30 Replaced Right Hepatic Artery

CASE 30


Clinical Presentation


A 45-year-old male presented to interventional radiology for chemoem-bolization to treat hepatocellular carcinoma involving the right lobe of the liver.




image


Figure 30-1 Selected arteriogram shows replaced right hepatic artery originating from the superior mesenteric artery and perfusing a hepatoma.


Radiologic Studies


Conventional Angiography


The right common femoral artery was punctured using the Seldinger technique, and a 5-French (F) sheath was inserted. The celiac artery was catheterized using an RC-1 (Boston Scientific, Natick, Massachusetts), and angiography was performed showing absence of flow to the right lobe of the liver. Subsequently, the superior mesenteric artery (SMA) was catheterized, and angiography showed a replaced right hepatic artery originating from the SMA and supplying the tumor (Fig. 30-1).


Diagnosis


Replaced right hepatic artery originating from the SMA feeding hepatocellular carcinoma.


Treatment


Using a 3F microcatheter, the subsegmental arteries supplying the hepatocellular carcinoma were superselected. Chemoembolization was performed by first injecting a mixture of doxorubicin and Ethiodol, followed by cisplatin and mitomycin.

















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Jan 8, 2016 | Posted by in INTERVENTIONAL RADIOLOGY | Comments Off on 30 Replaced Right Hepatic Artery

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Table 30-1 Variations in Main Upper Abdominal Mesenteric Arterial Branches
Variant Incidence
Right HA from SMA (Fig. 30-1) < 16%
Left HA from left gastric A (Fig. 30-2) < 10%