OBJECTIVETo analyze the angiographic features and factors related to the blood supply from right inferior phrenic artery (RIPA) branches in hepatocellular carcinoma (HCC).

METHODSAngiography images of blood supply from RIPA branches and clinical data from patients with HCC who had undergone tmnscatheter arterial chemoembolization in our hospital between 2009 and 2013 were collected for retrospective analysis. Angiographic features of the RIPA branches were assessed for correlation between treatment number, growth pattern, size, tumor location, and rates of blood supplying RIPA branches. Statistical analyses were carried out using chi-square test, t-test, Fisher's exact test and rank sum test.

RESULTSThe 140 patients included in the analysis were grouped according to primary HCC (n=63; group A) and recurrent HCC (n=77; group B) and no statistically significant differences were found between the two groups for incidence of each nutrient branch or total number of nutrient branches. In group A, tumor size was associated with number of nutrient branches (P=0.047). There were 32 cases with HCC lesions in the bare area of the liver, and among those 26 of the cases were supplied by the posterior branch of RIPA. Each branch of RIPA showed greater firequency for particular blood supply areas; the anterior branch (n=55) and lateral branch (n=98) fed tumor lesions in segments 7 and 8, the posterior branch (n=98) fed tumor lesions in segments 6 and 7, and the supra-renal branch (n=10) fed tumor lesions in segment 6. The diaphragmatic branch always fed HCC partly located in segments 4 and 8 (n=17). Unique features were present on the digitally subtracted angiography (DSA) image for each nutrient branch and may be useful for distinguishing in clinical examination.

CONCLUSIONCases of primary HCC and recurrent HCC are not distinguishable by incidence of each nutrient branch or total numbers of the nutrient branches. However, tumor size is related to the number of RIPA nutrient branches, and each RIPA nutrient branch shows a dominant preference for certain blood supply areas, with unique features on DSA.

Angiography, Digital Subtraction ; Carcinoma, Hepatocellular ; Diaphragm ; Hepatic Artery ; Humans ; Incidence ; Liver Neoplasms ; Neovascularization, Pathologic ; Retrospective Studies

OBJECTIVETo evaluate the characteristics of primary hepatic carcinoma (PHC) teed by the right renal capsular artery(RRCA) and to assess the technical success rate,tumor response and complications in patients treated with transcatheter arterial chemoembolization (TACE) via the RRCA with or without other extrahepatic arteries and/or intrahepatic arteries.

METHODSFrom July 2010 to February 2014,23 patients were treated by TACE via the RRCA. We evaluate the characteristics of tumor, the blood supply situation of RRCA and the technical success rate, complications and tumor response of TACE via the RRCA.

RESULTSTumor size was 90.60+/-48.23 mm. Of the 23 rumors,3 were located in segment V, 11 in segment VI and 9 in segment VII.8 cases were found to have RRCA supply at the first TACE session. The technical success rate was 100%.No severe complication occurred in 23 patients. Among the 23 patients, CR, PR, SD and PD were achieved in 3(13.0%), 10(43.5%), 2(8.7%), 8(34.8%) respectively. The objective response rate was 56.5%. The overall cumulative 6 month, 1-3-and 5-year survival rates and the median survival time were 82.6%, 52.2%,21.7%, 17.4% and 16.8 months, respectively.

CONCLUSIONRRCA can participate in tumor blood supply when it located in the right hepatic lobe and with a larger diameter, or it was small but located in the bare area.Superselective intubation of RRCA with microcatheter and precise TACE via right renal capsular artery is safe ,effective and feasible.

Carcinoma, Hepatocellular ; Chemoembolization, Therapeutic ; Humans ; Liver Neoplasms ; Renal Artery ; Survival Rate

Objective To evaluate the safety and efficacy of transcatheter arterial chemoembolization (TACE) combined with transjugular intrahepatic portosystemic shunt (TIPS) in the patients with primary liver cancer complicating cirrhosis portal hypertension.Methods Twenty-two cases of TACE combined with TIPS due to decompensation of liver cancer complicating cirrhosis portal hypertension in this hospital from January 2011 to January 2015 were collected as the combined group and 28 cases of liver cancer complicating cirrhosis portal hypertension treated only by TACE without conducting TIPS were screened out as the control group.The curative effect and prognosis of the two groups were observed.Results The success rate of TIPS was 100％,the preoperative portal pressure was (38.4±7.6) cm H2O and the postoperative portal pressure was (28.4±7.7)cm H2O,the difference was statistically significant (P＜ 0.05);the preoperative portal vein diameter was (16.2 ±2.5)mm and postoperative portal vein diameter was (13.3±1.8)mm,the difference was statistically significant (P＜0.05).The postoperative 1-year stent patency rate was 95％ and 2-year stent patency rate was 90％.The postoperative 1-year and 2-year re-bleeding rates in the control group were 60.7 ％ and 78.5 ％ respectively,which in the combined group were 9.1％ and 13.6 ％ respectively,the differences were statistically significant (P＜0.05).The 1-year accumulated survival rate in the combined group was 81％,2-year accumulated survival rate was 68％,and the median survival time was 53 months,while the 1-year accumulated survival rate in the control group was 78 ％,2-year accumulated survival rate was 15 ％,and the median survival time was 17 months,the differences were statistically significant (P＜0.05).Conclusion Conducting TACE combined with TIPS in the patients with primary liver cancer complicating cirrhosis portal hypertension can safely and effectively control the tumor development,reduce and even eliminate the portal hypertension syndrome,and increase the life quality and survival rate.

Objective: To study the clinical value of transcatheter arterial chemoembolization (TACE) therapy for hepatocellular carcinoma with blood supply from right adrenal artery. Methods: An imaging and clinical data of HCC patients with blood supply from right adrenal artery were collected from 2012 to 2016 after TACE treatment in the Second Affiliated Hospital of Chongqing Medical University and the safety and therapeutic efficacy of complete embolization therapy was analyzed retrospectively. Results: Twenty hepatocellular carcinoma patients with blood supply from right adrenal artery had received 23 times treatment. All lesions had invaded and protruded from the exogenous development of liver capsule. There were 14 cases with lesions > 5 cm in diameter. Right adrenal artery was found to be involved in the blood supply of three cases of hepatocellular carcinoma during TACE treatment for the first time. In addition, the remaining 17 cases had also received TACE treatment for the second to sixth time. The superior, middle, and inferior adrenal arteries were involved in 13, 3, and 9 cases, respectively. Twenty-four right adrenal arteries (96.0%) superselectively cannulated were successfully embolized without any serious complications. The standard method for evaluating the efficacy of liver cancer in 20 solid tumors follow-up cases showed that three cases were completely relieved, nine cases were partially relieved, two cases were stable, and six cases were progressive. The effective rate of embolization with blood supply from right adrenal artery lesions was 60.0%, and the control rate of lesion development was 70.0%. Conclusion The right adrenal artery is mainly located in the S5-S7 segments of the liver. TACE features are obvious to ascertain its safety and effectiveness in the treatment of right adrenal artery tumors.