Chulalongkorn Medical Journal


Background : Extrahepatic collaterals that supply hepatocellular carcinoma(HCC) were frequently encountered. Transarterial chemoembolization(TACE) of these vessels increased the efficiency controlof tumor. Impact of these collaterals in term of prevalence,success rate of TACE and complication were described.Objective : To find the prevalence of each extrahepatic collateral thatsupplied HCC and clarify technical success rates andpostprocedural complications following TACE of these vessels.Design : Retrospective descriptive study.Materials and Methods : We retrospectively reviewed angiograms and angiographicreports of 1,351 TACE sessions from 602 HCC patients between2008 - 2010. Patients with tumor supply from extrahepaticcollaterals were included. Then patient demographics, prevalenceof the each extrahepatic collateral, technical success rates ofTACE and post-TACE complications were recorded.Results : From the total of 141 cases of HCC, 119 men and 22 womenwith their median age 58 years old were found extrahepaticarterial supplies to the tumor on angiogram. Most patients hadchronic viral hepatitis or liver cirrhosis. The right inferior phrenicartery was the most common extrahepatic collateral vessel,followed by the right intercostal artery and the right gastroepiploicartery. There were high technical success rates of TACE viathe right adrenal artery (100%), cystic artery (100%), rightintercostal artery (96.3%), left inferior phrenic artery (94.7%)and right inferior phrenic artery (92.86%). TACE via thegastroduodenal artery (64.7%), superior mesenteric artery (65%)and right renal artery (66.7%) showed less technical successrates. Of the total 195 extrahepatic vessels that we embolized,only 4 patients developed complications. There was no procedurerelated mortality.Conclusions : HCCs with extrahepatic arterial blood supply were frequentlyfounded in our institute (23%). There were varying branches ofextrahepatic collateral arteries, which the right inferior phrenicartery was the most common. Selective chemoembolization ofthese vessels was safe. Postprocedural complications wereseldom observed. Therefore, extrahepatic collateral supply toHCC should be sought and treated for effective tumor control.


Faculty of Medicine, Chulalongkorn University

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