RESUMEN
We present a case of spontaneous rupture of hepatocellular carcinoma with poor liver function managed by transcatheter arterial embolization (TAE). The patient's bilirubin level was 2.1 mg/dL, albumin level was 2.4 g/dL, and prothrombin time international normalized ratio was 2.1. In addition, the patient had also developed a large number of ascites. The tumor was supplied by the right renal capsular artery, as observed on angiography. With successful TAE, no hepatic failure occurred. We believe TAE can be a safe and effective treatment option, even in patients with poor liver function, if tumors are supplied only by extrahepatic collateral vessels.
Asunto(s)
Humanos , Angiografía , Arterias , Ascitis , Bilirrubina , Carcinoma Hepatocelular , Relación Normalizada Internacional , Hígado , Fallo Hepático , Tiempo de Protrombina , Rotura EspontáneaRESUMEN
Objective To evaluate the technical success rate,effectiveness and safety of transcatheter arterial chemoembolization (TACE)via the omental branch in the treatment of hepatocellular carcinoma (HCC)with blood supply from the omental branch. Methods 45 patients with HCC fed by the omental branch who had undergone TACE were evaluated retrospectively.Results All patients had undergone several therapeutic procedures including TACE before the revelation of the blood supply from the omental branch,8 patients had a history of surgery of hepatic resection for HCC.45 patients had 48 tumors total,52 omental branches were observed angiographically,48 omental branches (9 2%)were successfully embolized.Stenosis or occlusion of the hepatic artery was observed in 37 patients(82%).The alpha fetoprotein (AFP)levels were reduced from 5.05－4 246.89 ng/mL(mean,1 748.52 ng/mL)before treatment to 3.78－1 048.32 ng/mL(mean,287.46 ng/mL)after TACE 4－6 weeks later.The tumors diminished in size in 32 patients,stabilized in 13 patients(29%),however,recurred 2－6 months (mean,3 months)after TACE.28 patients died after 6－18 months (mean,10 months),17 patients were alive for 3－32 months (mean,14 months),but tumor recurred in 8 patients.Severe complications were not observed in any patient.Conclusion TACE via the omental branch is safe,effective and had high technical success rate,it is important to embolize all the feeding arteries at the same time for reducing the recurrence rate.
RESUMEN
OBJECTIVE: Knowing the origin of the inferior phrenic artery (IPA) is important prior to surgical interventions and interventional radiological procedures related to IPA. We aimed to identify variations in the origin of IPA and to investigate the relationship between the origin of IPA and celiac axis variations using computed tomography angiography (CTA). MATERIALS AND METHODS: The CTA images of 1000 patients (737 male and 263 female, the mean age 60, range 18–94 years) were reviewed in an analysis of IPA and celiac axis variations. The origin of IPA was divided into two groups, those originating as a common trunk and those originating independently without a truncus. The relationship between the origin of IPA and celiac axis variation was analyzed using Pearson's chi-square test. RESULTS: Both IPAs originated from a common trunk in 295 (29.5%) patients. From which the majority of the common trunk originated from the aorta. Contrastingly, the inferior phrenic arteries originated from different origins in 705 (70.5%) patients. The majority of the right inferior phrenic artery (RIPA) and the left inferior phrenic artery (LIPA) originated independently from the celiac axis. Variation in the celiac axis were detected in 110 (11%) patients. The origin of IPA was found to be significantly different in the presence of celiac axis variation. CONCLUSION: The majority of IPA originated from the aorta in patients with a common IPA trunk, while the majority of RIPA and LIPA originating from the celiac axis in patients without a common IPA trunk. Thus, the origin of IPA may widely differ in the presence of celiac axis variation.