Hepatocellular carcinoma fed by the hepatic artery arising from the superior mesenteric artery: Angiographic analysis and interventional treatment

Abstract

Objective: To investigate the angiographic characteristics and the interventional catheterization techniques of hepatocellular carcinoma (HCC) fed by aberrant hepatic arteries arising from the superior mesenteric artery (SMA), namely SMA type.Methods: Digital subtraction angiography (DSA) manifestations and the data from interventional treatment in 41 cases of SMA type HCCs were retrospectively reviewed. The frequency of the aberrant arteries was summed up statistically and their anatomic characteristics (such as origin, course, branches and distribution) and the relationship with catheterization were described and analyzed.Results: Of 350 HCC cases, SMA type HCCs were/found in 41 cases (11.9%), including accessory right hepatic artery (15 cases, 36.5%), replaced right hepatic artery (16 cases, 39.0%), common hepatic artery (8 cases, 19.5%) and celiac artery arising from SMA (2 cases, 5.0%). Of the 31 cases with accessory or replaced right hepatic arteries, right hepatic arteries were small or absent on celiac angiograph in 29 cases (94.0%), and there was an avascular zone on the right liver. Superselective catheterization was successfully performed in 25 cases (61%) by using RH catheter, but the rest acquired successful superselective catheterization by using Cobra, Simmon catheters and microcatheters.Conclusion: SMA type is a commonly seen variation of hepatic arterial blood supply. A knowledge of this is very important in transcatheter arterial chemoembolization for HCC.