Coil Embolization of Variant Hepatic Arteries During Percutaneous Arterial Port Catheter Placement for Intraarterial Chemotherapy: Analysis of Intrahepatic Perfusion Redistribution and Treatment Efficacy

• Published in: Cardiovascular and interventional radiology Vol. 46; no. 1; pp. 69 - 79
• Main Authors: Kobe, Adrian, Deschamps, Frédéric, Meyblum, Louis, Varin, Eloi, Delpla, Alexandre, Hakime, Antoine, Teriitehau, Christophe, Roux, Charles, Boileve, Alice, Gelli, Massimiliano, de Baère, Thierry, Tselikas, Lambros
• Format: Journal Article
• Language: English
• Published: New York Springer US 2023; Springer Nature B.V
• Subjects: Adult; Aged; Angiography; Antineoplastic Agents; Arteries; Cardiology; Catheters; Catheters, Indwelling; Chemotherapy; Clinical Investigation; Computed tomography; Digital imaging; Effectiveness; Embolization; Female; Hepatic artery; Hepatic Artery - diagnostic imaging; Humans; Imaging; Infusions, Intra-Arterial - methods; Interventional Oncology; Liver; Liver Neoplasms - blood supply; Liver Neoplasms - diagnostic imaging; Liver Neoplasms - therapy; Male; Medical imaging; Medical instruments; Medicine; Medicine & Public Health; Middle Aged; Nuclear Medicine; Perfusion; Placement; Radiology; Reperfusion; Retrospective Studies; Tomography; Treatment Outcome; Ultrasound; Vascular Access Devices; Veins & arteries; Intrahepatic arterial redistribution; Variant hepatic arterial anatomy; Hepatic arterial infusion chemotherapy; Percutaneous arterial port catheter
• ISSN: 0174-1551; 1432-086X
• DOI: 10.1007/s00270-022-03303-y

Purpose The purpose of this study was to analyze the intrahepatic perfusion redistribution after embolization of hepatic arterial variants during percutaneous arterial port catheter placement as well as to investigate the treatment efficacy of intraarterial chemotherapy in perfusion redistribution-dependent compared to redistribution-independent liver areas. Materials and Methods This retrospective study included 62 patients (67.7% males, mean age of 56 ± 12 years). A replaced left hepatic artery was encountered in 36/62 (58.1%), a replaced right hepatic artery in 19/62 (30.6%) and a replaced left and right hepatic artery in 7/62 of patients (11.3%), respectively. Subjective perfusion analysis was performed on digital subtracted angiography and computed tomography (CT)/cone-beam computed tomography (CBCT) images evaluating the visibility of the main, segmental and subsegmental branches of the embolized variant hepatic artery, re-perfused from intrahepatic arterial anastomoses. For objective perfusion analysis ROI measurements on CT/CBCT images were taken in the redistribution-dependent and redistribution-independent liver lobe. Response analysis according to RECIST 1.1 was separately calculated for the redistribution-dependent and redistribution-independent liver lobe. Results Intrahepatic reperfusion of the embolized variant hepatic artery was observed immediately after embolization with visualization of the subsegmental branches in 95.2% of patients. ROI measurements on CT/CBCT images (right lobe mean 76 ± 30.2 HU, left lobe mean 74.4 ± 30.5, p -value 0.88) did not show any differences. Treatment response after intraarterial chemotherapy did not differ between the redistribution-dependent and redistribution-independent liver lobes. Conclusion Embolization of hepatic arterial variants during percutaneous arterial port catheter placement results in effective intrahepatic perfusion redistribution and does not compromise treatment efficacy of intraarterial chemotherapy in the redistribution-dependent liver lobe.