Pattern of extrahepatic collateral supply in recurrent hepatocellular carcinoma post-transcatheter arterial chemoembolization
Abstract Background Transcatheter arterial chemoembolization (TACE) is regarded as the first-line non-surgical management option for hepatocellular carcinoma (HCC). Subsequent development of extrahepatic collateral vessels markedly impairs the efficiency of TACE. Such collaterals may have various pa...
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SpringerOpen
2025-05-01
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| Series: | The Egyptian Journal of Radiology and Nuclear Medicine |
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| Online Access: | https://doi.org/10.1186/s43055-025-01467-4 |
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| author | Minatallah Elsadek Mohamed El-Gharieb Allam Elsayed |
| author_facet | Minatallah Elsadek Mohamed El-Gharieb Allam Elsayed |
| author_sort | Minatallah Elsadek |
| collection | DOAJ |
| description | Abstract Background Transcatheter arterial chemoembolization (TACE) is regarded as the first-line non-surgical management option for hepatocellular carcinoma (HCC). Subsequent development of extrahepatic collateral vessels markedly impairs the efficiency of TACE. Such collaterals may have various patterns as they easily change according to the tumor size and location. Aim To describe the pattern of extrahepatic collateral supply in patients with recurrent HCC who were previously treated with chemoembolization at our department. Methods A prospective interventional single-arm study that included 15 patients with recurrent HCC who underwent previous TACE sessions. Patients were retreated with TACE and the pattern of extrahepatic collateral supply noted was described. Results The recurrent HCC lesions had a mean diameter of 6.60 ± 1.72 cm. Most extrahepatic collaterals (93.3%) occurred in tumors with a diameter > 5 cm. Collateral vasculature development was closely associated with the number of prior TACE interventions. The most common extrahepatic collaterals came from the inferior phrenic artery (60.0%), followed by the gastroduodenal artery (26.7%), internal mammary artery (6.7%) and suprarenal artery (6.7%). Based on the findings, we recommend that: (1) in tumor lesions located in liver segments 4a/8, 7 and 8 that are in close proximity to the right hemidiaphragm, right inferior phrenic artery selective angiography is considered obligatory, (2) for tumor lesions located in segments 4b, 5 and 6 in close contact with the duodenum, selective catheterization of the gastroduodenal artery should be considered, (3) right internal mammary artery selective angiography is recommended in patients with large tumor lesions adjacent to the ventral diaphragmatic aspect, and (4) tumor lesions located in the posteroinferior segment of the right hepatic lobe (e.g., segment 6) may receive collaterals from the right suprarenal arteries. Conclusions Our findings confirm previous reports that extrahepatic supply in HCC is associated with larger tumors, peripheral tumor location, and multiple TACE sessions, while also identifying four common EHCAs and their corresponding liver segments. |
| format | Article |
| id | doaj-art-ba32a288f07f4ec79ec8d7ca60d411bc |
| institution | OA Journals |
| issn | 2090-4762 |
| language | English |
| publishDate | 2025-05-01 |
| publisher | SpringerOpen |
| record_format | Article |
| series | The Egyptian Journal of Radiology and Nuclear Medicine |
| spelling | doaj-art-ba32a288f07f4ec79ec8d7ca60d411bc2025-08-20T01:47:33ZengSpringerOpenThe Egyptian Journal of Radiology and Nuclear Medicine2090-47622025-05-015611810.1186/s43055-025-01467-4Pattern of extrahepatic collateral supply in recurrent hepatocellular carcinoma post-transcatheter arterial chemoembolizationMinatallah Elsadek0Mohamed El-Gharieb1Allam Elsayed2Ain Shams University HospitalAin Shams University HospitalAin Shams University HospitalAbstract Background Transcatheter arterial chemoembolization (TACE) is regarded as the first-line non-surgical management option for hepatocellular carcinoma (HCC). Subsequent development of extrahepatic collateral vessels markedly impairs the efficiency of TACE. Such collaterals may have various patterns as they easily change according to the tumor size and location. Aim To describe the pattern of extrahepatic collateral supply in patients with recurrent HCC who were previously treated with chemoembolization at our department. Methods A prospective interventional single-arm study that included 15 patients with recurrent HCC who underwent previous TACE sessions. Patients were retreated with TACE and the pattern of extrahepatic collateral supply noted was described. Results The recurrent HCC lesions had a mean diameter of 6.60 ± 1.72 cm. Most extrahepatic collaterals (93.3%) occurred in tumors with a diameter > 5 cm. Collateral vasculature development was closely associated with the number of prior TACE interventions. The most common extrahepatic collaterals came from the inferior phrenic artery (60.0%), followed by the gastroduodenal artery (26.7%), internal mammary artery (6.7%) and suprarenal artery (6.7%). Based on the findings, we recommend that: (1) in tumor lesions located in liver segments 4a/8, 7 and 8 that are in close proximity to the right hemidiaphragm, right inferior phrenic artery selective angiography is considered obligatory, (2) for tumor lesions located in segments 4b, 5 and 6 in close contact with the duodenum, selective catheterization of the gastroduodenal artery should be considered, (3) right internal mammary artery selective angiography is recommended in patients with large tumor lesions adjacent to the ventral diaphragmatic aspect, and (4) tumor lesions located in the posteroinferior segment of the right hepatic lobe (e.g., segment 6) may receive collaterals from the right suprarenal arteries. Conclusions Our findings confirm previous reports that extrahepatic supply in HCC is associated with larger tumors, peripheral tumor location, and multiple TACE sessions, while also identifying four common EHCAs and their corresponding liver segments.https://doi.org/10.1186/s43055-025-01467-4Extrahepatic collateral supplyHepatocellular carcinomaTranscatheter arterial chemoembolization |
| spellingShingle | Minatallah Elsadek Mohamed El-Gharieb Allam Elsayed Pattern of extrahepatic collateral supply in recurrent hepatocellular carcinoma post-transcatheter arterial chemoembolization The Egyptian Journal of Radiology and Nuclear Medicine Extrahepatic collateral supply Hepatocellular carcinoma Transcatheter arterial chemoembolization |
| title | Pattern of extrahepatic collateral supply in recurrent hepatocellular carcinoma post-transcatheter arterial chemoembolization |
| title_full | Pattern of extrahepatic collateral supply in recurrent hepatocellular carcinoma post-transcatheter arterial chemoembolization |
| title_fullStr | Pattern of extrahepatic collateral supply in recurrent hepatocellular carcinoma post-transcatheter arterial chemoembolization |
| title_full_unstemmed | Pattern of extrahepatic collateral supply in recurrent hepatocellular carcinoma post-transcatheter arterial chemoembolization |
| title_short | Pattern of extrahepatic collateral supply in recurrent hepatocellular carcinoma post-transcatheter arterial chemoembolization |
| title_sort | pattern of extrahepatic collateral supply in recurrent hepatocellular carcinoma post transcatheter arterial chemoembolization |
| topic | Extrahepatic collateral supply Hepatocellular carcinoma Transcatheter arterial chemoembolization |
| url | https://doi.org/10.1186/s43055-025-01467-4 |
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