Angiographic Anatomy and Relevance of 3 and 9 O'clock Arteries During Radioembolization

Powerski, Maciej; Bascik, Bartosz; Omari, Jazan; El-Sanosy, Shahen; Grosser, Oliver S.; Seidensticker, Max; Fischbach, Frank und Pech, Maciej (2018): Angiographic Anatomy and Relevance of 3 and 9 O'clock Arteries During Radioembolization. In: Cardiovascular and Interventional Radiology, Bd. 41, Nr. 6: S. 890-897

Abstract

Purpose 3 and 9 o'clock arteries (3&9As) which supply the common hepatic duct connect hepatic with duodenal/pancreatic territories. The study purpose is to describe the angiographic anatomy of 3&9As and discuss their relevance when performing radioembolization (RE) of liver malignancies. Materials and Methods The anatomy of the 3&9As was systematically investigated by a retrospective analysis of angiograms, technetium Tc-99 m-macroaggregated albumin (MAA) scintigrams, yttrium-90 (Y90) Bremsstrahlung-SPECT/CT datasets, and clinical data of 153 patients who underwent RE between 2010 and 2013. Results Analysis of preprocedural angiograms identified 3&9As in 36 (24%) of the 153 patients. Following embolization of the gastroduodenal artery, 3&9As were seen in 53 cases (35%). The three most common origins of the 3&9As were the right hepatic artery (n = 14), the cystic artery (n = 11), and S5 and S6 segmental arteries (n = 5 each). Extrahepatic Tc-99 m-MAA deposition in the territory of the 3&9As was significantly more frequent when 3&9As were detectable on preprocedural angiograms ( 28%(visible) vs. 11%( not visible);p = 0.001) and especially when the 3&9As were not embolized or bridged prior to RE (50 %(not occluded/bridged) vs. 19 %(occupied/bridged);p = 0.043). The presence of extrahepatic Y90 Bremsstrahlung after RE (n = 17) was attributable to microsphere diversion via the 3&9A territory in four patients and possible diversion via this territory in nine patients. Five of these 13 patients presented with epigastric pain, nausea, or vomiting (CTCAE severity grade <= 3) (p = 0.014). Conclusion 3&9As are commonly detectable during evaluation angiography prior to RE, have a variable angioanatomic origin, and should be prophylactically occluded to prevent complications.

• Dokumententyp: Zeitschriftenartikel
• Fakultät: Medizin
• Themengebiete: 600 Technik, Medizin, angewandte Wissenschaften > 610 Medizin und Gesundheit
• ISSN: 0174-1551
• Sprache: Englisch