digital subtraction angiography (DSA) and AFD was evaluated and compared using a χ(2) -test. Tumor response of target lesions in each patient at 2-3 months after treatment was evaluated using the modified Response Evaluation Criteria in Solid Tumors. Complications were also evaluated. Of 46 tumor-feeders, non-selective DSA and AFD could identify 26 and 44, respectively (P < 0.001). Regarding the origin of tumor-feeders, both non-selective DSA and AFD could identify 14 of 15, six of seven and two of two tumor-feeders of the right inferior phrenic, omental and right renal capsular artery, respectively. In the cystic and left gastric or right colic artery, AFD could identify 13 of 13 and nine of nine tumor-feeders but non-selective DSA could identify only three of 13 and one of nine, respectively (P < 0.001). Complete response was obtained in 15 patients, partial response in six, stable disease in three and progressive disease in one. No severe complications developed except for right pleural effusion after embolization of the right inferior phrenic artery. AFD has a sufficient ability to identify extrahepatic tumor-feeders and may improve the safety and local effects of TACE/TAE of extrahepatic collaterals.

Imaging findings and transarterial therapy of primacy hepatic carcinoma fed by right renal capsular artery

To evaluate the characteristics of primary hepatic carcinoma (PHC) teed by the right renal capsular artery(RRCA) and to assess the technical success rate,tumor response and complications in patients treated with transcatheter arterial chemoembolization (TACE) via the RRCA with or without other extrahepatic arteries and/or intrahepatic arteries. From July 2010 to February 2014,23 patients were treated by TACE via the RRCA. We evaluate the characteristics of tumor, the blood supply situation of RRCA and the technical success rate, complications and tumor response of TACE via the RRCA. Tumor size was 90.60+/-48.23 mm. Of the 23 rumors,3 were located in segment V, 11 in segment VI and 9 in segment VII.8 cases were found to have RRCA supply at the first TACE session. The technical success rate was 100%.No severe complication occurred in 23 patients. Among the 23 patients, CR, PR, SD and PD were achieved in 3(13.0%), 10(43.5%), 2(8.7%), 8(34.8%) respectively. The objective response rate was 56.5%. The overall cumulative 6 month, 1-3-and 5-year survival rates and the median survival time were 82.6%, 52.2%,21.7%, 17.4% and 16.8 months, respectively. RRCA can participate in tumor blood supply when it located in the right hepatic lobe and with a larger diameter, or it was small but located in the bare area.Superselective intubation of RRCA with microcatheter and precise TACE via right renal capsular artery is safe ,effective and feasible.

Transarterial Therapy of Hepatocellular Carcinoma Fed by the Right Renal Capsular Artery

PurposeTo evaluate the characteristics of hepatocellular carcinomas (HCCs) fed by the right renal capsular artery and to assess the tumor response and complications in patients treated with transarterial therapy via the renal capsular arteries with or without other extrahepatic arteries and/or intrahepatic arteries. Materials and MethodsBetween March 2006 and May 2012, 24 lesions in 19 patients were treated by transcatheter arterial chemoembolization (23 sessions), transcatheter arterial embolization (two sessions), or transcatheter arterial infusion (one session), with HCCs fed by the right renal capsular artery with or without intrahepatic arteries and/or other collateral arteries. Other intrahepatic lesions were concurrently treated if needed. ResultsTumor size ranged from 10 mm to 107 mm (mean, 30.5 mm). Of the 24 tumors, 12 were located in segment VI, 10 in segment VII, one in the posterior segment, and one in the anterior segment after posterior segment resection. Severe complication occurred in four patients: liver abscess (n = 2), pleural effusion (n = 1), and duodenal ulcer (n = 1). Pleural effusion might be related to chemoembolization via the right renal capsular artery. A complete response was obtained in six sessions and a partial response in eight; 10 sessions were associated with stable disease and two with progressive disease. ConclusionsPrecise renal capsular artery knowledge would facilitate successful and safe transarterial therapy for HCCs fed by the renal capsular arteries.

Spontaneous Perirenal Hemorrhage from Renal Capsular Artery in Cauda Equina Syndrome: A Case Report

PM&RVolume 5, Issue 9S p. S271-S271 Neurological Rehabilitation Spontaneous Perirenal Hemorrhage from Renal Capsular Artery in Cauda Equina Syndrome: A Case Report Hyun Seok MD, PhD, Hyun Seok MD, PhD Soonchunhyang University Bucheon Hospital, Bucheon, Republic of KoreaSearch for more papers by this author Hyun Seok MD, PhD, Hyun Seok MD, PhD Soonchunhyang University Bucheon Hospital, Bucheon, Republic of KoreaSearch for more papers by this author First published: 17 September 2013 https://doi.org/10.1016/j.pmrj.2013.08.467Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article. Volume5, Issue9SSeptember 2013Pages S271-S271 RelatedInformation

Spontaneous Perirenal Hemorrhage in Cauda Equina Syndrome: A Case Report

Neurogenic bladder is a common cause of acute pyelonephritis (APN) in cauda equina syndrome (CES). Perirenal hemorrhage, a rare complication of APN, can be a life-threatening condition. To our knowledge, there is no previous report of perirenal hemorrhage as a complication of APN in CES. A 57-year-old male, diagnosed with CES, due to a L3 burst fracture 3 months earlier, was presented with fever and chills. His diagnosis was APN due to neurogenic bladder. After treatment for APN, he was transferred to the department of rehabilitation medicine for management of his CES. Because of large post-voiding residual urine volumes, he performed self-catheterization after voiding. However, he presented again with fever and chills, and recurrent APN was diagnosed. On the third day of antibiotic treatment, he had acute abdominal pains and hypovolemic shock. Abdominal computed tomography and angiography showed left APN and a perirenal hematoma with left renal capsular artery bleeding. After embolization of the left renal capsular artery, no further active bleeding occurred. Because APN due to neurogenic bladder can lead to critical complications, such as perirenal hemorrhage, the physician should pay attention to the early diagnosis and treatment of urinary tract infection and the management of neurogenic bladder after CES.

Incidence and Management of Postoperative Abdominal Bleeding After Liver Transplantation

PurposeTo assess the incidence and management of postoperative abdominal bleeding after orthotopic liver transplantation (OLT) and to identify risk factors for abdominal bleeding. MethodsWe retrospectively reviewed the medical records of 1039 patients who underwent OLT at our institution from January 2008 to December 2010 seeking to identify subjects with posttransplantation abdominal bleeding, defined as any hemorrhage requiring radiologic intervention or laparotomy within the first month. ResultsAmong the 1039 patients, 94 (9%) showed abdominal bleeding, occurring at a mean of 6.1 days (range, day 1 to 21 days). Active bleeding was controlled by endovascular interventional techniques (n = 37; 39%), by surgical ligation or vascular reconstruction (n = 43; 46%), or by sequential combinations of endovascular intervention and surgery (n = 14; 15%). The most frequent bleeding sites for radiologic intervention were the right inferior phrenic artery (n = 14), right and left epigastric arteries (n = 7), intercostal artery (n = 5) and right renal capsular artery (n = 4). The most frequent bleeding sites requiring laparotomy were the hepatic artery (n = 9), diaphragm (n = 8), inferior vena cava (n = 5), abdominal drain insertion site (n = 4), portal vein anastomosis site (n = 4), abdominal wall (n = 3), liver graft cut surface (n = 3), hilar plate (n = 3), and greater omentum (n = 3). Bleeding episodes were associated with greater patient age and increased intraoperative blood loss. ConclusionsThe risk of bleeding from coagulopathy and iatrogenic injury is high during the early posttransplantation period. This risk of bleeding can be minimized by meticulous surgical dissection and bleeding control.

The March of Extrahepatic Collaterals: Analysis of Blood Supply to Hepatocellular Carcinoma Located in the Bare Area of the Liver After Chemoembolization

The purpose of this study was to evaluate changes in vascular supply to hepatocellular carcinoma (HCC) located in the bare area of the liver in patients who were mainly treated with chemoembolization. Twenty-six patients with HCC showing a mean diameter of 3.1 +/- 1.4 cm (mean +/- standard deviation) were mainly treated with chemoembolization. All patients underwent 2.7 +/- 2.3 chemoembolization sessions over 40.1 +/- 25.2 months. Tumor feeding branches demonstrated in each chemoembolization session were retrospectively evaluated. Initially, 18 tumors (59.2%) were supplied by the hepatic artery (H) and 8 (30.8%) by both the hepatic and the extrahepatic arteries (H + C). Fourteen tumors (53.8%) recurred at the posterior aspect of the tumor and were supplied by H (n = 4), H + C (n = 5), and extrahepatic collaterals (C) (n = 5). Several tumors recurred despite repeated chemoembolization, and these were supplied by H (n = 1), H + C (n = 7), and C (n = 2) at the second recurrence, by H (n = 1), H + C (n = 2), and C (n = 3) at the third, by H + C (n = 2) and C (n = 2) at the fourth, by H + C (n = 2) and C (n = 2) at the fifth, and by H (n = 1) and C (n = 1) at the sixth. One tumor was supplied by H at the seventh and by H + C at the eighth recurrence. As the number of local recurrences increased, the feeding vessel shifted from H to C. Especially, the right inferior phrenic artery (IPA) and renal capsular artery (RCA) supplied the tumor early, while the small right RCAs, adrenal arteries, and intercostal and lumbar artery supplied late recurrences in turns. In conclusion, HCCs located in the bare area are frequently supplied by extrahepatic vessels initially, while recurrence after chemoembolization is mainly due to extrahepatic blood supply. The right IPA and RCA are common feeding vessels demonstrated early, while other extrahepatic collateral supply from the retroperitoneal circulation occurs in turns during the later course.

Transarterial ethanol ablation for sporadic and non-hemorrhaging angiomyolipoma in the kidney

Purpose We evaluated the efficacy and side effects of transarterial ethanol ablation in sporadic and non-hemorrhaging angiomyolipomas (AMLs) in the kidney. Material and Methods A total of 10 patients with solitary and sporadic AMLs underwent selective transarterial absolute ethanol ablation for prophylaxis against hemorrhage. We confirmed the ratio areas of tumor vessel on angiogram, those of infraction on post-ablation computed tomography (CT) and those of tumor reduction in a 3-, 6- and 12-month follow-up CT. Results Once or twice a single infusion of 1 or 2 ml absolute ethanol achieved in a total occlusion of 22 feeding arteries which consisted of 7 proximal interlobar arteries, 12 distal interlobar arteries and 3 renal capsular arteries. Nontarget occlusion did not occur by ethanol reflux in any cases but occurred causing spasms provoked by repeated inflation and deflation of the balloon in one case. Total occlusion of tumor vessels was observed in 7 patients and 92–95% occlusion in 3. Ethanol ablation produced 1.8–22.5% (mean 8.4 ± 6.8%) areas of infarctions but the outcome was not serious in all cases. Mean percentage areas of tumor reduction were 29.4 ± 10.6% in a 3-month follow-up, 45.7 ± 11.9% in a 6-month and 59.3 ± 11.5% in a 12-month follow-up. Conclusions Absolute ethanol ablation for sporadic and non-hemorrhaging AML is safe and effective in reducing majority of tumor area in a 1-year follow-up.

Extrahepatic Blood Supply to Hepatocellular Carcinoma: Angiographic Demonstration and Transcatheter Arterial Chemoembolization

To evaluate the incidence of each extrahepatic collateral pathway to hepatocellular carcinoma (HCC) and to assess technical success rates and complications of transcatheter arterial chemoembolization (TACE) through each collateral. We retrospective evaluated extrahepatic collateral pathways to HCC on angiography in 386 procedures on 181 consecutive patients. One hundred and seventy patients had previously undergone TACE. TACE through extrahepatic collaterals using iodized oil and gelatin sponge particles was performed when a catheter was advanced into the tumor-feeding branch to avoid nontarget embolization. A single collateral was revealed in 275 TACE procedures, two were revealed in 74, and three or more were revealed in 34. Incidences of collateral source to HCC were 83% from the right inferior phrenic artery (IPA), 24% from the cystic artery, 13% from the omental artery, 12% from the right renal capsular artery (RCA) and left IPA, 8% from the right internal mammary artery (IMA) and right intercostal artery (ICA), and 7% from the right inferior adrenal artery (IAA). Technical success rates of TACE were 53% in the right ICA, 70% in the cystic artery, 74% in the omental artery, 93% in the left IPA, 96% in the right IPA, and 100% in the right RCA, right IMA, and right IAA. Complications included skin necrosis after TACE through the right IMA (n = 1), cholecystitis after TACE through the cystic artery (n = 1), and ulcer formation after TACE through the right gastric artery (n = 1), in addition to pleural effusion and basal atelectasis after TACE through the IPA and IMA. Our study suggests that TACE through extrahepatic collaterals is possible with high success rates, and is also relatively safe.

Recognizing Extrahepatic Collateral Vessels That Supply Hepatocellular Carcinoma to Avoid Complications of Transcatheter Arterial Chemoembolization

Extrahepatic collateral arteries commonly supply hepatocellular carcinomas if the tumors are large or peripherally located. Because development of these vessels interferes with effective control of the tumor with transcatheter arterial chemoembolization (TACE), radiologists should become familiar with the imaging findings of extrahepatic collateral vessels to detect them at an early stage. The authors observed 2104 such vessels in 860 patients over 5.5 years. The extrahepatic collateral vessels observed originated from the inferior phrenic artery, omental branch, adrenal artery, intercostal artery, cystic artery, internal mammary artery, renal or renal capsular artery, branch of the superior mesenteric artery, gastric artery, and lumbar artery. The authors suspected extrahepatic collateral vessels when (a) a tumor grew exophytically or invaded adjacent organs, (b) a tumor was in contact with the ligaments and bare area of the liver, (c) a hypertrophied extrahepatic collateral vessel was observed on a computed tomographic (CT) scan, (d) a peripheral defect of iodized oil retention within a tumor was seen during chemoembolization or on a follow-up CT scan, (e) a local recurrence developed at the peripheral portion of the treated tumor during follow-up, or (f) a sustained elevation in serum alpha-fetoprotein level was noted despite adequate embolization of the hepatic artery. When both the hepatic artery and extrahepatic collateral vessels supply a tumor, additional extrahepatic collateral vessel chemoembolization should be attempted to increase the therapeutic efficacy of TACE for hepatocellular carcinoma.

Hepatocellular carcinoma supplied by the ileocolic branch of the superior mesenteric artery

Transcatheter arterial chemoembolization (TACE) is now accepted as an effective palliative therapy for unresectable hepatocellular carcinoma (HCC). However, as noted in previous studies, this malignancy often parasitizes collateral vessels. This is of particular concern during repeat chemoembolization procedures. Other identified sources of collateral blood supply to HCC which have been described include the internal mammary arteries, omental branches usually from the gastroepiploic or the dorsal pancreatic artery, inferior phrenic artery, cystic artery, right renal capsular artery and the intercostal arteries. We report a case of exophytic HCC supplied by the ileocolic division of the superior mesenteric artery (SMA). To our knowledge, having reviewed the literature, this represents the first case of parasitization of this vessel.

Solitary fibrous tumor of the kidney originating from the renal capsule and fed by the renal capsular artery

Solitary fibrous tumors (SFT) are relatively rare spindle cell neoplasms that typically arise in the pleura. Recently, extrathoracic SFT that have arisen in various anatomic sites have been recognized. The histogenesis and prognosis of SFT of the kidney are not well understood because only 11 cases have been reported. We report a case of SFT of the left kidney arising from the renal capsule. The tumor was merged with the upper pole of the left renal capsule. The angiography revealed that the renal capsule artery fed the tumor. The tumor was a well-circumscribed, solid mass attached to the renal capsule without necrosis or hemorrhage. Microscopically the bland spindle cells proliferated and were accompanied by hyalinized collagenous tissue showing patternless or hemangiopericytomatous patterns. Some glomeluri and renal tubules were entrapped by the tumor cells. There were no mitotic figures. Immunohistochemically the tumor cells were diffusely positive for CD34, CD99 and bcl-2. There was no evidence of recurrence after a 4 year follow-up visit. The origin of SFT of the kidney remains uncertain. The tumor in this case merged with the renal capsule and was fed by the renal capsular artery, which suggests that some SFT of the kidney originate from the renal capsule.

Percutaneous renal biopsy complicated by renal capsular artery pseudoaneurysm

We report a case of renal capsular artery pseudoaneurysm caused by percutaneous renal biopsy. The injury was diagnosed and treated with arteriography and transarterial embolization. Because the arterial injury was extraparenchymal, the clinical manifestations of blood loss were flank pain and decreasing hematocrit without hematuria. Injury to renal capsular arteries during percutaneous renal biopsy is a rare possibility because of their small size. (Am J Kidney Dis 1998 Mar;31(3):533-5)