CardioVascular and Interventional Radiology

, Volume 34, Issue 2, pp 287–294

Embolization of Hepatic Arterial Branches to Simplify Hepatic Blood Flow Before Yttrium 90 Radioembolization: A Useful Technique in the Presence of Challenging Anatomy

  • Narayan Karunanithy
  • Fabiana Gordon
  • Marina Hodolic
  • Adil Al-Nahhas
  • Harpreet S. Wasan
  • Nagy Habib
  • Nicholas P. Tait
Clinical Investigation

DOI: 10.1007/s00270-010-9951-6

Cite this article as:
Karunanithy, N., Gordon, F., Hodolic, M. et al. Cardiovasc Intervent Radiol (2011) 34: 287. doi:10.1007/s00270-010-9951-6

Abstract

Purpose

In the presence of variant hepatic arterial anatomy, obtaining whole-liver coverage with yttrium 90 (Y90) radioembolization may be challenging. The purpose of this study was to determine whether a technique whereby variant hepatic arterial branches are embolized and then Y90 is administered selectively into one remaining hepatic arterial branch results in whole-liver coverage and effective therapy. A retrospective comparison of treatment response was made between a group of patients who underwent this technique before Y90 administration and a group of patients who received standard Y90 administration as a single dose into the proper hepatic artery or in divided doses into the immediate hepatic artery branches. The rest of the workup and treatment were identical in both groups, including routine embolization of potential nonhepatic, nontarget vessels (e.g., the gastroduodenal artery).

Methods

A total of 32 patients (mean age 56.9 years, range 39–77 years) treated with Y90 between June 2004 and March 2008 were analyzed. The primary malignancy was colorectal in 29, breast in 2, and cholangiocarcinoma in 1. Group 1 comprised 20 patients who had no alterations to their hepatic arterial supply. Group 2 comprised 12 cases who had undergone prior embolization of hepatic arterial branches before administration of Y90. The response to treatment was assessed by comparing standardized uptake value (SUV) on the pre- and postprocedure fludeoxyglucose positron emission tomographic studies of representative lesions within the right and left lobes of the liver.

Results

In group 1, significant response (P < 0.001) was seen among right lobe lesions but not among left lobe lesions (P = 0.549). In group 2, there was a significant response among both right (P = 0.028) and left (P = 0.014) lobe lesions. No difference was found in the response of right lobe lesions (P = 0.726) between groups 1 and 2; a significantly greater response was found in group 2 compared to group 1 (P = 0.004) for left lobe lesions.

Conclusion

Selective Y90 radioembolization after manipulation of hepatic arterial blood supply leads to an even distribution within the entire liver. When variations in hepatic arterial anatomy exist, this technique allows effective whole-liver radioembolization therapy from a single selective arterial injection.

Keywords

Yttrium Radioembolization Redistribution Flow hemodynamics Hepatic arterial anatomy 

Copyright information

© Springer Science+Business Media, LLC and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) 2010

Authors and Affiliations

  • Narayan Karunanithy
    • 1
  • Fabiana Gordon
    • 2
  • Marina Hodolic
    • 3
  • Adil Al-Nahhas
    • 3
  • Harpreet S. Wasan
    • 4
  • Nagy Habib
    • 5
  • Nicholas P. Tait
    • 1
  1. 1.Department of RadiologyImperial College Healthcare NHS TrustLondonUK
  2. 2.Statistical Advisory Service, Imperial CollegeLondonUK
  3. 3.Department of Nuclear MedicineImperial College Healthcare NHS TrustLondonUK
  4. 4.Department of OncologyImperial College Healthcare NHS TrustLondonUK
  5. 5.Department of SurgeryImperial College Healthcare NHS TrustLondonUK

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