Radioembolization: Identifying and Managing Anatomic Variants
Radioembolization treatment carries the risk of non-target embolization as well as of incomplete treatment. The distribution of microspheres reflects the arterial vascular territory subtended by the injected arteries. Thus, it is important to recognize anatomic variants in hepatic arterial anatomy. These variants include congenital accessory and replaced arteries supplying portions of the liver and the tumors within, as well as parasitized non-hepatic arteries recruited to supply arterial blood to intrahepatic tumors. Several different strategies allow more safe and complete radioembolization preparation and treatment in the presence of these variants. Consolidation or redistribution of flow may be performed to simplify or to increase the safety of microsphere administration. Likewise, parasitized extrahepatic vessels may be embolized to restore intrahepatic flow to tumors, thus, limiting risk for non-target embolization and increasing completeness of treatment. Both scenarios require close attention to tumor blood supply and recognition of arterial variants.
KeywordsSingle Photon Emission Compute Tomography Hepatic Artery Digital Subtraction Angiography Coil Embolization Common Hepatic Artery
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