Hepatocelluar carcinoma with blood supply from left inferior phrenic arteries:its significance in TACE

Objective To investigate the blood supply by the left inferior phrenic artery(LIPA) to hepatocelluar carcinoma (HCC) and to evaluate the efficacy and safety of transcatheter arterial chemoembolization(TACE) via LIPA.Methods Twenty-two patients with HCC fed by the LIPA underwent TACE of the LIPA. Twenty patients were with nodular-type HCC, and two patients with massive-type HCC.For treatment, enhanced CT and/or MRI scanning and celiac-hepatic and inferior phrenic arterial arteriography were performed to assess the arterial blood supply to the tumor, then selected catheterization and chemoembolization was achieved followed by embolization with polyvinyl alcohol particles. The LIPA angiographic features, tumor location, clinical observation, laboratory tests, imageology were monitored and analyzed. Results The tumor was located in the left lobe of the liver in 18 patients (81.8%): seven in segment 3, seven in segment 2, and four in segment 4. The tumor was located in the right lobe of the liver in four patients (18.2%) which were all in segment 5. Transarterial chemoembolization was technically successful in all patients. The hepatic artery was completely blocked in eight patients. Two patients developed basilar atelectasis of the left lung and pleural effusion without clinical sequelae. Conclusion HCC with blood supply from LIPA mainly occur in the patients whose tumor located on the left lobe of the liver and/or who have previously undergone multiple TACE. TACE via LIPA is a potentially safe and effective treatment option for these HCC patients with LIPA collateral vessels.