Arterial patency after repeated hepatic artery bland particle embolization

Abstract

Purpose: To evaluate hepatic arterial patency after serial bland particle embolization procedures in patients with hepatocellular carcinoma (HCC).

Materials and methods: All patients with HCC who underwent five or more hepatic artery bland embolization procedures with permanent particulate and spherical embolic agents between September 1996 and December 2007 were retrospectively reviewed. Data analyzed included patient demographics, vessels embolized, embolic agent used, and duration of arterial patency.

Results: Forty-three patients were identified who underwent five or more bland embolization procedures in the same arterial distribution. Of the 43 patients examined, 83% (n = 36) showed no change in the hepatic arterial tree after repeated bland embolization (mean treatment period of 48 months +/- 23). Six patients (13%) exhibited occlusion of a fifth-order or more distal vessel after an average of 5 embolizations +/- 2 over a period of 34 months +/- 27. A single case of vascular occlusion of a fourth-order vessel was observed after five embolizations over a period of 52 months.

Conclusions: Repeated bland embolization of the hepatic arteries in HCC preserves patency of the hepatic arterial vasculature despite the fact that embolization is carried out to complete stasis.

Figure 1.

(a) Initial digital subtraction angiogram of a 78-year-old man who underwent five right and one left hepatic artery bland embolizations. Black arrows point to the common hepatic artery in all four panels. (b) The hepatic arterial tree remains largely unchanged at the sixth bland embolization procedure performed 49 months later. (c) Initial digital subtraction angiogram of a 74-year-old woman who underwent nine right and seven left hepatic artery bland embolizations. (d) The hepatic arterial tree remains largely unchanged at the 12th embolization procedure performed 64 months later.

Figure 2.

Digital subtraction angiogram of a 63-year-old man who underwent five right hepatic artery bland embolizations. (a) Initial embolization procedure. (b) Fifth embolization procedure performed 38 months later. Only a single fifth-order branch of the right hepatic artery that was seen at the initial procedure (a, black arrows) had become occluded after five bland embolizations (b, gray arrows).