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Catheterization and embolization of a replaced left hepatic artery via the right gastric artery through the anastomosis: a case report
© Miyazaki et al; licensee BioMed Central Ltd. 2011
Received: 10 March 2011
Accepted: 3 August 2011
Published: 3 August 2011
Conversion of multiple hepatic arteries into a single vascular supply is a very important technique for repeat hepatic arterial infusion chemotherapy using an implanted port catheter system. Catheterization of a replaced left hepatic artery arising from a left gastric artery using a percutaneous catheter technique is sometimes difficult, despite the recent development of advanced interventional techniques.
We present a case of a 70-year-old Japanese man with multiple hepatocellular carcinomas in whom the replaced left hepatic artery arising from the left gastric artery needed to be embolized. After several failed procedures, the replaced left hepatic artery was successfully catheterized and embolized with a microcatheter and microcoils via the right gastric artery through the anastomosis.
A replaced left hepatic artery arising from a left gastric artery can be catheterized via a right gastric artery by using the appropriate microcatheter and microguidewires, and multiple hepatic arteries can be converted into a single supply.
Conversion of multiple hepatic arteries into a single vascular supply is a very important technique for repeat hepatic arterial infusion chemotherapy using an implanted port catheter system [1–4]. In cases in which a replaced left hepatic artery (LHA) arising from a left gastric artery (LGA) is present, the replaced LHA should be embolized at the proximal portion to convert multiple vascular supplies into a single supply. However, catheterization of an LGA using a percutaneous catheter technique is sometimes difficult, despite recently developed advanced interventional techniques. We report an unusual case of a patient in whom the replaced LHA was catheterized and embolized with a microcatheter through the anastomosis from the right gastric artery (RGA) to the LGA.
Repeat hepatic arterial infusion chemotherapy using an implanted port-catheter system is an accepted treatment for patients with unresectable advanced liver malignancies [5–7]. Recent advancements in interventional radiologic techniques have made insertion of the port-catheter system much easier [3, 4].
Conversion of multiple hepatic arteries into a single vascular supply is a very important technique to use in this treatment. For patients with multiple hepatic arteries, all except the one to be used for chemotherapy infusion must be embolized so that drugs can be distributed to the entire liver using a single indwelling catheter [1, 2, 4].
A replaced right hepatic artery arising from a superior mesenteric artery and a replaced LHA arising from an LGA are the most common hepatic artery variants . When a replaced LHA arising from an LGA is present, the proximal portion of the replaced LHA should be embolized with embolic materials. However, catheterizing an LGA using a percutaneous catheter technique is sometimes difficult, despite recent advanced interventional techniques. In most cases, an LGA can be catheterized easily using only a simple technique (for example, by turning the catheter tip to an up-swinging position by pulling the catheter). However, complicated techniques (for example, using the steam-shaped catheter or the catheter with a side hole) are occasionally needed to catheterize an LGA. In our patient, the causes of difficulties for catheterizing the LGA were assumed to be that (1) the LGA arose from the proximal portion of the up-swinging celiac trunk at a sharp angle, (2) vascular flexibility was lost because of arterial sclerosis, and (3) an undetectable intimal flap was present after multiple interventional treatments.
As is commonly known, the RGA generally anastomoses with the LGA. Some studies have reported the efficacy of catheter insertion for the RGA via the LGA through the anastomosis when catheterizing the RGA was difficult, and the RGA is then embolized to prevent a gastric ulcer during hepatic arterial infusion chemotherapy [8–10]. Alternatively, to the best of our knowledge, there have been no reports of catheterizing and embolizing the replaced LHA via the RGA through the anastomosis. In the present case, we inserted the catheter through the very thin anastomosis by using the appropriate microcatheters and microguidewires.
Our case indicates that a replaced LHA arising from an LGA can be catheterized via the RGA through the anastomosis and that multiple hepatic arteries can be converted into a single supply by using our method, even if, despite the recent development of advanced interventional techniques, catheterizing the LGA is very difficult.
Written informed consent was obtained from the patient for publication of this case report and any accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal.
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