Observational Study
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Radiol. Jul 28, 2019; 11(7): 102-109
Published online Jul 28, 2019. doi: 10.4329/wjr.v11.i7.102
Y90-radioembolization via variant hepatic arteries: Is there a relevant risk for non-target embolization?
Markus Zimmermann, Maximilian Schulze-Hagen, Federico Pedersoli, Peter Isfort, Alexander Heinzel, Christiane Kuhl, Philipp Bruners
Markus Zimmermann, Maximilian Schulze-Hagen, Federico Pedersoli, Peter Isfort, Christiane Kuhl, Philipp Bruners, Department of Diagnostic and Interventional Radiology, RWTH Aachen University Hospital, Aachen 52074, Germany
Alexander Heinzel, Department of Nuclear Medicine, RWTH Aachen University Hospital, Pauwelsstrasse 30, Aachen 52074, Germany
Author contributions: Zimmermann M, Schulze-Hagen M, Isfort P, Kuhl C and Bruners P contributed to study conception and design; Zimmermann M, Pedersoli F and Heinzel A contributed to data acquisition, data analysis and interpretation, and writing of article; Zimmermann M, Schulze-Hagen M, Pedersoli F, Heinzel A, Isfort P, Kuhl C and Bruners P contributed to editing, reviewing and final approval of article.
Institutional review board statement: Approval for this retrospective study was granted by the institutional review board, internal reference number: EK 308/18.
Informed consent statement: The need for informed consent was waived by the institutional review board due to the retrospective study design and use of fully anonymized patient data.
Conflict-of-interest statement: On behalf of all authors, the corresponding author states that there is no conflict of interest.
Data sharing statement: No additional data are available.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Markus Zimmermann, MD, Attending Doctor, Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Pauwelsstr 30, Aachen 52074, Germany. mzimmermann@ukaachen.de
Telephone: +49-241-8037443 Fax: +49-241-8082411
Received: May 8, 2019
Peer-review started: May 10, 2019
First decision: June 6, 2019
Revised: July 3, 2019
Accepted: July 25, 2019
Article in press: July 25, 2019
Published online: July 28, 2019
Processing time: 80 Days and 20.9 Hours
Abstract
BACKGROUND

The hepatic arterial anatomy is highly variable, with the two most common variants being a replaced right hepatic artery (RHA) originating from the superior mesenteric artery (SMA) and a left hepatic artery (LHA) originating from the left gastric artery (LGA). These anatomical variants could potentially increase the risk for non-target embolization during Y90-Radioembolization due to the close proximity between hepatic and enteric vessel branches.

AIM

To evaluate the safety of Yttrium-90 radioembolization (90Y-RE) with resin microspheres in patients with a variant hepatic arterial anatomy.

METHODS

In this retrospective single-center observational study, 11 patients who underwent RE with 90Y-resin microspheres via a LHA originating from the LGA, and 13 patients via a RHA originating from the SMA were included. Patient and treatment data were reviewed regarding clinical and imaging evidence of non-target embolization of 90Y-resin microspheres to the GI tract. Positioning of the tip of the microcatheter in relationship to the last hepatoenteric side branch was retrospectively analyzed using angiographic images, cone-beam CT and pre-interventional CT-angiograms.

RESULTS

None of the 24 patients developed clinical symptoms indicating a potential non-target embolization to the GI tract within the first month after 90Y-RE. On the postinterventional 90Y-bremsstrahlung images and/or 90Y-positron emission tomographies, no evidence of extrahepatic 90Y-activity in the GI tract was noted in any of the patients. The mean distance between the tip of the microcatheter and the last enteric side branch during delivery of the 90Y microspheres was 3.2 cm (range: 1.9-5 cm) in patients with an aberrant LHA originating from a LGA. This was substantially shorter than the mean distance of 5.2 cm (range: 2.9-7.7 cm) in patients with an aberrant right hepatic originating from the SMA.

CONCLUSION

90Y-RE via aberrant hepatic arteries appears to be safe; at least with positioning of the microcatheter tip no less than 1.9 cm distal to the last hepatoenteric side branch vessel.

Keywords: Radioembolization; Yttrium 90; Aberrant hepatic arteries; Hepatic arterial variants; Safety

Core tip: Anatomical variants of the hepatic arteries may complicate treatment with 90Y-Radioembolization (90Y-RE) due to a close proximity of hepatic and enteric vessel branches. Left hepatic arteries originating from the left gastric artery usually have a substantially shorter main stem than right hepatic arteries originating from the superior mesenteric artery. However, even a minimum distance of 1.9 cm between the tip of the microcatheter and the last hepatoenteric side branch appears to be sufficient to avoid reflux of 90Y microspheres. Therefore, 90Y-RE should be feasible and safe in most patients with aberrant hepatic arteries without a significantly increased risk for non-target embolization.