-2 :: Case - 8318 :: - Importance of recognizing vascular anatomy in chemoembolization
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Tx and Followup:
The replaced vessel was used to deliver the chemoembolic agents.

Discussion Author: George Spencer

Chemoembolization is recognized as a useful procedure for stemming the growth of liver tumors, whether primary or metastatic. During the course of the procedure, chemotherapeutic agents are delivered as directly as reasonably possible to the lesion(s) of concern. Of course, mis-delivery of these toxic agents is an undesired complication. Therefore, recognition of each patient's vasular anatomy in relation to the lesion(s) of interest is essential prior to delivery of the agents. The superior mesenteric artery and the celiac artery are each evaluated to determine which vessels contribue to a lesion's vascular supply. Vessels primarily contributing to the tumor's blood supply are used for the chemoembolization procedure.

One important variation of normal anatomy, occurring in about 10% of patients, is replacement of the right hepatic artery from its normal origin from the hepatic (proper) artery to the superior mesenteric artery.

Others include:
Hepatic gives off right hepatic and middle hepatic; left hepatic is replaced from left gastric. (10-12%)

Hepatic gives off right, middle, and left hepatic; an accessory left hepatic from left gastric. (8-13%)

Hepatic gives off right, middle, and left hepatic; an accessory right hepatic from superior mesenteric. (4-6%)

Entire hepatic trunk arises from superior mesenteric, there being no celiac hepatic artery. (2.5%)

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