Angiographic Anatomy and Relevance of 3 and 9 O'clock Arteries During Radioembolization
| Autor: | Frank Fischbach, Maciej Pech, Oliver S. Grosser, Max Seidensticker, Shahen El-Sanosy, Jazan Omari, Bartosz Bascik, Maciej Powerski |
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| Rok vydání: | 2017 |
| Předmět: |
Adult
Male Nausea medicine.medical_treatment Brachytherapy Cystic artery Epigastric pain 030218 nuclear medicine & medical imaging Gastroduodenal artery 03 medical and health sciences 0302 clinical medicine Hepatic Artery medicine.artery medicine Humans Radiology Nuclear Medicine and imaging Yttrium Radioisotopes Embolization Aged Retrospective Studies Aged 80 and over medicine.diagnostic_test business.industry Liver Neoplasms Angiography Anatomy Middle Aged medicine.anatomical_structure Common hepatic duct Liver Vomiting 030211 gastroenterology & hepatology Female medicine.symptom Cardiology and Cardiovascular Medicine business |
| Zdroj: | Cardiovascular and interventional radiology. 41(6) |
| ISSN: | 1432-086X |
| Popis: | 3 and 9 o’clock arteries (3&9As) which supply the common hepatic duct connect hepatic with duodenal/pancreatic territories. The study purpose is to describe the angiographic anatomy of 3&9As and discuss their relevance when performing radioembolization (RE) of liver malignancies. The anatomy of the 3&9As was systematically investigated by a retrospective analysis of angiograms, technetium Tc-99 m-macroaggregated albumin (MAA) scintigrams, yttrium-90 (Y90) Bremsstrahlung-SPECT/CT datasets, and clinical data of 153 patients who underwent RE between 2010 and 2013. Analysis of preprocedural angiograms identified 3&9As in 36 (24%) of the 153 patients. Following embolization of the gastroduodenal artery, 3&9As were seen in 53 cases (35%). The three most common origins of the 3&9As were the right hepatic artery (n = 14), the cystic artery (n = 11), and S5 and S6 segmental arteries (n = 5 each). Extrahepatic Tc-99 m-MAA deposition in the territory of the 3&9As was significantly more frequent when 3&9As were detectable on preprocedural angiograms (28%visible vs. 11%not visible; p = 0.001) and especially when the 3&9As were not embolized or bridged prior to RE (50%not occluded/bridged vs. 19%occupied/bridged; p = 0.043). The presence of extrahepatic Y90 Bremsstrahlung after RE (n = 17) was attributable to microsphere diversion via the 3&9A territory in four patients and possible diversion via this territory in nine patients. Five of these 13 patients presented with epigastric pain, nausea, or vomiting (CTCAE severity grade ≤ 3) (p = 0.014). 3&9As are commonly detectable during evaluation angiography prior to RE, have a variable angioanatomic origin, and should be prophylactically occluded to prevent complications. |
| Databáze: | OpenAIRE |
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