Go back
Title: Hepatic Artery Stenosis: An Unforeseen Challenge during TACE
e-poster Number: EPOS 38
Category: e Poster
Author Name: Dr. Gaurav Pawar
Institute:
Co-Author Name:
Abstract :
While performing the Trans Arterial Chemo Embolisation (TACE) of Hepatocellular Carcinoma it is crucial to know the anatomy and the common anatomical variations of Hepatic artery.
Classic anatomical branching pattern of hepatic artery is described as its origin from the Celiac artery and then the proper hepatic artery gets divided into the right and left hepatic branches. This is commonly seen in about 60% of population. However in the rest of the cases, the hepatic artery origin may be different.
Most common hepatic artery variation includes replaced right hepatic artery which arises from SMA in 12% of the cases. There can also be accessory hepatic artery with anomalous origin from right hepatic, proper hepatic or gastro-duodenal artery. Overall all this variations contribute to 40% of population. It is must to know origin in order to selectively cannulate the artery. In an variant anatomy, is it important to know the tumor feeders are from normal branch or variant artery.
Here we present an interesting case in which, the Hepatic artery anatomy was supposedly normal but still no tumor blush was seen. We tried cannulating all the possible origins of right hepatic artery including left hepatic artery, GDA and SMA.
Later, we re-visited to the cross-sectional imaging to discover there is focal stenosis in the right hepatic artery, which was likely changing the flow dynamics of the contrast reaching tumor and thus preventing the blush. When we tried angiogram from right hepatic artery with more injection pressure – satisfactory tumor blush was seen and then the TACE was completed in the conventional way.
This case depicts the importance of the knowledge of the variant anatomy and still how that may not be enough to face the challenges of the cases and how crucial it is for review and re-visit cross sectional imaging.
